The importance of vaccine development and deployment is hard to overstate

About 700,000 Americans have died of HIV, ever. As of the writing of this blog post, roughly 210,000 Americans have died of COVID-19 in about seven months. And that number probably underestimates the real death rate by a quarter (paywall).

After a very eventful week for COVID-19, some good news is poking up through the weeds. We’re close enough to getting one or more functional vaccines that we need to start thinking about how to distribute those vaccines. The National Academies of Sciences, Engineering, and Medicine, in response to a request from NIH and CDC, formed a committee to “assist policymakers in the U.S. and global health communities in planning for equitable allocation of vaccines against COVID-19.” Their report, authored by Emory University’s Dr. William H. Foege and 17 other members, is now available for free download. Some highlights:

First, the committee recommends that shots be free of charge to all, and that efforts to distribute them should focus on disadvantaged areas to “remedy” racial health disparities. The report further suggests CDC hold back 10% or so of the vaccine in reserve for use in “hot spots” identified through the Social Vulnerability Index, a tool that uses 15 Census data points on race, poverty, crowded housing, and other factors to estimate risk in natural disasters. Look at the figure below to get a sense of this:

Don’t worry about the text, which I know is hard to read. Look at how the green and gold counties on the left figure, which represent high-risk areas in the Social Vulnerability Index, line up with the red counties in the figure on the right, which represent the highest per-capita mortality rates. You’ll notice a pretty neat fit.

But beyond those broad measures, the guidance of the NAS committee is that immunization should be implemented in “waves.” See which one you fit into:

Wave One

When vaccines and supplies are expected to be scarce, they recommend the first doses should go to high-risk health care workers in hospitals and nursing homes and to those providing home care. First responders also would be in this group, along with anyone who works in a hospital or clinic, from clerks through janitorial staff. This is because, somewhat counter-intuitively, models show that vaccinating the workers will save more lives than vaccinating the residents.

Wave Two

This wave would come at an undetermined time related to the successful production and deployment of vaccine doses, which would include older residents of nursing homes and other crowded facilities, along with people of all ages with high-risk health conditions. The report lists cancer, chronic kidney disease, and obesity among possibilities, but does not commit to a full list of conditions that should be included.

Later Waves

Subsequent waves would vaccinate teachers, child care workers, workers in essential industries (which may vary state-to-state, since even though Federal health officials have the final say on distributing the 300 million vaccine doses the government is buying under Operation Warp Speed, state and local health departments will decide many details), people living in homeless shelters, group homes, prisons, and other facilities, since like nursing home residents, they can’t simply isolate themselves if they’re infected..

Everyone else—healthy children, young adults, etc.—are recommended to wait until vaccine supplies increase. The AP reports that “Many health experts predict a vaccine won’t be widely available to all Americans until mid-to-late next year.”

So this is where we review the fact that a vaccine won’t be magical. It’s worth emphasizing that the vaccine will add to, not replace, present efforts. Let’s assume that the best vaccine is 70 percent effective. By the standard we’re accustomed to with influenza vaccination that’s pretty good. That means that if 330 million Americans receive the vaccine, 99 million will be left vulnerable. And we still don’t know how long the vaccine will protect us; it could be months or it could be years. You’ll likely need to take multiple doses for maximum effect. So alas, the practices of social distancing of some sort and masking in crowded places aren’t going anywhere soon. But that caveat aside, there may be a vaccine-tinted light at the end of a very long tunnel.

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on topics that might affect employers or employees. This was a reprint of a blog post from KBGH.