Vaccination Strategy is Sacrificing Equity

A COVID-19 vaccine is drawn at Naval Hospital Pensacola late last year.
A COVID-19 vaccine is drawn at Naval Hospital Pensacola late last year. (Photo/Marcus Henry)

Standing around a fire pit watching flames jump off Douglas Fir logs, I talked about vaccine distribution with three other healthcare professionals and a teacher. As a paramedic and nurse seeing COVID patients, should I get the vaccine before teachers who have had in-person classes since September? The four of us contemplated this and softly agreed that providers should get the shot first soon followed by teachers. By mid-December, I had the first dose in my right arm and was elated we were moving forward as a nation. It seemed if I had it, as a rural paramedic, soon we all would. 

More from the author: Use Difficult Conversations to Provide Better Healthcare

In late January, my rural EMS agency helped with a vaccine event in our high school gymnasium. The growing narrative is if there are opened vials with extra vaccine liquid, lucky folks waiting can get those doses. That entire day, school district staff lurked with hope. Washington State is in phase 1B, which includes individuals 65+ and people living in multigenerational homes 50+. Unfortunately, most teachers are not included in the phase.1 At the end of the day there were four vaccine doses leftover. Teachers heard the news and lined up. They didn’t even make it past registration before the hospital administrator informed them they didn’t qualify under the current guidelines. The teachers left, despondent, tearful, and feeling not worthy of scraps. 

Since I got my first shot it seems we have deployed a vaccination strategy that seems to be uniquely American. Our plan, like much of our healthcare system, leverages some of the world’s smartest people and best technology only to end up with inequitable, mediocre results. Our current vaccination strategy has traded equity and the facts of disease spread to protect the elderly. Elderly people are tremendously vulnerable to hospitalization and death because of COVID illness. However, many older individuals are significantly buffered from potential exposure by their position within society. As a group, their relative wealth, and their lack of participation in the job market limits their overall risk of exposure. 

Related: Managing COVID-19: Applying an Asymmetric Solution to an Asymmetric Problem

In Washington State, 67 percent of COVID infections are in people 20 to 59 years old and about 40 percent of hospitalizations are in this age group.2 COVID is rampant in the U.S., in part, because younger groups cannot afford to stay home. By focusing our early vaccination strategy on older people, we are focusing limited vaccine doses on a group of people that, as a cohort, is already protected in many important ways. We are at an early inflection point and can use what we have learned to make a better plan. Instead of age, perhaps we focus our vaccination plans on risk factors such as congregate living and working situations. This would prioritize teachers, prisoners, nursing home residents, multigenerational homes, meat packing plant workers, hospitalized patients, and grocery workers. If they have living and working conditions that place them at risk, we vaccinate. I believe this is the most equitable and science-based way to move forward.

What did we do with the four extra doses? The teachers left the gym slouched over while we made frantic calls to lucky 70-year-olds. After waiting two hours for the last person who was a no-show, we folded our tables and headed down the snowy roads of Okanogan County to my neighbor’s house. There my 65-year-old neighbor reclined, kicked his feet back, and received his first dose. As I sat with him for 15 minutes, NBC Nightly News flickered on and Lester Holt alarmed the nation of vaccine shortages. I am happy for my neighbor and the 250 people we vaccinated that day, but we can do better by striving toward a more equitable strategy.

References

  1. COVID-19 Vaccine. Washington State Department of Health [Internet]. Tumwater (WA). 2021 Jan 22 [cited 2021 Feb 12]. Available from: https://www.doh.wa.gov/Emergencies/COVID19/vaccine.
  2. COVID-19 Data Dashboard. Washington State Department of Health [Internet]. Tumwater (WA). 2021. Feb 11 [cited 2021 Feb 12]. Available from: https://www.doh.wa.gov/Emergencies/COVID19/DataDashboard.

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