The vaccination strategy that will save the most lives
Chemo-patients and those immunocompromised should NOT have to wait months for vaccine.
The important decision our leaders face today is how to prioritize COVID vaccination. In these columns, three weeks ago, I put forward an evidence-based argument that we should give first priority to our seniors, in descending order of age. I proposed that if we use 90% of our vaccine for seniors and 10% for frontline healthcare workers and those with serious medical conditions, we will save 200,000 lives.
At that time, my proposal was contrary to CDC recommendations and to the state’s official strategy. However, since then a lot has changed. Policy makers at the CDC and at our state Department of Public Health have realized the merits of that plan and have prioritized seniors. However, beyond seniors, the state’s strategy is still unclear and sub-optimal. I believe that our next priority groups should be those who are immunocompromised and those who have co-morbidities. This prioritization strategy would save many lives, contain the pandemic and return us to normalcy in the shortest time.
There are three categories of our population which are most likely to be hospitalized or die from this virus. The first category is seniors (65+) — – nearly 85% of all deaths are from that demographic. Seniors represent 15% of our population and can be objectively identified. The second category is those people who are immunocompromised and pregnant women. This includes people who have received chemotherapy recently, received organ transplants or have autoimmune diseases, AIDS, sickle cell disease or some other serious illnesses which are known to compromise the immune system. This category represents about 5% – 8% of our population.
Finally, the third category is those between 20 and 65 with comorbidities like diabetes, COPD, obesity etc. This represents 10% – 15% of our population. The definition of this category has some subjectivity.
These three categories comprise a third of our population but contribute to over 99% of all deaths. If we prioritize the vaccine to these three categories we will minimize loss of life and expedite the return to normalcy. Based on current expected vaccine availability all these categories can be vaccinated in three months, by the end of April. This also means that hospitalizations, serious sickness and deaths can be eliminated in three months. That should allow our economy to fire back up and allow a return to normalcy. However, if we do not follow this strategy, the return to normalcy will be delayed.
Our state administration is currently prioritizing the first category in two tiers. We are providing vaccine to those age 75 and older now and it has been announced that those above age 65 will be offered the vaccine very shortly. This tiering is being done to make the administration of the vaccine more orderly.
However, there seems to be no clarity for what is to follow. There are some indications that it will be essential workers and some other suggestions that it will be those with co-morbidities. The immunocompromised category defined above is being merged with the co-morbidity category and delayed. The idea that someone who is undergoing chemotherapy has to wait until April is unjustifiable.
Similarly, delaying access to pregnant women is not fair. I ask Gov. Ned Lamont and DPH to offer vaccine to the “immunocompromised” category next and then follow it with the 20-65 year old with co-morbidities. It may also be a good idea to tier the co-morbidity category by age, like we are doing the seniors. The ages 45-65 can be offered first, followed by ages 20-45.
Across the country, a number of leaders are complaining that they need a lot more vaccine to restore normalcy. They are not being rigorous in their thinking. We do not need to eliminate the infections to get us back to normal. We need hospitalizations, serious sickness and deaths to go to zero to contain this pandemic.
That requires an effective allocation of the available vaccine. These tough decisions need to be made with clarity of purpose and a rigorous data-based approach. Politics has no place in that decision. The purpose should clearly be to minimize loss of life and return our society to normalcy as soon as possible.
State Rep. Harry Arora, a Republican, represents House District 151.
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