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COMMENTARY:
Once safe and effective Covid-19 vaccines are available, tough decisions will need to be made about who gets the first shots.
A committee of the National Academies of Sciences, Engineering and Medicine, at the urging of the Centers for Disease Control and Prevention and the National Institutes of Health, has proposed an equitable way to allocate the vaccine.
They recommend that first responders and healthcare workers have the highest priority. Older adults in group life situations would also be part of a first phase of vaccination, according to the plan.
We are professors at Johns Hopkins University and the University of Southern California and have spent decades studying health economics and epidemiology. One of us is a member of the National Academy of Medicine.
Having seen first-hand the real risks of a rapid and asymptomatic spread of Covid-19 among younger adults, we disagree with some of the recommendations. The asymptomatic spread is closing schools and universities across the country and threatening surrounding communities.
We argue that this pandemic requires a different model for making vaccination decisions. After taking care of essential workers, the greatest transmitters of the virus should be vaccinated, mainly the young, and only then the most vulnerable.
Lessons from the 2009 flu epidemic
The textbook vaccine model goes out the window when new viruses emerge.
Some lessons can be drawn from the 2009 H1N1 influenza epidemic, which killed an estimated 500,000 people worldwide. In the United States, President Barack Obama declared the spread a national emergency.
A vaccine was developed as early as the fall of 2009. However, initially only 16 million doses were available. The CDC was asked to make some tough decisions about the allocation. Some states applied for 10 times the amount allocated to them.
In the end, the CDC allocated the vaccine strictly in proportion to a state’s population, that is, per capita. Then the states assigned them, often with priority for infants and the elderly, along with those at high risk.
This priority, protecting the most fragile, has been public policy since at least the 1957-1958 influenza pandemic.
However, subsequent studies have shown that a better way to protect older people was to control the spread among the young, which has often meant vaccinating children of early school age.
One of the lessons from these past pandemics is that early vaccination of potential asymptomatic spreaders can prevent multiple infections with others.
The superspreaders
The experience of recent months has shown how important it is to verify transmission with Covid-19. A recent study found that only 10 percent of those infected lead to 80 percent of cases of infection. What has made it more difficult is that up to 40% of carriers of the virus, often known as super-spreaders, do not show any symptoms.
Very few of the Covid-19 super-spreaders are elderly. It is the youngest people who have a greater propensity to resume social life in schools and elsewhere.
Among young people there is a subset of highly social people with wide circles of friends who become the most fertile ground for the spread of Covid-19. These youngsters are also at a much lower risk of death or even severe symptoms, which also means that they are more likely to infect others.
Cases have skyrocketed in the 15-25 age group, another likely sign that they are driving the spread of the virus. A recent outbreak at the University of Southern California fraternity line infected at least 40 people.
The American Academy of Pediatrics and the Children’s Hospital Association report that at least 338,000 children have tested positive for the virus as of July 30, and more than a quarter of that number have tested positive in the last two weeks of that month. .
More generally, younger residents in the Los Angeles County virus hotspot make up the majority of new positive cases. In California, young people between the ages of 18 and 34 account for more than a third of cases.
Young versus old
Anticipating that young people will participate in activities that spread the virus, many colleges put their fall classes exclusively online. Some who decided to go in person had to close after just a week on campus.
With or without a vaccine, the best strategy for older Americans, especially those with underlying medical conditions, is to avoid contact with potential carriers.
Optimally, older people will reduce deaths by staying home in large numbers, and younger people will reduce infections by getting vaccinated in even larger numbers. Everything works if the vaccine is effective and enough people take it.
We anticipate that the pressures and policies around prioritizing vaccine distribution will be intense. We argue that the key will be to take the most beneficial route, not the most obvious one. With a large-scale public health campaign behind it, that will mean prioritizing those who are driving transmission, not the most vulnerable.
As contradictory as such a strategy may seem, much evidence shows that this would be the correct approach.
Dana Goldman, president of Leonard D. Schaeffer and distinguished professor of public policy, pharmacy and economics, University of Southern California; David Conti, Professor of Preventive Medicine and Associate Director of Data Science Integration, University of Southern Californiaand Matthew E. Kahn, Bloomberg Distinguished Professor of Economics and Business, Director of JHU’s 21st Century Cities Initiative, Johns Hopkins University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
