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Expert advice: – Herd immunity is not the goal to open society.
Several coronavirus vaccines may be right around the corner, but it will probably be a long time before Norway receives enough vaccines to vaccinate everyone who needs it.
Who should be given priority when Norway receives the first doses?
And most importantly: who to turn to no prioritize?
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That was the task entrusted by the Norwegian Institute of Public Health to a group of ethics experts.
– In an ideal world, everyone would receive medical resources according to their needs. However, resources are scarce and have alternative uses. In the event of a vaccine shortage, vaccinating someone could mean at the same time that others don’t get it. Therefore, you are forced to prioritize, the expert group writes about their own task.
The commission’s report is controversial and there are three points in particular that surprise:
- Health professionals are not prioritized
- The recommendation breaks with what tends to prioritize healthcare
- It is not a goal to control the infection as soon as possible.
It will not prioritize healthcare professionals.
Since the beginning of the pandemic, there has been talk that health professionals are the first to have access to a vaccine.
The purpose of vaccinating health personnel is to keep hospitals and other health services running. In March, hospitals were partially paralyzed by the fact that thousands of employees ended up in quarantine, and this fall the Hammerfest hospital was closed for more than two weeks due to the outbreaks.
But when the report was released last week, the main message was this: Healthcare professionals should no prioritize first, unless the infection is completely out of control in society.
Instead, the vaccine was recommended to go to risk groups.
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But the risk pool of around 1.6 million is too large to prioritize as a whole. Therefore, experts believe that we should prioritize the “disadvantaged”, especially the very old have the highest risk of death.
It also means that the first few doses of vaccine will help to a small extent to develop immunity in the flock, which is the ultimate goal of vaccination.
Basic principles of vaccine prioritization
This is what the group writes about the fundamental principle that will be used as a basis:
The ethics advisory group proposes five goals and a framework for the coronary vaccination program. The goals are classified:
1. Reduce the risk of death
2. Reduce the risk of serious diseases.
3. Maintain essential services and critical infrastructure
4. Protect jobs and the economy
5. Reopen the company
The framework is corona vaccination, in line with the five objectives, it should not involve discrimination or aggravation of existing inequalities. Whenever possible, all five goals should be addressed simultaneously. However, the Ethics Advisory Group suggests that when two or more of the objectives conflict, the highest ranked objective should be prioritized.
The relevant effects of the coronary vaccination program can be both direct (for the vaccinated person) and indirect (for people other than the vaccinated person). For example, a direct reduction in the risk of death may have the indirect effect that society can gradually return to a normal function. In this way, a direct objective of reducing the risk of death will also indirectly help the most disadvantaged in society, who in turn have been the most affected by current infection control measures.
According to the group, it must always be there to “reduce the risk of death” to go ahead both to maintain critical infrastructure, safeguard jobs and to reopen the community.
Breaks with the basic principle of healthcare
The top priority is daily medical care. A basic principle is that the more useful a treatment is, the higher its priority. In most cases, the benefit is measured as the (good) year of life saved, and a price is put on each year saved.
In concrete terms, this means that saving the life of a 10-year-old is considered more valuable than saving the life of a 90-year-old, because a 10-year-old is supposed to have several years to live.
Also read: The new vaccine should be 94.5 percent effective
The expert group concluded in their report that this principle should not be applied this time, without giving a great reason:
– The Ethics Advisory Group considers that the distribution of scarce health resources in general should aim to reduce the number of years of life lost, with special priority to the most disadvantaged. But in a pandemic like this, the distribution of the vaccine will affect behavior and well-being beyond health. The indirect value of deaths averted is so great to society that an adjustment to years of life lost is likely to be of little consequence, the group writes.
– Therefore, the ethics advisory group will recommend focusing on the number of deaths rather than years of life lost.
The group believes that a basic principle for prioritization should be “equality”:
– This means that similar cases should be treated equally. Combined with our inherent worth as human beings, equality therefore means that all human beings count equally and deserve the same respect, the group writes.
So a child, a 40-year-old diabetic, and a nursing home patient count equally when it comes to prioritizing.
– If we vaccinate them, we can reopen
Committee members Gry Wester, professor of bioethics at King’s College London, and Berge Solberg, professor of medical ethics at NTNU, explain to Nettavisen why they prioritize differently:
– It is true that both the 90-year-old and the 40-year-old will be located in the same priority group based on our criteria, and that usually within the prioritization we would have thought that the years of life lost would later weigh more if we were forced to choose between them, they write. in an email.
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– But that presupposes that both have the same risk. There is strong evidence that the 90-year-old with dementia is at significantly higher risk than the 40-year-old with diabetes. We prevent the highest number of deaths by vaccinating those most at risk of dying. Also, people in their 80s and 90s may receive poorer treatment if they get sick. This is another reason to offer vaccines to these groups. Dying from Covid-19 is not a good death, so even if you don’t have many years to live, vaccination will make sense.
They think this could have a big ripple effect:
– To prevent as many deaths as possible, although there are 90 years with dementia that avoids dying, it is important above all because of the indirect benefit preventing death. The indirect benefit is that we can reopen, not only nursing homes, but society as a whole, because the most vulnerable are protected by a vaccine.
– Many of the measures and the closure of society that we have today are based on the danger that the weakest and most vulnerable will become infected, seriously ill and die. If we vaccinate them, we can reopen. The value of the goal of preventing death is based on both the direct benefit of saving lives and the indirect benefit of reopening society.
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Does not have herd immunity as a priority
The long-term goal of a vaccine is to increase the herd’s immunity to coronavirus. It is achieved when so many in society are immune to the virus, that the virus will no longer be able to spread.
By prioritizing the first doses of vaccine for the most vulnerable in, for example, nursing homes, it also means that the doses are not used to initiate the development of herd immunity in the population.
An alternative strategy for vaccinating nursing home residents is to vaccinate them employees. So you can prevent the infection from entering the nursing home in the first place, at the same time that employees will be part of the immune system that moves in stores, public transportation and other places.
In his report he does not explain to the group why they have chosen to prioritize preventing the spread of the infection, but the manager of face explains Westermann and Solberg below:
– Importantly, the uncertainty surrounding, for example, the effect on the spread of infection. The vaccine is expected to have some effect in reducing the spread of infection, but it has also been suggested that this effect is likely to be limited. This is relevant in light of his proposal to possibly vaccinate employees rather than residents of nursing homes.
– If the vaccine does not have a good effect on preventing infections, then it would be unwise to vaccinate employees to prevent infection in nursing homes, instead of vaccinating residents directly. In addition, family members could also be a major source of infection and then an unknown number of family members should be vaccinated, and again with an unknown effect. On the other hand, we are reasonably confident that by vaccinating those most at risk of death, namely residents, we will prevent the majority of deaths. This is also the necessary condition for the reopening of society, not herd immunity.
Therefore, they are not concerned with the long-term effects on
The report does not discuss other troublesome aspects of coronary heart disease. Among other things, it has been reported that otherwise healthy people can experience MS, permanent heart and lung damage, as well as mental problems.
Also read: What exactly are the long-term effects of covid-19? Researchers scratch their heads
– It wasn’t a big topic in the group. There’s a lot we don’t know about long-term effects, but we also don’t want knowledge about long-term effects to affect our priorities. The fact that young and healthy people in some cases can become seriously ill, and in some cases can also suffer serious long-term injuries, does not change the fact that high-risk people much more often become seriously ill, suffer long-term serious injuries or die. In this sense, a strategy that focuses on vaccinating people at risk will save many more people, with the use of far fewer vaccines, from death, serious diseases and serious long-term effects than a strategy that focuses on healthy young people say committee members.
The online newspaper has asked FHI a number of questions about the committee’s recommendations, but has so far not answered them.
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