A vaccination strategy that can save more lives

I believe that our next priority groups should be those who are immuno-compromised and those who have co-morbidities.

The important decision our leaders face today is how to prioritize COVID vaccination. 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 percent of our vaccine for seniors and 10 percent for front-line health care workers and those with serious medical conditions, we will save 200,000 lives. At that time, my proposal was contrary to Centers for Disease Control and Prevention (CDC) recommendations and to the state’s official strategy.

A lot has changed since then. Policy makers at the CDC and at our state Department of Public Health (DPH) have realized the merits of that plan and have prioritized seniors. However, beyond seniors, the state’s strategy is still unclear and suboptimal. I believe that our next priority groups should be those who are immuno-compromised 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-and-over). Nearly 85 percent of all deaths are from that demographic. Seniors represent 15 percent of our population and can be objectively identified. The second category is those people who are immuno-compromised, 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 percent of our population. The third category should be those between 20 and 65 with comorbidities such as diabetes, COPD, obesity etc. This represents 10-15 percent of our population. The definition of this category has some subjectivity.

These three categories comprise one-third of our population but contribute to more than 99 percent 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 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 immuno-compromised 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 the DPH to offer vaccine to the immunocompromised category next and then follow it with the 20- 65year-old group 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.