‘We’re talking about enormous effects’
Study: Age-based COVID vaccine rollouts could save 85% more lives
A strict age-based vaccine rollout — like the one in Connecticut — could result in 85 percent fewer deaths, according to a study from researchers at the University of California’s department of demography.
The study, due to be released this week, presents a thought experiment, according to lead author Joshua Goldstein.
If the vaccine was rolled out using a lottery system, in which everyone had the same chance of being vaccinated regardless of age, 85 percent more people would die than in a system that followed a strict agebased rollout.
“We’re talking about enormous effects,” Goldstein said. “Here’s a tiny example. Say that it takes us 150 days to vaccinate everybody, and say that, in the absence of vaccination, there were going to be 2,000 deaths a day . ... Over those 150 days, if we had no vaccine, 300,000 people would die. If you did a lottery, it turns out that about 150,000 people would die. So you’d save half the lives. If you did age prioritization, only 22,000 people will die.”
The real world is far more complex, but Goldstein said “the magnitudes are enormous.”
A study published in January showed that not only does an age-based vaccine rollout save lives, it saves the number of years of life that might have been lost.
In the real world, “it may not be 85 percent,” Goldstein said. “But it may be 60 percent. It may be 95 percent. It’s a huge difference.”
Connecticut announced a largely age-based rollout in February, one of the few states to ignore other risk factors such as comorbidities when deciding who to prioritize for the vaccine.
“The reality is, older people have been dying in disproportionately high numbers,” said Josh Geballe, the state’s chief operating officer, who argued that an age-based vaccine rollout targets that reality.
Geballe said it makes things simpler from a logistical standpoint. When you allow people with comorbidities — who are also very much at risk from severe COVID-19 reactions — to get in line, you end up with people “inadvertently or consciously jumping the line.”
So, you end up with a healthy, active weightlifter eligible to get vaccinated because the person has a high body-mass index. Or a 30-year-old with a well controlled, mild case of asthma taking a slot that might otherwise have gone to a 60-year-old who could be much more likely to die.
“Statistically speaking, these are not the people who need to get priority,” Geballe said.
Goldstein’s research supports that contention. A
study he and his colleagues published in January showed that not only does an age-based vaccine rollout save lives, it saves the number of years of life that might have been lost.
When there is a scarce medical resource, all things being equal, doctors are trained to provide that resource to the patient who would have the most life to live if they survive.
But, with the coronavirus, all things are not equal. Goldstein simplified the equation to the idea that “the years of life that you’ll save is the years of life that person has left to live, times the chance that the vaccine is going to make a difference.”
“In the weeks that we’re in now, anybody who gets the vaccine means somebody else doesn’t get the vaccine. So the fact that you’re at heightened risk is not enough to say that you should go first, you have to have the highest risk of the remaining people,” he said. “The argument is not that people with underlying health conditions don’t have higher risk. The argument is, do they have so much higher risk that they should go in front of, say, the 80-year-olds we haven’t vaccinated? And we don’t know the answer to that. But that’s the question.”
Saad Omer, Yale School of Public Health epidemiologist and the director of the Yale Institute for Global Health, argued the opposite earlier this month.
Omer said that by following a stricter age-based rollout, the state was essentially de-prioritizing younger adults with comorbidities that put them at higher risk of dying from COVID-19.
“We have an obligation to both administer vaccine quickly and protect the people at highest risk, and do that in a way that balances the two the most carefully, and doesn’t disadvantage certain populations along the way,” he said.
Goldstein acknowledged that there are other risk factors.
“You can give everybody a risk score, which would be a combination of their age, health status, and it could be their occupation, risk of exposure,” he said. “Then our argument would say, you should give it to the highest risk people by that composite score. Instead of giving people a credit risk score, you could give them a COVID risk score. And then the people you’d want to vaccinate first would be the people with the highest scores.”
His research did not address the question of whether there are any younger people at higher risk. But age, Goldstein said, is perhaps the most compelling of those risk factors, increasing the risk of death by as much as double for every six years of age.
“We know that age is multiplying your risk by not just two, four, eight, 10 times, if you’re very old,” he said.
Harlan Krumholz, a professor of investigative medicine at Yale’s Institute for Social and Policy Studies of Investigative Medicine and of Public Health, called Connecticut’s agebased rollout, “brilliant.”
“Yes, we need to be attentive to people in highrisk communities and those with comorbidities — but we can end up doing worse for everyone without a simple, clear strategy that can be executed well and rapidly,” he said.
Geballe said it won’t matter as much in a few months, anyway. Everyone 16 and older will be eligible to be vaccinated on May 3. And on Friday, Gov. Ned Lamont said the state could accelerate that timeline even more.
“We’re moving so fast that we’re optimistic that by the time we get to May, it’s likely that anyone who wants to get vaccinated will be eligible,” Geballe said. “At this point, our goal is marching through these phases as quickly as we can.”