1. young people first
After front-line workers, Indonesia, home to one of Southeast Asia’s most devastating COVID-19 outbreaks, is prioritizing its young, working-age population, rather than the elderly, partly because its vaccine — Coronavac, made by China’s Sinovac Biotech — comes with a scarcity of data on how it behaves in older people (it wasn’t tested in people over 59). But officials also told Bloomberg that vaccinating those 18 to 59 would help Indonesia build a “fortress” around the elderly and slow viral spread.
In Canada, 20- to 29-year olds account for the highest percentage (18.7) of all confirmed COVID-19 infections. However, 96 per cent of the nation’s more than 17,500 deaths have occurred in people 60 and older.
If the main goal is to minimize deaths, those 60 and older should go first, according to a recent preprint of a modelling study comparing five different vaccine strategies. There were a few scenarios in which prioritizing everyone over age 20 provided greater mortality benefits, but only under certain conditions — a large enough vaccine supply, say, and a vaccine highly effective in young adults, and less effective in the old.
Canada’s two approved vaccines, Pfizer’s and Moderna’s, are 90 to 95 per cent effective at preventing people from getting sick with COVID-19, should they get infected. Less clear is whether they prevent people from spreading the virus to others, though vaccinated people may shed less virus, making them, therefore, less contagious.
“If everything were flipped, and what we knew was that the vaccines were 95 per cent efficacious in preventing transmission, but we had no data about whether it would prevent disease or mortality, perhaps that would shift my thinking,” said Maxwell Smith, a bioethics professor at Western University and a member of Ontario’s COVID-19 vaccine distribution task force.
But 80 per cent of the mortality from COVID-19 has been among older adults in long-term care homes.
While he appreciates the argument it would be nice to prevent transmission in the first instance, given the high death rates among the elderly, “I think there’s an ethical obligation to go in and protect those populations, first and foremost, before anyone else,” Smith said.