Vaccine rollout an evolving logistical, ethical dilemma

The incredibly rapid development of multiple COVID-19 vaccines, their mass production and mass distribution has actually been an amazing feat when we consider the arduous development of other vaccines, such as those for hepatitis and the ever elusive AIDS vaccine.

Unfortunately, the goal of reaching herd immunity with the need to vaccinate an overwhelming majority of the population has been thwarted by limited supplies and the lack of unified criteria for vaccine eligibility. How to prioritize a limited resource especially in the first phase of rollout has led to much frustration with many people desperately seeking vaccines.

Right now, the United States is administering nearly 1.5 million doses per day. At midweek, more than 13% of residents had one dose and more than 6% received both. California

has closely followed the U.S. trend. California has 12% of the country’s population and has received an appropriate supply of the total doses distributed.

At the national level, the Centers for Disease Control and Prevention provides guidelines, not rules, as to who should be prioritized, leaving each state the responsibility of how to distribute it.

Each state, in turn, distributes to the counties and, in California, to inter-county health providers, who have further autonomy in developing distribution criteria. This process inevitably leads to confusion and distress as long as the need outstrips the supply of vaccine and vaccination capacity.

Online systems for vaccine signups vary but all are unavailable to those without internet access or technical skills.

The Marin Department of Health and Human Services recently changed the criteria from residents 75 years old and up to those age 65 and over, along with health care workers and residents of long-term care facilities.

In the past month, many desperate Marinites in the 65-74 age group received vaccines offered through Sutter Health and UCSF Health, among others. They also traveled to other counties, where residency was not being closely checked. The ethics of “crossing county lines” is questionable. Hopefully it did not lead to the preventable illness and deaths in the elderly who may have missed vaccinations intended for them.

In addition to the age discrepancies among counties, there have been occupational differences. Based on the low transmission rates in schools that have opened, the CDC does not require vaccination of staff members and teachers before reopening for in person instruction. Nevertheless, 35 of California’s 58 counties were prioritizing teachers, day care workers and other public school employees.

Gov. Gavin Newsom recently announced that he wants to standardize vaccination for teachers in all counties, beginning March 1, he will reserve 10% of doses for this group. There are good arguments on both sides of this issue, but science is not yet able to fully guide us.

A very significant concern in vaccine distribution has been the racial and ethnic inequities that have occurred. According to CDC data, in Black and Hispanic people, who have been the most impacted by COVID-19, vaccination rates are lagging behind White and Asian residents.

In California, only 16% of doses have gone to the Latino residents, who are nearly 40% of its population. In comparison, almost 33% of doses have gone to White residents, who are less than 37% of the population. Part of the reason may be that the Latino population is younger and doses have been given to those 65 and older. Nonetheless, these worrisome disparities need to be monitored and effectively addressed going forward.

Finally, the emergence of

“variants of concern” raises worries of reduced vaccine effectiveness, which may threaten the goal of achieving herd immunity. There is increased effort to track these variants and to be ready for modifications of vaccines and the possibility that booster shots may be needed.

Hopefully vaccine supply will continue to increase and we can achieve the ambitious goal of doubling the number of daily doses achieving herd immunity as soon as July.

In the meantime, get the vaccine when it is your turn, continue to practice social distancing, make sure you are wearing an effective mask and limit unnecessary travel that can lead to the spread of variants. Please, if you can, volunteer to help in the vaccination effort.