News on the distribution of coronavirus vaccines.

There were two new reports today on plans for the distribution of coronavirus vaccines once they are approved. The first came from the United States National Academies Advisory Group, which was developed specifically to address the distribution issue. It addresses some very important issues on the distribution of the vaccines and prioritizing which individuals get the vaccine first. 

The first individuals to get the vaccine will be health care workers in high infection risk occupations where they are exposed to coronavirus on a routine basis. Subsequent to that, individuals with specific medical conditions that predispose them to severe illness with coronavirus will be prioritized to get the vaccine. This includes heart or kidney failure or a body mass index over 40. Also in this group are older adults in long-term nursing facilities or other crowded housing. The vaccine will then be given to individuals who are in high risk groups but who don’t have specific medical conditions predisposing them to worse outcomes with COVID-19. 

The report suggests that a second phase of vaccinations should involve critical risk workers — people in industries essential to the functioning of society — as well as teachers and school staff; people of all ages with an underlying health problem that moderately increases the risk of severe Covid-19; all older adults not vaccinated in the first phase; people in homeless shelters and group homes, and prisons; and staff working in these facilities.

Young adults, children, and workers in essential industries not vaccinated previously would make up the third priority group.

This approach seems to be very reasonable and will certainly target those individuals most at risk. There were requests that certain social groups be targeted because of increased frequency of infection, but the Academies focused primarily on medical conditions. A virtual town hall will be held tomorrow for comment.

These recommendations may very well be modified however by the availability of specific vaccines and their use in different risk groups. If a vaccine shows particular utility in older individuals, it may be prioritized to that group. Certainly, it is likely that there will be multiple vaccines available, and individuals with immune problems may be prioritized to certain vaccines that would be safer for them and do not contain a live virus.

A report also surfaced today explaining that the United States will not participate in viral vaccine distribution efforts organized by the WHO. This group, called Covax, is co-led by the World Health Organization, the Coalition for Epidemic Preparedness Innovations, and Gavi. It hopes to  purchase two billion doses of potential Covid-19 shots from vaccine makers by the end of 2021 and distribute them worldwide.

While the US refusal to participate sounds problematic at first glance, the actual mechanics of COVID-19 vaccine distribution in the developed world will not be defined by the WHO but more likely by different governments’ contracts with vaccine suppliers. The WHO will have more input in developing countries that don’t have contracts with specific vaccine suppliers. Therefore, whether the United States participates in the WHO effort is probably not relevant to the success of that distribution.