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Debate Over Who's 1st for COVID Vaccine08/02 10:40


   (AP) -- Who gets to be first in line for a COVID-19 vaccine? U.S. health 
authorities hope by late next month to have some draft guidance on how to 
ration initial doses, but it's a vexing decision.

   "Not everybody's going to like the answer," Dr. Francis Collins, director of 
the National Institutes of Health, recently told one of the advisory groups the 
government asked to help decide. "There will be many people who feel that they 
should have been at the top of the list."

   Traditionally, first in line for a scarce vaccine are health workers and the 
people most vulnerable to the targeted infection.

   But Collins tossed new ideas into the mix: Consider geography and give 
priority to people where an outbreak is hitting hardest.

   And don't forget volunteers in the final stage of vaccine testing who get 
dummy shots, the comparison group needed to tell if the real shots truly work.

   "We owe them ... some special priority," Collins said.

   Huge studies this summer aim to prove which of several experimental COVID-19 
vaccines are safe and effective. Moderna Inc. and Pfizer Inc. began tests last 
week that eventually will include 30,000 volunteers each; in the next few 
months, equally large calls for volunteers will go out to test shots made by 
AstraZeneca, Johnson & Johnson and Novavax. And some vaccines made in China are 
in smaller late-stage studies in other countries.

   For all the promises of the U.S. stockpiling millions of doses, the hard 
truth: Even if a vaccine is declared safe and effective by year's end, there 
won't be enough for everyone who wants it right away -- especially as most 
potential vaccines require two doses.

   It's a global dilemma. The World Health Organization is grappling with the 
same who-goes-first question as it tries to ensure vaccines are fairly 
distributed to poor countries -- decisions made even harder as wealthy nations 
corner the market for the first doses.

   In the U.S., the Advisory Committee on Immunization Practices, a group 
established by the Centers for Disease Control and Prevention, is supposed to 
recommend who to vaccinate and when -- advice that the government almost always 

   But a COVID-19 vaccine decision is so tricky that this time around, 
ethicists and vaccine experts from the National Academy of Medicine, chartered 
by Congress to advise the government, are being asked to weigh in, too.

   Setting priorities will require "creative, moral common sense," said Bill 
Foege, who devised the vaccination strategy that led to global eradication of 
smallpox. Foege is co-leading the academy's deliberations, calling it "both 
this opportunity and this burden."

   With vaccine misinformation abounding and fears that politics might intrude, 
CDC Director Robert Redfield said the public must see vaccine allocation as 
"equitable, fair and transparent."

   How to decide? The CDC's opening suggestion: First vaccinate 12 million of 
the most critical health, national security and other essential workers. Next 
would be 110 million people at high risk from the coronavirus -- those over 65 
who live in long-term care facilities, or those of any age who are in poor 
health -- or who also are deemed essential workers. The general population 
would come later.

   CDC's vaccine advisers wanted to know who's really essential. "I wouldn't 
consider myself a critical health care worker," admitted Dr. Peter Szilagyi, a 
pediatrician at the University of California, Los Angeles.

   Indeed, the risks for health workers today are far different than in the 
pandemic's early days. Now, health workers in COVID-19 treatment units often 
are the best protected; others may be more at risk, committee members noted.

   Beyond the health and security fields, does "essential" mean poultry plant 
workers or schoolteachers? And what if the vaccine doesn't work as well among 
vulnerable populations as among younger, healthier people? It's a real worry, 
given that older people's immune systems don't rev up as well to flu vaccine.

   With Black, Latino and Native American populations disproportionately hit by 
the coronavirus, failing to address that diversity means "whatever comes out of 
our group will be looked at very suspiciously," said ACIP chairman Dr. Jose 
Romero, Arkansas' interim health secretary.

   Consider the urban poor who live in crowded conditions, have less access to 
health care and can't work from home like more privileged Americans, added Dr. 
Sharon Frey of St. Louis University.

   And it may be worth vaccinating entire families rather than trying to single 
out just one high-risk person in a household, said Dr. Henry Bernstein of 
Northwell Health.

   Whoever gets to go first, a mass vaccination campaign while people are 
supposed to be keeping their distance is a tall order. During the 2009 swine 
flu pandemic, families waited in long lines in parking lots and at health 
departments when their turn came up, crowding that authorities know they must 
avoid this time around.

   Operation Warp Speed, the Trump administration's effort to speed vaccine 
manufacturing and distribution, is working out how to rapidly transport the 
right number of doses to wherever vaccinations are set to occur.

   Drive-through vaccinations, pop-up clinics and other innovative ideas are 
all on the table, said CDC's Dr. Nancy Messonnier.

   As soon as a vaccine is declared effective, "we want to be able the next 
day, frankly, to start these programs," Messonnier said. "It's a long road."

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