There is an argument that the rationing/prioritization scheme that is currently in use is inherently unjust, and that no one is entitled to faster vaccination than anyone else.
Yes; however, prioritization lets us speed up the effects of population-scale vaccination by either...
1. Vaccinating people who are the most likely to get sick
2. Vaccinating people who are the most likely to spread the virus
Option 1 makes the death and hospitalization rates fall quicker, so that anyone we miss is more likely to still have a hospital bed to get treated in. Option 2 reduces the total number of people exposed to the virus.
The whole point of vaccination is to keep people from having to go to the hospital or dying - protecting the weakest first achieves that better than random vaccinations. Someone like me who basically lives in his room and works remotely can afford to wait for shots - someone who works in retail and has 1000s of exposures per day needs their shots yesterday.
Vaccine trials have shown that approved vaccines reduce moderate to severe illness and death. There is no trial-based evidence that they prevent people from catching the virus and spreading it [1]. It's even possible that people who are vaccinated are more likely to be asymptomatic and more likely to unknowingly pass it on.
So "vaccinating people who are the most likely to get sick" is the only option supported by the evidence. Or preferably vaccinate people most likely to become moderately to severey ill, or die.
At this time we should not be "vaccinating people who are the most likely to spread the virus". We don't know if approved vaccines will help with this.
It’s arguable the point of the vaccine is secondarily about protecting individuals due to the immunity it confers, and primarily about accelerating herd immunity to kill the virus off, which would counterfactually save thousands of lives per day in perpetuity. (It’s in either case very close between the two.) Given this, it makes prioritization pretty tricky under a supply constraint after you’ve immunized people who are objectively in a revere risk pool. For example, if we knew someone would be a super spreader, but would be at a low risk of severe covid, the margin of lives saved by prioritizing them over others that are at more risk of severe covid may be much higher. (Fwiw, I am skeptical the current prioritization regimes are designed around this optimization problem.)
> Someone like me who basically lives in his room and works remotely can afford to wait for shots - someone who works in retail and has 1000s of exposures per day needs their shots yesterday.
I think this is an oversimplification. We are living in our rooms because we choose to; many who don't work in retail that could be living in their rooms are not, and are voluntarily engaging in 1000s of exposures per day. If those people are young and not in healthcare (mostly true), such potential superspreaders are not priorities for vaccination due to this convoluted priority system.
This isn't my stance, but I'll steelman it anyway:
Those at highest risk of death are the 70+. Coincidentally, people 70+ also have already led long lives / have the least utility left to give back to the society that is doing the prioritization. It is therefore more important to give doses to young people first, as someone needlessly dying with 60 years left on their clock is significantly worse than someone who has already had the opportunity to live a full life and statistically would've died within the next 10 years anyway.
Seems like a false dichotomy. You can have a policy of prioritisation while also allowing vaccination of non-prioritised people if/when there are excess doses available that are approaching expiration. This is the approach currently being taken here in the UK.
> The “all or nothing” approach many states has built is extremely foolish, yes, but that isn’t inherently part of an approach based on prioritization.
If you start from the assumption that a successful Covid vaccination rollout protects the most people from serious illness and death, it follows pretty quickly. My parents are significantly more likely than I am to be hospitalized and/or die from Covid than I am. My grandparents as well, but their risk is even an order of magnitude higher than my parents face.[1]
A successful vaccination program, then, would aggressively work through the most vulnerable populations first.
> Yes, that seems to be the consensus, although I don't share it.
I know, you said:
>> There is an argument that the rationing/prioritization scheme that is currently in use is inherently unjust, and that no one is entitled to faster vaccination than anyone else.
I’ll bite. There is actually a very simple argument to be made as long as you accept the premise that 1. Death is a natural part of life, and 2. It’s not years of life that should be saved, but _quality_ years of life.
I find it unethical to take away all quality of life for hundreds of millions of young people in the prime of their lives, as well as destroying thousands of small businesses, so that bed ridden 90 year olds can be bed ridden for a couple more years, at best. Yet this is exactly what is happening, at least in Europe, with draconian lockdowns and curfews in place while vaccinating groups that didn’t leave their houses pre-COVID either.
With how things are going currently in my country my peers and I will be lucky if we can be vaccinated in 2021.
If we are going all in on “project cull the old”, we’re missing a few big things.
One that jumps out is a blanket, age-based DNR. A 70 year old who has been refused the shot but subsequently develops Covid is significantly more likely to be hospitalized than your “prime of their life young person”, for whom Covid isn’t nearly as likely to be severe.
This means they’re going to be an overall resource strain on the system. It wouldn’t be logical to refuse vaccinations for those most likely to be seriously sickened by the disease but then to try to provide advanced life support when they need it.
We will need to convert some percentage of hospital staff into “Covid hospice workers” to allow those who are sick to die as peacefully as one can when their lungs are shutting down.
I get that. I don’t think you get my point though. The reason I want young people to get vaccinated is not due to COVID, since they’re very unlikely to have severe complications anyway. In fact, the actual vaccination is not the point at all.
The reason I’d like them to be vaccinated is so that normal life can resume to some degree. All public places save for grocery stores and pharmacies have been closed here since early December. There’s been a 9PM curfew in place for a month with no end in sight. People’s mental health is rapidly deteriorating. I would not be making this argument if we were simply required to wear masks and could go about our business as is the situation in many places around the world. But that is not the case at all here.
That's kind of why I want the vaccine early, because there are a lot of underground things that are happening anyway that I'm avoiding. When I could be socially and having fun.
I don't think just swapping priority from elderly to prime age is a solution. As elderly will still be the ones bogging down emergency services, making relatively benign injuries a huge massive problem for everyone else. When returning to the normal distribution of emergencies after opening everything up, this is still a disaster for the hospitals.
That’s a consumer argument. The public health argument while vaccination is still constrained is that you prioritize vaccination for populations where they are most likely to be hospitalized.
What we’ve seen is that if hospitals aren’t overloaded, they are effectively able to treat people.
In a few weeks, as production ramps, the priority will shift to mass vaccination to everyone. You’ll literally have vans driving around setting up pop up events.
