Jan 8, 2021 - Health

Why some experts want to relax vaccine prioritization

Illustration of a clock with a syringe hand pointing to people where the hours would be

Illustration: Annelise Capossela/Axios

Some political leaders and public health experts are rethinking strict prioritization for coronavirus vaccines, suggesting that it might make more sense to simply try to administer as many doses as possible as quickly as possible.

Why it matters: Especially while supplies are still limited, there's an inherent tension between trying to focus first on the people most at risk from the virus — including those most likely to spread it — and getting shots into arms at maximum speed.

Driving the news: Nationwide, only about 29% of the doses delivered to the states have been administered, according to Bloomberg.

  • New York Gov. Andrew Cuomo has spared controversy by saying he’ll propose a criminal penalty on health care providers who don’t follow state guidance on who should get vaccines, per Syracuse.com.
  • The French government announced this week that the vaccine would be offered in more places and to a broader group of people, after a sluggish rollout, per the Post.
  • Israel, which has the highest per-capita vaccination rate in the world so far, made everyone over 60 eligible for the first round of vaccines, per The Times of Israel.

What they're saying “There has to be this change in paradigm from being very, very measured to realizing we’re kind of in a warlike situation — we have to move as fast possible,” said Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security.

  • “It would be much better to move quickly and end up vaccinating some lower-priority people than to let vaccines sit around while states try to micromanage this process,” Health and Human Services Secretary Alex Azar said this week, per NBC.
  • Surgeon General Jerome Adams echoed this sentiment, saying that if states have exhausted the demand from one priority group or one location, they should quickly move to the next one.

Between the lines: The two authorized vaccines in the U.S. must be used within hours after they're removed from subzero storage, the Washington Post reports, and each vaccine has multiple doses in one vial.

  • Some of the groups most vulnerable to the virus — who are likely to be high up the priority list — are also the most vaccine-hesitant.
  • The first round of vaccinations were focused on health care workers and nursing home residents, all of whom are physically concentrated and therefore easy to reach — but even that part of the process has still been uneven, and experts say enforcing any kind of prioritization will only get harder from here.

Yes, but: “You don’t want any doses of vaccine to be wasted, and so if strict adherence to a distribution schedule would lead some doses of vaccine to be thrown away, then you have to add some more flexibility into the system," said Richard Besser, president and CEO of the Robert Wood Johnson Foundation.

  • "I am concerned, though, that some may be moving too quickly to...opening the floodgates to anyone who wants a vaccine, because the prioritization is really important," he said. "If you make the system too open to those who are not in priority groups, you run the risk of developing, in a sense, a two-tiered system.”

“If we don’t start planning now and working with the community-based organizations that already work with these groups and reach these populations, the logjams we see now will be nothing compared to when the vaccine is rolled out to the broader public,” said Nina Schwalbe, a professor at Columbia’s Mailman School of Public Health.

The bottom line: “The current logjams do not bode well for protecting those most vulnerable when we move beyond ‘Phase 1,’” Schwalbe said.

Go deeper