Posted on December 28, 2020
The governor’s office and the Department of Public Health (DPH) are deciding on vaccine allocation and prioritization with the help of Centers for Disease Control and Prevention guidelines. CDC guidelines issued Dec 21 recommend vaccinating health care and essential workers before vaccinating seniors aged 65 to 75. However, simple math based on mortality numbers show that if we first vaccinate all seniors over 65 (17 percent of our population) we will end most of the harm. As per current vaccine availability, this can be done in the next five weeks. The best way to prioritize the vaccine is to provide 90 percent of all available vaccines to the elderly (in descending order of age) while reserving 10 percent for health care workers who are directly exposed to COVID and younger adults who have high vulnerability.
COVID is dangerous because it has a high mortality rate for certain groups — mainly seniors. In Connecticut and across the United States, 94 percent of deaths are of people over age 60. Once everyone over 60 is vaccinated the death rate from COVID will be comparable to that of influenza. If we target 10 percent of the vaccines to health care workers who have higher exposure and those who have higher vulnerability, we can reduce the harm further. The plan described above will reduce more than 95 percent of deaths in five weeks and drastically reduce the menace of this pandemic.
Under a plan which follows CDC suggestions, those 75 and over will have to wait for an extra two months and those 65 and over will likely wait an extra four months, compared with the above plan. Using the current rate of spread and mortality, such a plan would lead to an additional 200,000 deaths among seniors. Under that CDC plan, those vaccines will instead be given to younger people who are essential workers or working in health care. The probability of death of a 75-year-old who gets COVID is 500 times that of 30-year-old. However, the probability of infection of 75-year-old is only half of that of a 30-year-old, based on current Connecticut COVID data. Prioritizing younger population does not seem to be the right thing to do.
Most experts agree with this assessment. The United Kingdom and Canada are setting up vaccination programs prioritizing the elderly. Scott Gottlieb, the former Food and Drug Administration commissioner, said recently “If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans. If your goal is to reduce the rate of infection, then you would prioritize essential workers.” Mike Wacek, chief risk officer of an insurance firm (and a Greenwich native) confirms the conclusion “If the objective is to minimize future deaths from COVID-19, then priority must be given to the elderly. As long as the vaccine has to be rationed, giving it to younger people without co-morbidities, even if they are essential workers, is a waste and will cost lives.”
What is puzzling to most experts is why the CDC is recommending vaccinating younger essential care workers and health care workers ahead of the seniors. The basis for their recommendation is that the ratio of people who die from COVID to the total number of natural deaths is similar for middle age Americans (45-65) and senior Americans. Their argument does not work for many reasons. First, the sheer number of seniors whose lives would be lost if essential workers are prioritized over seniors in the first four to six weeks. Second, half of the essential workers are below 40 and not middle age. Finally, the fear of COVID and the transmission concerns are not relevant if we get to a point when there are no deaths.
There are two ways to end the pandemic. Either we immunize 80 percent of our entire population and get herd immunity or we immunize the older 25 percent of our population and reduce the death rate to an infinitesimal level. I ask that our governor and DPH make prioritization decision based on rigorous analysis and evidence. The CDC guidelines need to be examined carefully. If experts confirm the above conclusions it is important we take a different track which saves lives. In our state, this equates to saving more than 2,000 lives. We should offer 90 percent of all vaccine allocation to our seniors (in descending order of age) and 10 percent to health care workers who are directly exposed to COVID. Based on science and evidence, this is the right decision and will save lives.