Science Corner: A Shot in the Priority Order

One topic at the intersection of COVID-19 updates and concern for racial justice is the distribution of vaccines. Assuming we eventually identify one or more safe and effective immunizations to prevent SARS-CoV-2 infection, it is unlikely we will be able to nearly instantaneously manufacture the two to three hundred million doses we’d need just to cover the US population. In theory, we could just stockpile doses until there’s enough for everyone, but then we miss out on some of the benefit as more people get infected while we wait. And it’s not like we can inject everyone simultaneously anyway, so we’ll still need some kind of plan for who goes first (assuming they’re interested).

The film Contagion anticipates this concern and proposes a lottery system based on birthdays. It reminded me of the way fuel was rationed during a gasoline crises in 1979, or more recently in the New York metro area after Hurricane Sandy. Such randomization appeals to a sense of fairness because the system is arbitrary and shouldn’t favor any person or group in particular. But as a way of distributing vaccines, such a lottery may be unfair in the sense that not everyone’s needs are equal. We can also look at trying to maximize benefit, which includes looking at how will benefit most individually and also the collective benefit from reducing spread. And so multiple solutions may be rational, even before we acknowledge that we will never have the complete information needed to fully answer the quantitative questions about risks and benefits. So I’m glad there are national and international discussions already underway to address these issues, even if there are more questions than answers at this stage.

As the article mentions, prioritizing healthcare workers and others playing essential roles in meeting our collective needs seems pretty straightforward, but things get more challenging from there. I’ve had folks ask me about potentially prioritizing racial groups who have experienced disproportionate numbers of cases, so it would seem that possibility is not purely an academic one. I can see why that’s a concern for many, and I can also imagine there will be some sharp resistance to prioritizing based primarily on race. Perhaps if the elevated cases in those populations has to do with the demographics of employment and underlying conditions, prioritizing on factors like those will address the racial disparities as well. Obviously that would need to be validated rigorously, and perhaps I am overlooking some other dimensions of justice that merit consideration. I’m just trying to think through how to plan in a way that is just as well as realizable.

Vaccines are fairly conventional public health tools at this point. It’s also interesting to see more cutting edge approaches, like a new design for the fabric for masks, gowns, etc. that can actually neutralize pathogens rather than just trap them. Of course, any new technology will have its own manufacturing scale considerations and possibility of scarcity raising questions of fair distribution. Still, I think the more creativity we can apply, the more likely we are to find better outcomes for more people. And hopefully that’s what we’re all aiming for.