Who will be vaccinated first in the United States?

The list of priority populations in the United States for vaccination against Covid-19 has not been officially decided, but the opinions of experts already diverge from the choices of other countries such as France, in particular on workers. essential.

There will be no single rule in the United States: at the risk of creating confusion, as during the 2009 H1N1 flu vaccination campaign, the federal government will make recommendations and leave each state free to decide. distribution method and order of priority, among the elderly, assistants, supermarket employees …

Divergent opinions

Recognized groups of experts have already expressed opinions, sometimes divergent, revealing the central tension of the debate: vaccination should both protect the most vulnerable and facilitate the rebirth of society.

It is on this issue – how to restart the economy as quickly as possible – that the United States could stand out.

According to the Higher Health Council, 3 groups will be a priority in Belgium for the COVID-19 vaccine. The Vaccine Task Force refines and clarifies these populations:

• All workers in the health sector. The Vaccine Taskforce proposes that vaccination begin earlier in hospitals and institutions for vulnerable people, for epidemiological and practical reasons. Health personnel who are not dependent on a hospital will be vaccinated at the nearest health institution. In nursing and nursing homes, workers and residents would first have been vaccinated at the same time, for geographic logic but also to give priority to these vulnerable people, while the first wave had somehow forgotten them.
• All people over 65 will follow immediately: this could be done in the age groups from the oldest to the youngest in this category.
• Patients aged 45 to 65 years with specific comorbid factors at risk of developing severe COVID-19: known obesity, diabetes, hypertension, chronic cardiovascular, pulmonary, kidney and liver disease or haematological problems (blood disease) up to 5 years after diagnosis and all recent solid tumors (or recent cancer treatments).

Privileged caregivers

In the United States, in a report of more than 200 pages, the National Academies of Science, Engineering and Medicine put caregivers first. “on the front“of the pandemic, and paramedics, police and firefighters who are very exposed to the virus.

People who have two or more medical conditions (cancer, obesity, type 2 diabetes, etc.), regardless of their age, will follow the 2 million people in nursing homes.

American experts then rely not on age but on profession and favor workers “criticisms“who run America: first the teachers and workers who feed the Americans, from slaughterhouses to supermarkets, who drive buses and trains, sell drugs, maintain order or deliver mail and packages.

Often it is also precarious workers, of Hispanic and black minorities, who have been disproportionately affected by the pandemic, an injustice that experts explicitly want to repair.

After these tens of millions of workers, people with a single disease could be vaccinated, the homeless, inmates and the over 65 without comorbidities … Then young adults and especially students, who are less at risk but have shown how much they spread the coronavirus.

Just a proposal

This is just a proposal. The Center for Disease Prevention and Control (CDC) is awaiting the opinion of its expert (advisory) committee, which will vote on Tuesday.

That committee suggested it could prioritize healthcare workers and essential workers, as immunization will provide a “multiplier effect“: not only are they essential cogs in the healthcare response and the economy, but they are in contact with many people.

In practice, these ethical, epidemiological and economic considerations can be ignored in the initial rush to doses.

Concrete problems remain: if it is easy to turn to nursing homes and hospitals, how should pharmacists and doctors confirm that a customer is indeed an essential worker or that he has two conditions? ?

Additionally, the Trump administration has said it will not be bound by its health agency’s advice and that nursing homes will receive Pfizer / BioNTech vaccines as early as mid-December in the event of a regulatory go-ahead, whatever. ‘experts say. The logistics are also already in place.