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Who will get the COVID-19 vaccine first? Gundersen doctor among group examining ethical, epidemiological factors
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Who will get the COVID-19 vaccine first? Gundersen doctor among group examining ethical, epidemiological factors

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Raj Naik

Raj Naik

Experts are hoping to see a COVID-19 vaccine approved by early 2021. But how soon it will be available to you is another question.

The decision of who will receive the potentially life-saving vaccine first is a profound one, and not being taken lightly by committees at both national and state levels.

In Wisconsin, the Ethics Subcommittee of the State Disaster Medical Advisory Committee, comprised of physicians, scientists, educators and community leaders, has been working since late August to develop a vaccine allocation strategy for the Wisconsin Department of Health Services.

The therapeutics currently available for COVID-19 patients are limited, and a future vaccine or proven treatment will be even more meager once available.

It is the responsibility of the Ethics Subcommittee to provide a guideline based on meticulously considered ethical principles that ensure no ethnic group, income level or geographical location is at a disadvantage to receive the immunization.

All discussions by the subcommittee, which is nonpartisan, are public record, and at the end of October residents will be invited to provide feedback during a two-week comment period before recommendations are submitted to the State Disaster Medical Advisory Committee.

The subcommittee will review resources disseminated by other states, federal guidelines and the proposals of other organizations in regard to ethical allocation policies to help determine whether modifications to the recommendation should be made.

Once the federal government secures the vaccine, supplies will be distributed to state health departments, and from there sent to local health departments and health-care organizations.

“The big question that everyone wants to know (is when a vaccine will be ready), but nobody knows when it will be available or how many (doses) will be available,” says subcommittee co-chair Dr. Raj Naik, a primary care pediatrician at Gundersen Health System, adjunct faculty of UW School of Medicine and Public Health, Medical Director of Informatics at Gundersen and immunization specialist. “Looking at to whom the vaccine will go is a very complex issue.”

In an effort to eliminate bias from the equation, subcommittee members were carefully selected to represent a broad spectrum, including individuals with disabilities, those who identify as Latinx, Black and Hmong, various age brackets and places of residence both urban and rural.

Working under the premise of “promoting the common good, based on scientific evidence,” the group is examining all angles to arrive at a guideline, including whether it is appropriate to give preference to those in regions that are disproportionately burdened by COVID-19 or other health inequities, including those with comorbidities or a high number of elderly residents, and if there are circumstances under which priority should be given to frontline workers and those “instrumental to the COVID-19 response.”

“It’s more complicated than just looking at demographics,” Naik says.

When it comes to therapeutics and a vaccine, Naik emphasizes, “equity doesn’t mean an equal proportion” when it comes to individual cities or counties. It’s not as simple, Naik says, as allocating one dose per a set number of people in each area. A location with very few coronavirus cases may wait longer than one with a surge in positives.

There are also hypotheticals to contemplate, such as whether a vaccine proves more effective on a particular age group. Even those ultimately designated as top candidates may have a wait ahead of them.

“When a resource is scarce ... not everyone is able to receive it right away,” Naik says. “If there are only a few thousand doses and 100,000 people in the high priority group, that’s an impossibility.”

Decisions, Naik concedes, “won’t be perfect — we will do the best we can under the circumstances.” Transparency every step of the way in vaccine allocation strategy deliberations will be critical in establishing trust with community, he notes, and that forthcoming will also be crucial in proving the legitimacy of the vaccine once approved.

“Just because you recommend a vaccine doesn’t mean they will accept it,” Naik says.

Naik encourages residents to participate in the public comment period, the details of which will be shared closer to the date.

Says Naik, “We want voices to be heard.”

“When a resource is scarce ... not everyone is able to receive it right away. If there are only a few thousand doses and 100,000 people in the high priority group, that’s an impossibility.” Dr. Raj Naik, Gundersen primary care pediatrician and co-chair of the

Ethics Subcommittee of the State Disaster Medical Advisory Committee

Emily Pyrek can be reached at emily.pyrek@lee.net.

"When a resource is scarce ... not everyone is able to receive it right away. If there are only a few thousand doses and 100,000 people in the high priority group, that's an impossibility."

Dr. Raj Naik, Gundersen primary care pediatrician and co-chair of the Ethics Subcommittee of the State Disaster Medical Advisory Committee

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