Joe Amon: Plan now for vaccination decisions to come
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Joe Amon: Plan now for vaccination decisions to come

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Matthias J. Schnell, professor and chair of Microbiology and Immunology at Thomas Jefferson University, is working on a coronavirus vaccine. 

Recent news from researchers at Oxford University gives some hope that a vaccine for COVID-19 could be ready as early as this fall. But as with test kits, N95 masks and ventilators, the demand will far exceed the supply - at least initially. So, who should be first in line for a vaccination once it is available?

Health care workers, from doctors to hospital janitors, are on the front lines of fighting this pandemic, so protecting them should be our first concern. After that, deciding who should get vaccinated could get contentious, with states competing against one another for limited supplies, various industries claiming priority and those who can afford it arguing for a free market approach.

Epidemiologists might recommend giving certain populations or regions priority based on mathematical models of disease spread. Others might advocate protecting those at greatest risk of severe illness or death, such as older people and those with underlying health conditions.

Still others will want to prioritize those most at risk of infection, including people who work in "essential industries" or where alternative strategies such as wearing masks and social distancing are difficult.

Asked during a congressional hearing on May 14 whether Americans will have trouble getting a vaccine once one is available, Dr. Rick Bright, the recently ousted director of a key federal agency overseeing vaccine production and purchasing, replied "absolutely."

We have seen the free-for-all, if not downright corrupt, nature of government support programs such as the Paycheck Protection Program, in which large institutions have gamed the system to soak up funds intended for, and desperately needed by, small businesses. So it is critical that we devise a transparent and bureaucratically simple system, one that caters to those in greatest need.

To reach older people and those with serious underlying health conditions, Medicare-eligible people could get priority. To reach people living in poverty who have been disproportionately affected by COVID-19 - and who may work in service industries that are essential for opening up the economy, and that put them at high risk - people on Medicaid can be fast-tracked.

Some of the largest outbreaks in the United States have occurred in detention facilities. The government has an obligation to protect inmates and ensure that they have access to care.

Reaching other vulnerable populations can be achieved through public health clinics, the Indian Health Service, and the Vaccines for Children Program. While children seem to have mostly mild or asymptomatic infections, vaccinating them will help get the economy back on track and provide an important check to broader transmission.

This pandemic has made clear that, in our interconnected world, we need to act globally. The U.S. government recently declined to help fund a global effort to support vaccine development. That's a huge mistake. We need to support global efforts not only for vaccine development but also to expand manufacturing capacity and the distribution of an eventual vaccine.

Going further, we must support the development of a system to pool intellectual property rights for technologies used in preventing, detecting, controlling, and treating COVID-19, to ensure that any breakthroughs are available through licensing at reasonable and affordable terms.

To ensure fair and equitable access to an eventual COVID-19 vaccine, we need to build upon the public health care system we have, and strengthen pandemic preparedness through strengthening the patchwork of programs that provide care to those most vulnerable.

As we face an uncertain future of second, third and perhaps seasonal waves of COVID-19 cases, we need not only more investment, but national leadership and greater recognition of health as a human right, available to all.

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