Coronavirus vaccine priority list – if I were elected the Emperor of Vaccines

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Despite the wild claims that a COVID-19 vaccine will be available real soon now, the initial limited supply would require a coronavirus vaccine priority list. Despite what Donald Trump says, and his veracity is limited, the supply of the vaccine will be limited for many months after approval, whether that approval is legitimate or not

The supply of a new COVID-19 vaccine is limited by many factors – regulatory review (yes, the FDA and other regulatory agencies must approve the manufacturing facilities for new drugs after the company receives approval to market their drugs), manufacturing bottlenecks, the number of doses required for “immunity,” and distributions problems, especially the need to store these vaccines at extremely low temperatures (no, your home refrigerator won’t get that cold).

In fact, that last point is something that everyone overlooks – your average physician does not have the ultra-low temperature freezers, usually only hospitals and major health departments. And they aren’t cheap. Furthermore, vaccines just don’t show up at a physician’s office or hospital directly from Big Pharma – they are delivered by a massive distributor network that may not have delivery vehicles that can properly store the vaccines as they drive their trucks across the deserts of Arizona in October.

This isn’t just an issue in the USA, it’s across the world. People magically believe that once a vaccine is approved it will suddenly be available to hundreds of millions of people. Nothing could be further from the truth.

Because the Big and Little Pharma companies are being much less transparent than they should, we have really no clue how many doses may be available soon after they get the go-ahead. 

Using the USA as an example, we’ll need around 750 million doses for every individual (assuming that two doses will be necessary and everyone gets the vaccine, which won’t happen). Overlooking the fact that the USA probably has a total vaccine manufacturing capacity of 200 doses at best (most of our current 300 million a year of vaccines are manufactured not only in the USA, but also in Canada, Belgium, Germany, France, and Japan), it’s highly improbable if not impossible to have 750 million doses on day 1. It may take years to manufacture that many.

If there are only 10-20 million doses available on day 1 (I’m highly skeptical of even that), you have to assume that there will be a coronavirus priority list. 

Now, there is a group that will be developing a coronavirus vaccine priority list (they’ll probably give it a better name) – the CDC’s Advisory Committee on Immunization Practices (ACIP). Dorit Rubinstein Reiss reported on a recent ACIP meeting which reviewed the ongoing efforts with the COVID-19 vaccine, but they did not make any recommendations on who should get the vaccine.

In light of that,  if I were elected Emperor of Vaccines, then I would have to create an official coronavirus vaccine priority list so that the right people get the vaccination. Spoiler alert – most of us aren’t on that list.

Coronavirus vaccine priority list – my rules

I’ve read a few articles regarding who should get the first round of vaccines, and most of them agree with me – this isn’t because I’m brilliant about this or anything, it’s because it’s pretty logical.

My first rule for this list, as the Emperor of Vaccines, is that those who are at most risk from the disease and who are most necessary in event that the pandemic gets worse (in the USA, worse happens every day) should get the first doses. So you billionaires, other than Bill Gates, can go pound sand. 

The second rule of this list is that even though it’s US-centric, I think that as Emperor, I would make it apply across the world. 

The third rule of this list is that because two doses are probably going to be required, each group gets the full two doses before we move on to the next step. I know, we could stagger this, but it would give me a headache to list out all of the steps that way, so I’m making it a bit easy for me and for you, the reader.

The fourth rule is that I’m going to assume that no one at the top of the list will sell their spots to those entitled billionaires. Of course, there will be a black market – go watch Contagion, a great movie about a pandemic, where criminals were trying to get supplies of the new vaccine. However, if someone wants to cut ahead, the Emperor is open to receiving a brand new Ferrari plus gold bars to pay for mechanics. Oh wait, I’m the Emperor of Vaccines, so obviously Big Pharma will do that for me.

Anyway, those are the rules. 

Group 1 – frontline healthcare workers

This should be obvious to anyone creating a coronavirus vaccine priority list. These physicians, surgeons, nurses, EMTs, techs, and everyone else that makes the healthcare system run efficiently are going to encounter more people with active coronavirus than just about anyone else, other than people attending Trump rallies. 

Because their primary job during this pandemic is to treat sick and injured people, they must be protected from the virus. If these healthcare workers get sick and die from COVID-19, there will be fewer and fewer resources to treat others.

Despite the feeling across the world that we beat this virus (we haven’t, not anywhere), hospitals are still overloaded with coronavirus patients. 

They will be number one until they have been vaccinated with the best vaccine that is available.

Group 2 – individuals with coronavirus comorbidities

Including this group on the coronavirus vaccine priority list is difficult, mainly because most of the vaccines are not undergoing robust testing with them. Most of the large trials are including mainly healthy individuals – there will be minimal data on the safety and effectiveness within these groups. For example, what if someone with diabetes requires three doses of the vaccine? It would be good to know this.

Anyway, what are these comorbidities:

  • Age > 60 (give or take, the exact cutoff seems to be in flux)
  • Obesity
  • Type 1 and 2 diabetes
  • Pulmonary diseases (even though most are caused by tobacco smoking, and I have zero patience with smokers who bring this on themselves)
  • Other conditions I haven’t thought of.

Finally, I hate combining these groups in here, but in the USA, people of color are at higher risk of death from COVID-19. African Americans are twice as likely to die from COVID-19 than a white person. 

Now, this probably isn’t a result of an individual’s race (an artificial construct that has no meaning in biology) – an African American probably does not have some genetic predisposition to dying from coronavirus. The higher mortality rate is probably as a result of racism in healthcare (like lack of access), lower incomes, and contributing health issues like diabetes and obesity. 

Nevertheless, people of color probably should be in this group so that we can protect them from this disease.

Group 3A – other first responders

This will be firefighters, police, and others who interact with the population not knowing who is infected or not. A lot of police officers and firefighters have died during the pandemic – not to go off-tangent, but US cops ought to be more worried about the virus that’s killing them than non-violent protests. Seriously, the president you support has lied about the virus continuously, putting you and all of us at risk of dying. But you are more worried about Black Lives Matter than COVID-19. 

Anyway, I got off track. Despite the police, at least in the USA, being very unpopular, they deserve to be vaccinated in the second group. As Emperor of Vaccines, I may re-examine my position if they keep senselessly killing citizens for no reason.

Group 3B – teachers

In the USA and few other areas (Quebec, you’re copying the US, not a bright move), governments are literally forcing students back to school and, of course, making teachers teach them. Despite the lies of Donald Trump, children are at risk of death or serious morbidities from the disease, and they can infect the teachers. They are not immune to the disease.

For this Emperor, teachers are essentially first responders and should be in this group. They probably should be in the top group, but difficult choices had to be made. The better choice would be to not have in-person schools until we have this solved.

But I’m only Emperor of Vaccines, I am not the Minister of Education. But if I were, things would be different.

Group 3 – the military

The military across the world are tasked with protecting their citizens, and they cannot do a good job if a ship or a battalion is at a low-level of readiness as a result of this disease. So, the military gets the number 3 position on my coronavirus vaccine priority list.

One more thing, at least in the US military, anti-vaxxers don’t exist. There are no exemptions whatsoever – no personal, no religions, and no medical (usually because someone with a medical issue that prevents vaccination probably couldn’t medically qualify to be in the military). You get your vaccine (and the military gets more than just about anyone else) or you are gone. Even spouses and children, especially ones that live on bases, are thoroughly vaccinated.

The US military, to some extent, will be a huge observational trial for the new vaccine – will know a lot more about the vaccine’s safety and effectiveness after a couple of million of them receive the new vaccine.

In the USA, the military works outside of the normal healthcare system, so they will either manufacture their own vaccines or purchase them independently of other purchasers, so there probably is no need to put them in a group. They’ll probably be among the first to get them.

Group 4 – essential workers

There are workers in essential industries in every country. Some grow and process food. Some distribute and sell food. Some manufacturers of medical devices and drugs (like this vaccine). These are individuals that keep the economy going and keep us alive. The USA had (possibly still have) meat shortages because of the pandemic.

And no, billionaire CEOs are not essential workers. Except for Bill Gates, but he’s no longer a CEO.

Group 5 – everyone else

After the first four groups, it’s hard to break out any other group that is more deserving of being higher up the coronavirus vaccine priority list than another group. So if you’re a millennial? You wait. If you’re a politician? You wait. If you’re some entitled person who thinks they should be first in line? You wait.

And this is probably the largest group, and they may not see a single dose of the vaccine until – well, I don’t know, but many vaccine experts are saying that most doses will be available in 2021 IF EVERYTHING GOES RIGHT, which almost never happens in clinical trials. 

coronavirus vaccine priority

So what does this all mean?

I was being a bit snarky about my list, but to be fair, it’s pretty close to what others have written. The National Academy of Science, the most prestigious independent science advisory group in the world, has made draft recommendations on a coronavirus vaccine priority list:

But other agencies, like ACIP, will be the ones who will make final recommendations. However, despite what your local anti-vaccine zealot might say, no one is going to mandate this across the country. Each state will probably fine-tune their priority list to meet the needs of their state.

However, all of these groups know one thing that President Trump doesn’t – when and if we get a vaccine, it will be in a limited supply which will require this type of prioritization. There will be some hard choices, but our various public health agencies should be able to do this well with the help of vaccine experts.


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The Original Skeptical Raptor
Chief Executive Officer at SkepticalRaptor
Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!