Dr. Jacob Eapen-
Dr. Jacob Eapen, a Medical Director at the Alameda Health System(AHS) and a member of the Board of Directors at the Washington Hospital in Fremont, California. He is also the Regional Vice President of the Federation of Kerela Association in North America(FOKANA). The views expressed are his own.
Scientists have put logistical pundits to shame. Vaccines were discovered in record time to tackle the pandemic, but the rollout has hit bumpy roads. The touted promises have been broken. It was promised that 20 million Americans were to be vaccinated by year-end, but so far only 2 million people have been vaccinated in 16 days. More than 10 million doses have been distributed so far. At the same time, the pandemic is running at full speed taking a record number of lives. The nation has reached nearly 4.00 deaths per day and the more infectious UK variant strain is on the spread. The White House had previously said it aimed to vaccinate 80% of Americans by end of June, which would require more than 3 million vaccinations per day. There seems to be no planning when the vaccine reaches the states. This is an amazing display of ineptitude, especially considering that in 1947, 6 million people in New York were able to be vaccinated against smallpox in less than one month.
The prioritization of vaccine recipients is a very sticky issue. Recommendations from different agencies like ACIP and CDC on who should first receive the vaccines have been made. Changes have been made at the state, county and tribal levels making the whole process seem very non-equalitarian. How do you divide health care workers into the frontline and non-front line workers? In our local system, all the people in the hospital setting are given vaccines first irrespective of their exposure levels.
At the same time, there are health care workers in clinics who are exposed day in and day out with COVID-19 cases, but are slated for a later round of vaccinations and asked to wait. The virus will do not follow any priority list. This has created an atmosphere of non-transparency and lowering the morale of the staff who are already putting their life in harm’s way. This is certainly not an isolated occurrence, but a common scenario found in many parts of the country. By now everyone knows about the apologies Stanford University had to make to their medical residents for bypassing them in the first round of vaccinations while senior clinical and non-clinical staff, many not directly involved in direct patient care, received the shots. How do you say a pediatrician in a clinic is less at risk than an administrative employee in a hospital?
In my opinion, the advisory board should have prioritized specialty to specialty rather than grouping people based on their place of work. Pediatricians are still seeing their patients face-to-face as children have to physically come to clinics for their normal childhood vaccinations. By now we also know that most of the children do not exhibit any symptoms even if they have COVID. Children are also not covered for the new Covid vaccines. This group remains a source of transmission even after the vaccinations are bumped up. For this reason, I would recommend that this group of physicians be considered in the first line of prioritization. Personally, I am aware of a few pediatricians who have lost their lives to Covid. I did receive my Pfizer first dose 2 days ago and, other than slight soreness at the site of the injection, have not experienced any untoward side-effects.
The main hiccup the hospitals are facing, more than the logistical aspect, is that there is not enough manpower to vaccinate people. Clinicians are all busy taking care of sick patients. The Federal government should have done a better job in mobilizing forces like the National Guard to help with vaccinations. Whatever happened to our technology? We have super robots who can conduct surgery but are yet to see any type of this automation in other areas of healthcare delivery, in this case, administering vaccinations.
Forty-five states are following ACIP’s interim Phase 1a recommendation to prioritize HCWs (Health Care Workers )and LTC (Long Term Care) residents. Some states will start vaccinating both of these groups together, while others will start with one of these groups first as they await more supply to start vaccinating the other. Still, even with these state criteria, decisions about how to allocate limited initial vaccines to HCWs and LTC residents will mostly be left to facilities. States like Nevada will add law enforcement to the Phase 1a recommendations.
As of mid-November, high-income countries, including the European Union bloc, reserved 51% of nearly 7.5 billion doses of different Covid-19 vaccines, although these countries comprise just 14% of the world’s population. Meanwhile, only six of the 13 manufacturers working on Covid-19 vaccine candidates have reached agreements to sell their shots to low and middle-income countries. India is purchasing 1.5 billion doses compared to America which is purchasing about one billion doses. The UK has already vaccinated about 400,00 people.
India is yet to roll out its vaccinations. The Astra Zeneca/ Oxford vaccine was just approved in the UK and although it’s efficacy is about 76%, the vaccine is relatively cheap, costing only a couple of dollars per dose. This is also a 2 dose vaccine, but does not require the stringent cold chain operations the currently approved vaccines do.
The last thing we want is to create is a climate of disparity and bias in vaccinating people. Though African Americans are being hospitalized for COVID-19 at more than triple the rate of white Americans, the wariness of the new vaccine is higher in the Black population than in most communities. Years of mistreatment both by the government and the medical community ranging from the Tuskegee Experiments to forced sterilizations have fueled this distrust. This will only add fuel to the situation of a clear disparity in healthcare access and delivery currently existing among minorities, particularly in Black, Latino, and Tribal communities who are the highest risk groups because of their type of employment and comorbidities. Instead, this should be a time to win them over and not to increase the gap in health disparities.
Until we all get vaccinated we must continue to wear masks and continue social distancing. I am reminded of the line from the ABBA song, “Can you hear the drums Fernando?”… I think I can hear them. Let us keep ringing in the bells of the New Year and beating the solo drums of celebration until we can all dance to the music of ABBA en mass. God bless!