Chapter 16 : Allocation of Resources: Scarcity and Triage

Section 5. Case Study   PANDEMIC NOVEL CORONA VIRUS (COVID-19)   VACCINE DISTRIBUTION

The the issue of medical scarcity prsents itself in many ways. How do you care for people when there are more in need than you have the resources to provide?   A variation of that is how do you dispense care/treatment/cure/vaccine when there are more people in need than you can provide for at once?  How do you provide?  Who goes first?

 With the PANDEMIC COVID-19 in July 2020 there were several groups attempting to develop a vaccine.  They took different approaches to doing that.  When a vaccine would become available the question presents itself of who will be first to get it?   Some want the prioritizing to go this way:

  • ·        Frontline health workers

  • ·        national-security personnel

  • ·        blacks

  • ·        Hispanics

  • ·        Native Americans

  • ·        obesity, hypertension, cardiovascular disease, diabetes and other complications make the virus more life-threatening.

  • ·        elderly

 The Betsy McCaughey is author of the article "The lunatic drive for racial quotas for COVID-19 vaccines"   wanted the authorities deciding such a question  “to put aside racial politics and be guided by science”.

Others raised the basic issues and dilemmas and discussed them as well.

 RESOURCES:

http://search.ebscohost.com.lib1.lib.sunysuffolk.edu/login.aspx?direct=true&db=a9h&AN=143018476&site=ehost-live.

https://www.trialsitenews.com/the-covid-19-vaccine-race-status-update-as-of-july-5-2020/

https://www.barrons.com/articles/race-for-a-covid-19-vaccine-might-have-political-side-effects-51595011445

https://scopeblog.stanford.edu/2020/06/25/the-race-for-a-covid-19-vaccine-whats-ahead/

https://www.pennmedicine.org/coronavirus/covid-19-clinical-trials

https://www.massgeneral.org/news/coronavirus/research/therapies/coronavirus-clinical-trials

https://jamanetwork.com/journals/jama/fullarticle/2765944

https://hbr.org/2020/04/a-covid-19-vaccine-will-need-equitable-global-distribution

https://hub.jhu.edu/2020/07/01/covid-vaccine-ethics-faden/

https://www.medscape.com/viewarticle/933066

https://www.cnn.com/2020/07/10/opinions/covid-19-vaccine-allocation-decision-peterson/index.html

https://www.gavi.org/vaccineswork/lessons-preparing-distribute-covid-19-vaccine

https://www.fiercehealthcare.com/payer/lawmakers-press-cdc-for-plan-distributing-covid-19-vaccine-combating-mistrust

https://www.raps.org/news-and-articles/news-articles/2020/3/covid-19-vaccine-tracker

https://www.aappublications.org/news/2020/04/03/bioethicscommentary040320

https://success.ada.org/~/media/CPS/Files/COVID/ADA_COVID_How_Do_I_Ethically_See_Patients_During_Pandemic.pdf

https://www.fastcompany.com/90529289/ending-the-pandemic-will-require-big-pharma-to-put-ethics-before-profits 

https://www.jacobinmag.com/2020/06/patent-coronavirus-vaccine-big-pharma-market

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327159/

https://www.fastcompany.com/90529289/ending-the-pandemic-will-require-big-pharma-to-put-ethics-before-profits 

https://apps.who.int/iris/bitstream/handle/10665/331976/WHO-2019-nCoV-Ethics_criteria-2020.1-eng.pdf?ua=1

https://www.sciencemag.org/news/2020/06/line-forming-covid-19-vaccine-who-should-be-front 

https://sph.umich.edu/pursuit/2020posts/why-are-ethical-concerns-blocking-the-progress-of-covid-vaccine-efforts.html 

https://www.statnews.com/2020/05/23/when-a-covid-19-vaccine-becomes-available-who-should-get-it-first/

https://abcnews.go.com/Health/injecting-healthy-adults-live-coronavirus-moral-dilemma-faster/story?id=70331610

https://www.thetablet.co.uk/news/12849/covid-19-vaccine-could-present-ethical-dilemma-for-catholics

https://www.medpagetoday.com/infectiousdisease/covid19/86260

https://www.ctvnews.ca/health/coronavirus/ethical-dilemma-who-should-get-a-covid-19-vaccine-first-1.4977914

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30438-2/fulltext

https://hub.jhu.edu/2020/07/01/covid-vaccine-ethics-faden/

https://www.reliasmedia.com/articles/146109-the-covid-19-vaccine-usual-ethical-questions-in-unusual-times

https://unfoundation.org/blog/post/qa-with-dr-peter-hotez-behind-the-scenes-of-covid-19-vaccine-research/?gclid=Cj0KCQjw3s_4BRDPARIsAJsyoLPln4FCAE3_To8dx3tS4w-pRDcbjqGEn3oos_ItRjEOCG575t8hkecaAqCpEALw_wcB

https://www.cidrap.umn.edu/sites/default/files/public/php/566/566_aar.pdf

 

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The lunatic drive for racial quotas for COVID-19 vaccines

By Betsy McCaughey July 16, 2020 | 7:38pm  https://nypost.com/2020/07/16/the-lunatic-drive-for-racial-quotas-for-covid-19-vaccines/

At least two COVID-19 vaccines are scoring major successes in trials. That means a vaccine might be ready by year’s end, but not in sufficient quantity to vaccinate more than 300 million Americans. Frontline health workers and national-security personnel will be top priority, but after that, who comes next?

A federal committee is considering pushing blacks, Hispanics and Native Americans to the front of the line, ahead of whites.

Dr. José Romero, who chairs the CDC’s Advisory Committee on Immunization Practices, wants minority groups to get favored treatment. Billionaire donor Melinda Gates likewise is pushing for blacks to get vaccinated right behind health workers but ahead of “people with underlying health conditions, and then people who are older.”

Americans need to speak up, before such a plan is adopted. If the virus surges, getting the vaccine could mean the difference between leaving your house safely or being shut-in, or even the difference between life and death. Making race a factor is unjustified by medical science and will only inflame the racial hostilities already roiling America.

If blacks were more vulnerable because of race, as they are with sickle-cell anemia, there would be a medical argument for racial preferences. But scientific data show no direct causal connection between race and COVID-19 deaths.

Scientists in the United States and Europe have plentiful data on who gets infected and who is least likely to survive COVID-19, and their findings can help prioritize who should get vaccinated.

Forget using crude racial proxies.

Who is at risk of dying? The elderly, above all, and anyone with medical conditions such as heart disease, morbid obesity, hypertension and diabetes.

People of all ethnicities can suffer from these conditions, but blacks do so disproportionately. That’s why, if they contract COVID-19, they’re more apt to need hospitalization and ICU care than infected whites, according to new research in the New England Journal of Medicine. African Americans made up 31 percent of the Louisiana population studied, but 70 percent of the infected, 77 percent of hospitalized cases and 80 percent of patients in the ICU.

New York City data show that blacks with COVID-19 are more likely to be hospitalized than whites are, largely because obesity, hypertension, cardiovascular disease, diabetes and other complications make the virus more life-threatening.

ACIP should prioritize vaccinating people with these complications. Many will be black, to be sure, but they will be getting priority treatment for medical reasons, not skin color.

People who live in crowded urban areas and in multi-generational households are at higher risk of COVID-19. So are mass-transit riders and people who work in close contact with the public, such as fast-food attendants and bus drivers.

In Britain, that group is heavily Middle Eastern and East Asian. In the United States, it’s often black and Hispanic. But not always. Using race to prioritize vaccinations would result in unfair situations, like putting the black college professor who works from home ahead of the white transit worker.

Instead, the CDC committee should prioritize population-dense neighborhoods and multi-generational households, as well as highly exposed workers like ­supermarket cashiers and bus drivers.

What about claims that blacks with COVID-19 are getting inferior medical care? That’s an insult to frontline health workers of all races, and the evidence suggests it’s also untrue. In the New England Journal of Medicine study, 80 percent of patients sick enough to be in the ICU were black, but only 71 percent of those who died. In other words, blacks in the ICU had a better chance of surviving than whites in the ICU did.

The same holds true in New York City, though the data are incomplete. Black hospital patients with COVID-19 appear to survive at slightly higher rates than do hospitalized COVID-19 patients of other races.

To get Americans vaccinated — a huge challenge — we need to put aside racial politics and be guided by science. Many minorities will still go to the front of the line, but based on medical need, not woke ideology.

Betsy McCaughey is author of the forthcoming book “The Next Pandemic.”

 

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© Copyright Philip A. Pecorino 2002. All Rights reserved.

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