Thread by @bopinion

If the Pfizer-BioNTech vaccine gains regulatory approval by Christmas, we can cheer the scientists for heroic work.

But tough decisions lie ahead: Who should get the vaccine first? trib.al/RtnmyWd

💉Pfizer expects to produce up to 50 million vaccine doses in 2020 and up to 1.3 billion in 2021, to be split between several nations.

The U.K. has ordered 40 million, enough to vaccinate 20 million people in two doses trib.al/RtnmyWd

Countries have started to outline strategies to ration the vaccine:

🇬🇧U.K. plans to start with the very old, care home & health care workers, before moving down the age brackets
🇩🇪Germany will vaccinate at-risk groups first, along with nurses and doctors trib.al/RtnmyWd

But what if vaccinating the elderly first isn’t the best way to minimize fatalities?

A recently published model from three academics suggests priority should be accorded to groups with the highest number of daily in-person interactions trib.al/RtnmyWd

Prioritizing those with the most contacts could reduce total fatalities by up to 70% and amplifies the vaccine’s effectiveness by reducing infections among:

👤The vaccinated group
👥The vaccinated group’s contacts trib.al/RtnmyWd

Taking this approach would change the priority list somewhat, into perhaps something that looks like:

👩🏾‍⚕️Health-care workers
👱🏻‍♀️Young workers
👨🏽‍🍳Hospitality sector staff
👦🏾Children trib.al/RtnmyWd

Seasonal flu vaccination programs are a case in point. Flu deaths don’t decline significantly from programs just targeted at the elderly. That’s why some countries have encouraged inoculating children, including:

🇫🇮Finland
🇱🇻Latvia
🇸🇰Slovakia
🇬🇧The U.K. trib.al/RtnmyWd

The efficacy and safety of a vaccine is also harder to establish among vulnerable or elderly populations.

Vaccinating younger people earlier and faster would help amass more data on the vaccine while also reducing the spread in the population trib.al/RtnmyWd

75% of deaths are in the 65+ age group, so any unknown safety risk may be worth taking to protect the elderly & the immunocompromised.

But whatever its calculations, governments need to be transparent about their models and the assumptions they contain trib.al/RtnmyWd

The success of any early vaccination program also depends on how effectively available doses can be deployed. Germany will have:

-60 vaccination centers
-Help from the German military
-Training for medical workers
-A database to keep track of vaccinations trib.al/RtnmyWd

This week brought good vaccine news, but the next steps must be carefully planned.

We are still far from the point when a vaccine will be available to all. Until then, prioritization and distribution are key trib.al/RtnmyWd