Thread by @DrMattMcCarthy

Here's a controversial paper that's often referenced during ethics meetings when we discuss how to allocate the limited supply of #COVID19 vaccines. Lead author is Ezekiel Emanuel, a member of Biden's coronavirus task force. Key arguments: 1/
nejm.org/doi/full/10.10…

Frontline health care workers should be given priority "not because they are somehow more worthy" but because they're essential to pandemic response. Younger patients should not be prioritized. Avoid first-come, first-served distribution as it may encourage crowding or violence.

If vaccine supply is insufficient for high-risk patients, consider a lottery. People who participate in COVID research (think of someone who enrolled in a remdesivir trial) should receive some priority.

This paper was published in May, when we assumed a COVID vaccine was a distant dream. It was also assumed inoculation would just prevent disease rather than transmission. Press releases from Moderna & Pfizer have altered the calculus. Vaccines appear better than we ever expected.

Key stakeholders around the country are now discussing how best to distribute limited quantities of what appear to be 2 highly effective vaccines. Invariably, someone mentions Emanuel's paper. Many take issue with its thesis, especially the part about deprioritizing young people.

Question that came up today: Should a COVID19 vaccine go first to an older physician, who is more at risk, or a younger doctor with small children? Who has more to lose? Who has more to gain? And who decides?

When a COVID vaccine is authorized, the Advisory Committee on Immunization Practices (ACIP) will hold a public meeting to vote on whether to recommend the vaccine and, if so, who should receive it. Then we must do the hard part & figure out who gets priority within those groups.