Thread by @TimLaheyMD

Key point re who is first for a #coronavirus #vaccine 💉

THERE IS NOT ONE LINE.

This isn’t really a sequence.

A THREAD 🧵

#bioethics #justice #SDOH

nytimes.com/2020/12/05/hea…

Instead, different organizations will receive vaccines in parallel at roughly the same time. Long term care facilities and hospitals 🏥for instance will get shipments early on and at roughly the same time.

Each of those organizations, in turn, will prioritize vaccine allocation within. Hospitals for instance will prioritize vaccination of patient/public-facing members over other important staff, because they have higher risk of exposure/transmission 🦠

Simultaneous distribution to different institutions means that hospitals will be vaccinating ICU staff 👩🏾‍⚕️around the same time that nursing homes are vaccinating their residents 👵🏽

The same thing will happen in later phases. Schools 🏫and fire departments 🚒will get vaccines at roughly the same time. And so on.

In other words, THERE ARE MULTIPLE LINES. It's more like a grocery store than the door of an exclusive dance club. 🕺🏼

These vaccine distribution phases will overlap - hugely. Hospitals will still be vaccinating health care workers by the time new phases start. Some EMT's 🚑 will get their shots around the same time as grocery store clerks🌽 & some teachers may be vaccinated before I will

It's easier to reach workers in health care organizations than others. Primary care clinic workers are easier to reach than say grocery store clerks whose employers may not have the same vaccine distribution experience. Some high priority folks will need to go to clinics.

Clinics, for their part, are not going to sort through crowds of people to see who "deserves" a shot at 9 am vs. 1 pm. It'll be first-come-first-served at that point, meaning grocery store workers & high risk older folks👴🏼 will likely be in line with younger healthy folks.

Vaccines, in other words, will go to crowds 👨‍👨‍👧‍👧 that we will not rank perfectly by need.

That's totally fine. We will hit the hotspots, and at roughly the same time we will start to reach everyone. Speed🚨is more important than perfect prioritization🏅. We have to keep it simple.

If so, can we really distribute vaccines to redress health disparities? ✊🏽Yes, but that sorting method, too, will be imperfect. Most likely we'll distribute to clinics & other community organizations who serve higher risk populations, perhaps by area deprivation index

This is all to say, don't sweat the details. We will prioritize, but approximately. Then, much more importantly, this is a race and we'll go as fast as we can. 🏃🏾‍♀️In COVID-19 vaccination, perfect is the enemy of good.

End - and be well