It’s not (just) fairness. Goal = reduce cases/hospitalizations/deaths as much as possible w/ scarce doses. Haphazard delivery to any readily available arm rather than doing the work to get it right -> running out b4 we reach those whose vax will most improve the situation for all
If we have (or expect very soon to have) enough doses for all, then by all means, take a shotgun approach (while tracking who gets what so appropriate follow up/2nd dose can be ensured) but we don’t have enough doses to do that yet.
If doses have been thawed & need to go somewhere ASAP, better to get them in any available arm than toss them. But even better to plan to avoid that scenario if possible.
Within any particular hospital system (eg Stanford) expecting enough doses to vax all staff within a matter of days, getting day-1 doses to people behind the scenes ahead of front-line workers could be tragic at individual level, but won’t have a big population-level impact.
But if we’re talking about the state level (eg Florida), pushing doses out to relatively healthy 65 yos who have time/resources to wait in line, instead of doing the work to deliver them to folks in higher risk groups will prolong death & overwhelmed hospitals, bad for everyone.

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More from @ProfLWiley

30 Dec 20
This was predictable. This was predicted. Public health experts & state & local leaders have been sounding the alarm for months. We knew state & local govts needed fed funds to build vaccination infrastructure. Trump knew. McConnell knew. They didn’t care. Receipts attached.
July 2020, @NACCHOalerts letter to Congress. naccho.org/blog/articles/…
Read 8 tweets
28 Dec 20
It's been 2 weeks since vaccine doses were first reported to be en route to nursing home residents. Pretty much every day since there've been reports that vaccination in LTCFs will begin "soon" in this or that state. I've seen very little reporting re: what the hold ups have been
In this report, from 2 weeks ago, lots of vague statements re: opting into federal programs with different start dates tied to Pfizer vs. Moderna. But even this indicates plans to reach only a small % of the 70K facilities where vax is needed. usatoday.com/story/news/hea…
Yet at the time of this report, the administration was still saying 20 million ppl would be vaxxed by end of calendar year. So much unwarranted optimism. So little planning & investment of needed resources.
Read 6 tweets
24 Dec 20
We’re likely to be dealing w/ covid in some form for years to come. We’ve basically known this since the beginning. The good news is we have to the tools to save lives in ways that minimize disruption & even have side benefits. The bad news is we’re not good at long-term thinking
Global eradication of a respiratory virus that spreads in the absence of obvious symptoms & has an animal reservoir is extremely unlikely, even with highly effective & widely accepted vaccines. Opposite of smallpox, the only virus to be entirely eradicated through vax.
When I say we have the tools to manage life with covid long-term, I’m not talking about physical distancing & masks for the general population. Those are for when all else fails, as it has in 2020.
Read 6 tweets
22 Dec 20
K-12 schools, colleges & universities need to be planning for reopening in August/Sept 2021 assuming many staff & faculty will have access to vaccination (though some will decline) but most students will not have the opportunity yet.
3 reasons: 1) even on most ambitious Trump admin timeline (which doesn’t appear to be backed up by purchase agreements or distribution plans) *beginning* to offer vaccination to the general population in late spring doesn’t mean most will actually have access by August.
2) To actually *start* vaccinating the general population by late spring will require everything to go perfectly, as Murthy & others are pointing out. Less than 10% of nursing homes have been able to start vaccinating residents so far.
Read 4 tweets
9 Dec 20
Here’s the text of Trump’s “America First” vaccine EO. I read it to direct admin officials to allocate vaccines *owned by the federal govt* for use on US residents prior to distributing any US federally-owned doses to other countries. whitehouse.gov/presidential-a…
I don’t read it to invoke export controls to prohibit vaccines produced in the US (eg Pfizer’s Michigan facility) from being sold to other purchasers.
I don’t read it to invoke the Defense Production Act or any other possible authority to “jump the line” of contracts Pfizer has entered into with other countries.
Read 12 tweets
6 Dec 20
Not sure how an order to stay at home adds much to closure of high-risk settings plus gathering ban when nonessential retail is still open. I assume this is just a messaging tactic, given that the order itself amounts to “stay at home unless you feel like shopping at the mall.”
The prohibition on outdoor dining & closure of outdoor playgrounds, etc. is also an odd move.
I assume part of the thinking is that closure of (low risk) non-essential retail doesn’t provide much benefit & disproportionately harms small businesses b/c most big box stores can stay open by selling some essentials.
Read 4 tweets

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