Who Comes First?

By Lance Chilton, M.D.

We don’t just need a vaccine, we need vaccination! Yes, having a vaccine is a vital first step, but then actually getting it into the arms of the American public is the ultimate goal.  As we hear the promising news that the Pfizer and Moderna vaccines appear to be 90% effective or more and the Astra Zeneca and Johnson and Johnson vaccines may be close to that, and that the FDA may give Emergency Use Authorization to one or more vaccines within the next few days, we may be seeing light at the end of the tunnel. All but possibly the Johnson and Johnson vaccine will require two spaced doses.

New Mexico’s Department of Health has a committee making decisions on that essential second step, planning for and delivering the vaccine to patients. The committee is likely to face sequential problems: initially, the desire of New Mexicans for the vaccine will be greater than the supply; later, with ample supplies of one or more vaccines, the resistance of some people to getting it. And the protection of the whole population requires that a large proportion be vaccinated.

The first people in line, according to Daniel Burke, MPH, Infectious Diseases Branch of the NM Department of Health, will be medical personnel who daily risk contact with infected patients at their jobs – that’s called phase 1a. Estimates of the number of health care workers who have died of COVID-19 in the US range up to 1700.  The next priority, phase 1b, would include workers in places where people live together over time, such as jails and long-term care facilities, many of whom are at high risk of severe disease as well as residents in long-term care facilities for the elderly. Other residents of congregate care facilities, such as prisoners, would be next in line. In phase 2, the vaccine would be rolled out to more and more people, perhaps beginning with the elderly, who are most at risk of severe disease and death.  And then the public as a whole, though as yet no vaccine has been tested on children or pregnant women, so they would probably wait the longest.  The DOH COVID committee and its 50-member advisory committee submitted a detailed 60-page New Mexico plan to the federal government on October 16.

Both the Moderna and Pfizer vaccines appear to be very effective in the elderly, assuaging the fears of many of us that older people don’t respond to most vaccines as well as others.  Safety of the first vaccines appears assured, based on tens of thousands of doses tested.  Mr. Burke stated that he was proud of the agencies evaluating the vaccines and their independence of the tremendous pressures placed upon them to cut corners.

But a large part of the general public may need reassurance to be convinced of the vaccine’s safety and efficacy after a president advocated drinking bleach and seemed inclined to subvert the Federal Drug Administration’s safety checks. Then there’s the problem of vaccine transport and storage. The Pfizer vaccine must be stored at a temperature colder than the Antarctic; most doctors’ offices can’t do that. The Moderna vaccine still must be frozen; the Astra Zeneca vaccine is a bit easier and is perhaps a little less effective.  Which will you get, and when will you get it?  

Fortunately, here in New Mexico, our state’s leaders have mandated a science-based approach, looking closely at guidance to the states from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

And while you’re waiting, be sure to get your flu vaccine because no one should have deal with influenza, let alone influenza plus COVID.