US Adults’ Preferences for Public Allocation of a Vaccine for Coronavirus Disease 2019 | Infectious Diseases | JAMA Network Open | JAMA Network
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    1 Comment for this article
    Social inequities have been magnified. This is the time to reverse it
    Dana Ludwig, MD | Stanford University
    This study of preferences for vaccine allocation was excellent and worthwhile in elevating the visibility of discussion of this important topic. But around the edges of it's conclusions, I suggest there is a possible insidious insertion of biases that could promote inequities further.

    Several weeks ago, a JAMA Viewpoint recommended that prison inmates be recruited for vaccine trials, as inmates might benefit from access to the studies because they are at high risk for death from COVID-19;  regulatory guidelines view inmates as a group vulnerable for exploitation by clinical investigations. At the time, I objected to this
    view, and recommended that if the authors were especially concerned about inmates, they should give inmates first priority to receive vaccines AFTER the studies are complete.

    In this research, in the results of the survey, I see no mention of the priority that should be given to prison inmates. This is consistent with my observation that the scientific community biases the outcome of studies in favor of their interests by the way they formulate the questions, and not by violating their study design. If you don't ask about inmates, you won't get an answer.

    But addressing that inequity is not as simple as adding a question. One of the shortcomings of democracy is that the majority vote for policies that support their interests, without regard to the negative impact on the minorities.

    I believe there is a simple solution to this problem of inequities. The Gates Foundation has a guiding principal in their work: "All lives have equal value". In light of this principle, the policy guiding allocation of vaccines could be based on two variables only:

    * the chance of death of the individual who does not receive the vaccine
    * the chance of the individual, if infected, passing the virus on to other individuals.

    If these criteria are applied based on available data, priorities would be something like this (just a guess):

    1) Healthcare providers in nursing homes, that represent 35%-50% of cases in many counties (SFN providers are a greater risk of transmission to multiple SNF residents)
    2) nursing home residents
    3) Inmates and staff of prisons
    4) Agriculture workers (noting the oversized impact on the California Central Valley).
    5) Native Americans in high risk communities
    6) Healthcare providers and patients in acute care hospitals. Priority to the most at-risk staff such as CNAs, LVNs, RNs, and then physicians
    7) Other essential workers (risk-stratified) such as first police, paramedics, etc, and then retail workers and trades. Possible preference to workers with high numbers of individuals living in the worker's home, to address the inequities in mortality of low income workers in high density housing with extended families.

    Dana Ludwig, M.D.
    Research Letter
    Public Health
    September 29, 2020

    US Adults’ Preferences for Public Allocation of a Vaccine for Coronavirus Disease 2019

    Author Affiliations
    • 1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
    • 2Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    • 3State Health Access Data Assistance Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
    • 4Health Policy and Management and Director, State Health Access Data Assistance Center, University of Minnesota, School of Public Health Minneapolis
    JAMA Netw Open. 2020;3(9):e2023020. doi:10.1001/jamanetworkopen.2020.23020

    A vaccine against severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) will be essential for mitigating the pandemic. However, given global need, demand is expected to exceed supply. When vaccines were limited during the 2009 H1N1 pandemic, the Centers for Disease Control and Prevention developed recommended priority populations based on ethical criteria.1 Experts have begun to identify which groups ought to receive priority for a SARS-CoV-2 vaccine, including elderly people, front-line health care workers, and people with existing medical conditions that put them at high risk of severe illness and death.2-4

    Public engagement can contribute to resource allocation decisions. Incorporating public preferences could advance the perceived legitimacy of vaccine allocation guidelines.4 This survey study’s objective is to describe the public’s preferences for allocating a SARS-CoV-2 vaccine.