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How States Are Prioritizing Limited Vaccine Supplies


Earlier this week, California Governor Gavin Newsom announced that his state would be shifting its vaccine distribution guidelines to prioritize recipients based on age. That set off complaints by essential workers and advocates for the disabled who worried that this could mean a longer wait for their groups to receive vaccines. Meanwhile, in neighboring Arizona, essential health workers are still being given priority, along with residents over the age of 75, while in Massachusetts, the governor's changes in his state's priority list pushed early education and K through 12 workers further down the list while he's still pushing for schools to reopen.

Now, each state makes its own decisions when it comes to who gets access to COVID vaccines and when, but we were wondering what accounts for these plans, which seem to vary so much from state to state, so we called Ruth Faden once again to help us understand this. She is a professor of biomedical ethics and the founder of the Berman Institute of Bioethics at Johns Hopkins University. She's with us once again.

Professor Faden, thank you so much for joining us.

RUTH FADEN: Totally my pleasure, Michel.

MARTIN: So have you noticed this, by the way...

FADEN: Oh, yes.

MARTIN: ...The fact that all the states are making all these different decisions? And what do you make of it?

FADEN: We have most definitely noticed it, and we've been monitoring it very carefully since December. First of all, it's extremely sort of distressing for people to see that there's so much variation from state to state. And that's understandable. There is a sort of general sense that there must be something unfair, and if not unfair, at least arbitrary. If I'm over 65 in one state, I can get a vaccine, but if I am over 65 in another state, I can't. If I'm a teacher in one state, I can. If I'm a teacher in another state, I can't. And if I am a meatpacking plant worker, same thing. So what sense is there in that?

What I think this reflects is the fact that we are really struggling as a country to figure out how best to use this vaccine and how equitably to use this vaccine. And so there are different interpretations of both - both what is the most efficient way to do it and what is the most equitable way to do it.

MARTIN: It does seem as though there may be different, you know, conditions in different places. Like, you know, certain places, as you mentioned, have these large meatpacking sort of processing plants where people are working in close proximity. To my understanding - not having been inside one, it's my understanding from their self-reporting that they've tried to, you know, give workers PPE, give them as much physical distancing as possible, but we still know that these are hotspots. We know that in other places, say, nursing homes and other congregate facilities have been very, very heavily hard-hit, and in other places, maybe not so much.

So it does seem like just the facts on the ground would indicate some sort of different priorities. But at this point, do we have a sense of what would be best practice? I mean, is there any standard that would indicate this is the way you should do it?

FADEN: First, of course, you're right, Michel. There can be differences at the state or even the local level that are morally relevant, that are appropriate reasons to set your prioritization somewhat differently in one jurisdiction than another, so we want to give people discretion.

One important thing to recognize is no matter which priority we pick - right? - whether we pick going with older people first, or we pick going with essential workers first, unless we address the legitimate concerns of people in minority and disadvantaged communities who are worried about whether they should take the vaccine, we will not achieve our equity objectives. So either way we go, if it's not accompanied with a very intense effort to meet people where they are, we'll have not everyone that we want to be vaccinated, vaccinated.

MARTIN: And, of course, the problem is in part that you have hesitancy among some folks who should be prioritized, and you have an eagerness to get the vaccine among others who are lower down on the priority list, which is creating a lot of anger because people hear about this. They hear that people aren't getting the vaccines. They're not showing up for appointments, for example. There have been situations where people didn't show up for appointments, and so random folks who just happen to be at the grocery store got the vaccine.

It seems like it's causing a lot of feelings. So I'm just wondering if there's a way to address this. Is it possible even to do a reset at this point that...

FADEN: Oh, yes.

MARTIN: ...Helps people feel like it's fair, and it's in the society's best interests?

FADEN: Oh, absolutely. I think the watchword for right now is flexibility and reset, right? We have to do course corrections constantly, and we have to make sure that two things happen in communities that are not sure about the vaccine. We have to both simultaneously address concerns about the vaccine, and we have to reduce, if not eliminate, all obstacles to getting the vaccine - because if you have any concern about getting it, and it's hard to get, that's kind of a game stopper, right?

And I know that people on the ground who are running vaccination programs are working so hard to get it right. So we just need to give people a little bit of space, patience and a little bit of recognition that, at least in our country, you will get your vaccine. We are not worried about running out of vaccine. We're not getting it as fast as we would like. But you will get your vaccine, so just hang in there a little bit longer.

MARTIN: That is Ruth Faden. She is a professor of biomedical ethics and the founder of the Berman Institute of Bioethics at Johns Hopkins University.

Professor Faden, thank you so much for talking with us once again and sharing your wisdom.

FADEN: Of course, Michel. Take care.

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