26 Time March 1/March 8, 2021there would be enough vaccine doses to inoculate everyone who
wanted to get immunized against COVID-19. People would get
their shots on a first-come, first-served basis; we would achieve
herd immunity in a matter of months; and COVID-19 would
soon become a distant memory. But with some 240 million peo-
ple over age 16 who need a COVID-19 vaccine (and two doses at
that) and just over 42 million administered by early February,
supply is far below demand and will likely remain that way for
months to come, despite vaccinemakers’ pushing production
lines as hard as they can.
As the U.S. works through the vaccine priority groups and
begins to shift into ever larger populations in coming months,
the pace of doses shipped could continue to outstrip the pace
of administration. So far, the shots have been reserved primar-
ily for health care workers, people living in long-term- care
facilities and those over 65. Some states have begun vaccinat-
ing essential workers like law-enforcement officers, teachers
and those who work in mass transit. All of these groups are
relatively easy to reach and vaccinate since they’re well de-
fined. But the U.S. Centers for Disease Control and Preven-
tion (CDC) guidelines’ next big priority group—people with
underlying health conditions that make them more vulnerable
to COVID-19—is much less so.
While many are connected to the health care system by vir-
tue of their medical conditions, there is a substantial portion of
these patients who aren’t seeing doctors or getting their medi-
cal problems addressed. There are also likely to be a lot of them.
According to the CDC, up to 60% of adult Americans havechronic conditions, some of which put them at higher risk of de-
veloping COVID-19. And around 28.5 million Americans have
no health insurance, making them less likely to have regular ac-
cess to health care. The CDC lists 12 conditions ranging from
diabetes to chronic obstructive pulmonary disease, heart and
kidney diseases, cancer and obesity that put people at higher
risk of getting COVID-19 or having complications if they do.
And there are other conditions like asthma, hypertension and
many more for which data is still being gathered, but those con-
ditions too might make people more vulnerable to COVID-19.
Given that there continues to be a limited supply of doses,
doctors and local health officials are bracing for gut- wrenching
decisions about which patients to vaccinate first, with a poten-
tial nightmare scenario of cancer patients fighting with heart
patients for scarce doses. Should someone with cancer under-
going chemotherapy get vaccinated before someone awaiting a
liver transplant? Does someone with asthma have a higher risk
of getting COVID-19 than someone with dementia?
“No one wants to be on the committee that makes these
allocations,” says Dr. Cameron Wolfe, associate professor of
medicine at Duke University School of Medicine. Just over
a decade ago, Wolfe was part
of his hospital’s committee
that determined how to dis-
tribute scarce H1N1 vaccines
during that outbreak, and he
knows doctors and patients
can make compelling argu-
ments for nearly every pa-
tient. It’s a problem for which there are no right answers.
Daniella Levine Cava, mayor of Miami-Dade County in
Florida, is concerned about how her health officials will make
those distribution decisions when the time comes and hopes
for more guidance from either the federal or state government.
The governor of Florida has opened up vaccination to people
over age 65, including those with health conditions, and that’s
already caused confusion and anxiety among residents, since
there aren’t enough doses for this group. “We have a lot of people
desperate in that category and very worried, very anxious,” she
says. “It will be complicated to determine eligibility. There are
so many different categories: How do you determine and judge
who is more at risk? I’m in favor of national uniformity... This
is the kind of thing that cries out for predictability—the more
predictability and clarity we can have, the better.”
State health departments, however, are inclined to stay out
of such granular decisions, for two reasons. First, there’s no
universal solution that works for everybody, and any strategy
they might choose to use to triage patients for vaccines would
leave some eligible people behind. Second, the more prescrip-
tive states are about allocating vaccines, the longer the shots
can take to get into people’s arms, and the greater the chance
that some are wasted as doctors try to parse the policies and
spend precious time making sure they’re complying with them.
“When we get to that population, our preference would be to
have the decision made between the provider and the patient,”
says Dr. Jinlene Chan, acting deputy secretary of public-health
services for the Maryland department of health. That, ChanIN
AN
I D E A L
W O R L D,
HealthDIRECTING TRAFFIC AT
VACCINATION SITES—LIKE
THIS ONE IN LOUISVILLE,
KY., SHOWN ON JAN. 25—
IS ABOUT TO GET HARDERJON CHERRY—THE NEW YORK TIMES/REDUX