COVID vaccination and politics
By now most are aware that the COVID vaccine roll out has gone poorly in Pennsylvania, with the state ranking near the bottom. There is more than one reason for this and three come readily to mind. The first is that normal distribution channels were not followed and to date private practices have little to no access to the vaccines. A recent letter to the state from a consortium of PA medical societies was published in this paper and outlined the problem well.
The second reason comes directly from the American Committee on Immunization Practices (ACIP) recommendations regarding prioritization of COVID-19 vaccine recipients, which PA adopted without question until Jan. 19. Phase 1a included healthcare workers and long term care facility residents, thus those most exposed and at highest risk. Most people would accept this as very reasonable, though PA took longer than most other states to fully implement Phase 1a and then begin Phase 1b. Phase 1b included frontline essential workers and individuals 75 years of age or older. This is where it gets problematic; who and how are essential workers defined? How well did the choice of essential businesses go in Pennsylvania? This also neglects the glaring fact that individuals 65 years and older plus those under 65 years with comorbidities (obesity, diabetes, heart disease, etc) are 10 to 50 times more likely to be hospitalized and/or die from COVID-19 than essential workers. One argument put forth for placing essential workers ahead of those 65 years and older was that the 65-plus year demographic was too white. There should be no place in health care or public policy to sacrifice certain individuals in the name of social/racial justice or equity. Everyone should have the right to equality, but equity chooses winners and losers, thereby creating division and resentment. Phase 1c includes other essential workers, persons 65-74 years of age, and 16-74 years with underlying medical conditions. Fortunately on Jan. 19 many in 1c were moved into 1b, though we are still left with the nebulous category of essential worker and thus a reliance on politicians to decide winners and losers, i.e. who is essential and who is not. With vaccine supplies limited, those most vulnerable, and thus likely to fill our hospitals and morgues, should be prioritized. One could legitimately argue that “super spreaders,” i.e. those occupations most likely to spread the virus, should also be prioritized to receive the vaccine.
The third reason is that individuals are receiving the vaccine who should not be, namely those who have already contracted and survived COVID-19. Recent studies have confirmed protective immunity out to six months in the large majority of survivors and those few who got reinfected had only mild disease. While a lot was unknown about the immune response early on to natural infection with COVID, it would have been very unusual that natural immunity would not have developed in most individuals. The exception to this is the very elderly and those with immunocompromise. In addition, those who had the disease and get immunized are significantly more likely to have a severe reaction to the vaccine. I have personally witnessed this with an individual developing severe colitis (abdominal pain with bloody diarrhea). It is time for this group to move to the back of the line, as should have been the recommendation months ago, and yet most professional organizations still advise individuals to ignore antibody titers and get the vaccine. Since when is a vaccine more effective than natural immunity?
Lastly, I want to stress the importance of those eligible to receive the COVID-19 vaccine to get vaccinated. It literally could save your life! The two currently available are 95-percent protective and have a very low incidence of severe reactions. Rarely does a pandemic arise with this morbidity and lethality (10-15-percent risk of death in the high-risk groups). To have these vaccines so rapidly available and effective is truly a miracle of modern science.
DR. RUSSELL GOMBOSI
Submitted via email