Who should be second? And other hard questions needing answers.

vial and needle

Yesterday the FDA and CDC placed their stamp of approval on the Pfizer-BioNtech vaccine against Sars-CoV-2, the virus responsible for COVID-19. As part of this approval, the CDC established basic guidelines on who should be first-in-line to get the vaccine. With this news, the debates will undoubtedly begin to escalate. For those of you who are against the vaccine in general, you can stop reading here.

Most people agree that front-line healthcare workers should be the first to receive the vaccine. After all, front-line nurses, doctors, therapists, and hospital support get exposed to COVID-19 daily, and without them, who would care for severely ill COVID-19 patient. However, when it comes to who should be second, any agreement seems to stop. Should politicians really be second? Currently, they are based on the guidelines. What about the elderly that do not live in nursing homes? And then there are those who are at high-risk (a term that is poorly defined at this time)?  The questions keep mounting.

As my browser history would reveal, I love statistics. I check several of the sites that track COVID-19 cases, deaths, trends, and more at least a couple of times per week. As I read different sources, defining who is at high risk seems to change. One crucial question is, how many factors do you want to include when you make your decision? Age, race, medical history, current medications, socioeconomic status, blood-type, and weight are just a few of the factors you can use. You may also want to include access to healthcare, history of compliance, history of prior infection, and the ability to follow-up for both shots needed to activate the vaccine fully.  A discussion between a group of decision-makers will likely make our heads spin.

Dealing with the “Grey Zone”

One of my medical school professors told me that if I don’t’ consider all the possibilities, the answer will surprise me. In that vein, I am trying to anticipate the moral dilemmas I will undoubtedly have to face over the next few months. I suspect patients will need a prescription to act as a “ticket” to get their vaccine. Acquiring that “ticket” will fall on doctors like me, primary care doctors. That is where the dilemma starts since the definition of who is at high-risk has not been well defined. Do I include those that are borderline diabetic? How about those who are overweight but not defined as obese? What if I have a friend that gives me a convincing story about why he needs the vaccine? Do I accept a new patient who is only seeking a prescription for the vaccine, knowing I am accepting his payment for one reason and one reason only? What about a patient who is threatening to write a negative review on Google if a prescription is not provided? These questions are what prompted me to write this blog entry (and to create a blog in the first place).

After twenty years of treating patients, it seems that there is more grey zone in medicine than I care to admit. Perhaps I am overthinking this issue, and I will not have to make a moral decision. I truly hope so because I am not sure how I will handle some of the questions I proposed above. After all, when the rules are grey, it leaves a lot of the decision-making process up to the doctor. At heart, I am a pleaser. I want to make my patients happy. Will this cloud my judgment? I am hopeful that at least 1 of the 13 other vaccine candidates currently being studied will join the Pfizer vaccine soon to put an end to this part of the discussion. That will allow us to turn our attention to the more important questions that are looming.

Harder questions that need answers

  1. How do we educate people that the vaccine doesn’t solve this pandemic; vaccinations do. We somehow need to convince 70% of the population to get this vaccine (the number of people estimated to achieve herd immunity) when we can only get 45% of people to get the flu shot that has been around for years.
  2. How do people without insurance pay for the vaccine? After all, many of the uninsured have been identified as part of the moving target we call “the high-risk group”.
  3. How do we demonstrate to the public that the vaccine is safe? I have a fair number of patients who feel the vaccine was rushed and want to see what happens to other people first.
  4. How do we keep the anti-vaxxers from blaming every symptom someone has on this new vaccine? With the power of social media, these groups have an incredibly powerful platform to spread their opinions and stories that can certainly influence a person’s decision to get the vaccine.
  5. How do we explain to people that 90 out of 100 means ten people who got the shots are still people who can get sick and spread the virus? Are we giving people who get the shots a false sense of security?  
  6. Do we need to give people a “vaccine passport” to prove he or she can eat in a restaurant, enter a movie theater, or attend a sporting event? Is it legal for those places to ask to see our medical history?
  7. How do we move on from worrying we have COVID-19 every time we feel tired, have a headache, feel an ache or pain, or perceive a change in our taste or smell.? I have made the statement multiple times that the next pandemic will be anxiety. I have many patients that have never dealt with anxiety until now.
  8. How do we justify keeping the lion’s share of the vaccine in America when other parts of the world need the vaccine as much as we do? What if Europe comes out with a vaccine that eradicates COVID altogether? Wouldn’t we want them to share that with us?
  9. How do we convince people that they will still need to get the next vaccine released on top of the one they just received? It will likely be months away, but the next few vaccines that are trying to finish up their studies appear to show a better immunity than the Pfizer version.
  10. How do we convince people to still wear masks despite getting the vaccine? (Remember, this vaccine does not prevent you from catching the Sars-CoV-2 virus – it keeps you from dying from the infection.)

These are just ten questions I came up with off the top of my head. I am sure many questions asked by much smarter people need answers first. Let me be clear that when my turn comes up, I will get this vaccine and the next. I have directly seen the devastation COVID-19 has had on my patients, friends, and neighbors. However, as my professor taught me; if I don’t think about all the possibilities, the answer will surprise me. I look forward to watching how 2021 evolves. After all, no one would have predicted 2020 would turn out the way it did.

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