PUBLIC HEALTH Getting in Line for a Vaccine Like Giphy Reality check: There won't be enough Covid-19 vaccines for everyone for a while. Probably years. Thankfully, the CDC has some rules so distribution won't look like a run on the Hunger Games cornucopia. Once a vaccine is approved by the FDA, the CDC's Advisory Committee on Immunization Practices will hold an emergency meeting within 48 hours to finalize recommendations around who gets the first shots. That guidance will be given at the national scale, which means state health officials will be left to figure out the nitty-gritty details of where the vials are going. As we saw early in the pandemic with various lockdown measures, approaches by states can vary.  Who's first?  The U.S.' ~20 million healthcare workers, including doctors, nurses, and support staff, will likely be top priority. Three other groups are widely considered to be especially vulnerable to the coronavirus:  The elderly (about 50 million Americans ages 65+) People with underlying conditions (80–100 million) Essential workers (40–60 million) That's a lot of millions, and definitely more than we'll have vaccines for at first. Even people who qualify for priority vaccination will contend with limited supply.   Some public health experts have also argued for early vaccinations for racial and ethnic minorities, who've experienced higher rates of coronavirus infection and death. And the children? Pharmaceuticals are, for good reason, not tested on kids first, and it'll take longer to get a vaccine approved for the youths. Only a few companies, including Pfizer, have started pediatric trials. Other factors to consider #1: Different vaccines have different logistical challenges and health considerations, which could affect who gets what when. Some vaccines may be better suited for the elderly, people with heart conditions, or pregnant women. Single-dose vaccines and ones that don't require ultra-cold storage can reach rural communities more easily.  #2: Is the goal to limit spread or deaths? Before the swine flu pandemic, the strategy was to vaccinate the most vulnerable first. But in 2009, researchers published a study suggesting a focus on vaccinating the biggest spreaders—in the case of swine flu, children ages 5–19—to protect everyone else.  It helped, and now CDC guidance advises annual flu shots for kids six months and older. #3: Not everyone will get a vaccine. In the last decade, the U.S. has never vaccinated more than half of adults for the flu, and vaccination rates for Black, Latinx, and high-risk adults trend lower.

 

GEOPOLITICS Once We Have a Vaccine...Will We Share It?   If you thought state bidding wars for ventilators were ruthless, wait until you learn about the global competition for coronavirus vaccines. The Duke Global Health Institute estimates 9.6 billion doses are already reserved by individual countries, without any vaccines having reached the market yet.  The early leaders? Wealthier countries. The U.S., UK, EU, Canada, and Japan have secured 1.1 billion shots of Pfizer's vaccine, roughly 85% of planned production through 2021.  Moderna's first 20 million doses will head to the U.S., which has a contract for 100 million.  Governments were hedging bets by investing in multiple vaccine candidates. But some have struck enough deals that, if multiple vaccines get regulatory approval, they could control a big chunk of supply. For instance, Canada could end up with enough doses to vaccinate its population 5x over.  Economist That's a bit lopsided Which is where Covax comes in. This WHO-led initiative is working to ensure equitable vaccine access across the world.  How it works: There are 184 countries participating, with wealthier countries subsidizing vaccine access for 92 lower- and middle-income ones, particularly across Africa and South and Southeast Asia. The goal is to raise $5 billion and provide 2 billion doses by the end of 2021. So far, Covax has secured 700 million doses and $2 billion in funding. The U.S. is not currently participating; President-elect Joe Biden hasn't said whether his administration will join. Pharma companies AstraZeneca, Johnson & Johnson, Novavax, and Sanofi plan to produce 3 billion doses for developing countries—some through Covax.  Big picture: The Duke Global Health Institute thinks it'll take until 2024 for vaccines to reach the entire population. In that time, vaccines could be a new front in geopolitics.

 

POLL Prick Me With Your Best Shot Giphy Or don't. In a Gallup poll this month, 42% of U.S. adults said they would not get an FDA-approved coronavirus vaccine. That's down from a peak of 50% in September, but remains a concerning number for public health officials who want to get Covid-19 under control. There are several reasons why the public's confidence is cracking harder than an iPhone screen on concrete. 37% of respondents who said they wouldn't get vaccinated are worried about a rushed timeline. 26% want to wait until they confirm it's safe. 12% don't trust vaccines generally.  That's despite nine pharmaceutical companies, including frontrunners Moderna and Pfizer, pledging to hold their products to "high ethical standards and sound scientific principles." Dr. Fauci has also tried reassuring the public that the process "did not compromise at all safety nor did it compromise scientific integrity." Zoom out: At the very end of the Covid-19 vaccine's supply chain are injectees, and the WHO estimates 60%–80% of them need to be immune for a population to hit herd immunity. Establishing public trust in these vaccines will be the next major challenge for health officials.