I think this is the right forum, but if not please move it.
Imagine that in January, say, a safe and effective vaccine has been found and several billion doses have been prepared. How do you organize the vaccination program. It is a non-trivial problem and one that bears thinking about now, not in January.
One way that would not work is the way my town of 20,000 deals with the flu vaccine. On a designated day in mid Nov. I will go the Town Hall some time between 10 AM and 8 PM. I will stand in line for a few minutes as someone looks at my health card and determines I am in the elegible age group (something like over 60 or under 10) and hands me a number. I then sit in a room shoulder to shoulder with several hundred others until I am registered, injected and wait 15 minutes in case of shock.
A much better model is the way elections are held here. Every registered voter (it is possible to vote unregistered but you need a registered voter to vouch for you, but regisration is as easy as ticking a box on the income tax form) receives a card giving a polling place and station. You go to the polling place, usually a school gym, and wait in a line of generally fewer than a half dozen and often empty where someone at the door points you to your station on the card. You line up there behind a couple people at most and eventually get a ballot, go behind a curtain and mark it, then put it in the ballot box and leave. It seems to me that this sort of operation would work well maybe with a few tweaks, such as assigned times and leaving through the emergency exit so that people coming in don’t contact people going out.
If I may ask, where do you live that you get a flu shot at the Town Hall, rather than a doctor’s office or pharmacy? And only on one day a year?
Here in Maryland, most pharmacies provide flu shots and other vaccinations (shinlges, etc) on a walk in basis, anytime they are open. I would think the COVID vaccine could be done the same way.
A bigger issue will be dealing with those who refuse to get the vaccine. I know several people who have already said they won’t get it.
I get my flu shot at my clinic, which used to do them on several Sundays but now has a desk where you can walk in and get it. Pharmacies give them also - I need a shingles vaccination when things open up.
The bigger question would be vaccine shortages. I’d hope that vulnerable populations would get the chance to be vaccinated first, and then open it up when more is available.
We have drive-through testing locations now, they can be adapted into drive-through vaccination locations with some screening.
There will definitely not be enough vaccine to inoculate everyone at once. A staged lottery system–where first the most vulnerable demographics are given priority, and then everyone else based upon a random draw of birthday–makes the most sense.
I don’t know that drive through inoculation would work unless it is an oral or nasopharyngeal vaccine. A intramuscular injection requires exposing and sterilizing the injection site, and at least with the influenza vaccine they generally want to observe you for a few minutes to ensure that you have no adverse reaction. However, would certainly want to set up some kind of queue where you could line people up with space in between them because the vaccine will probably not impart immunity for a period of many days, and people will still be able to contract the illness int he meantime. It has been suggested that an adequately oral vaccine could just be mailed to people for home use but I think that is unlikely as I would assume epidemiologists and public health officials would want some kind record that the vaccine has been applied.
I am a little curious about the o.p., however. He states “…someone looks at my health card and determines I am in the elegible age group (something like over 60 or under 10)”; is this just for a free inoculation and people between 10 and 60 are expected to procure one through their personal physician or pharmacy? The benefit of the influenza vaccine is that even though only about a third of the population is vaccinated, it provides sufficient “herd immunity” to prevent it from breaking out into an epidemic (most years although 2019-20 slightly exceeded the M&I mortality threshold even before SARS-CoV-2 broke out) and if 60% or more of the population were vaccinated it is possible that we could significantly attenuate lost productivity and even prevent some recombination of circulating influenza A viruses such that future overall morbidity and mortality is reduced in the aggregate. This is really something that should be free to everyone for the benefit of the economy and national well-being instead of being dependent upon insurance coverage and employers’ largess.
Just to answer some of the questions raised, I live in a suburb of Montreal and the province pays for the vaccination of certain age groups. Anyone can go into any pharmacy and pay for a shot any time after Nov. 1. In fact, I wonder what they are planning for the flu shots this fall, since their usual model just won’t work. It will be a dry run, I guess for the Covid-19 vaccine I am hoping for. But my point was that someone should be thinking about these questions.
Interesting that they only inoculate ‘vulnerable’ groups even though the more mobile teenagers and adults are probably at greater incidence to spread the infection farther.
But regardless, health officials should be pushing for influenza vaccination for the 2020-21 North American flu season because a combination of SARS-CoV-2 and severe Influenza A epidemics could be devastating. There is some hope that with all of the lockdown measures and lack of international travel now that we’ll see a significantly less severe influenza season but we’ll see how that plays out in reality.
I thought the vaccine for this was going to be added to the annual seasonal flu vaccine. If that is the case people will be vaccinated via the normal channels. If there is a concern about paying for it, maybe the US makes the next couple year’s flu vaccine free for anyone who wants it. National security and the economy depend on it.
The bigger issue is getting enough people vaccinated. As mentioned, there are those who will refuse, and of course there are a few who cannot be vaccinated. Smallpox was eliminated due to a global effort at a time when it was possible. However, these days highly doubt a global disease eradication program via vaccination could ever happen. It’s like we have the capability, but not the will.
I’m not disagreeing much but do have to throw into the mix the possibility that any SARS-CoV-2 vaccine ends up being significantly less effective for the most vulnerable. I’d prioritize the caregivers of the most vulnerable in that case, and them second in any case. Third, front line workers like grocery store clerks, meat packers, and others in higher than average closer contact jobs. And key worker groups in vital links of critical supply chains.
I’m on record with my belief that those who assume a safe and at least moderately effective vaccine will be available in any particular time frame should prepare for the possibility that such is no sure thing. Another item to not just assume is that enough people will go and get the vaccine to achieve herd immunity if it is developed and is widely available in adequate supply. Less than half of American adults get a flu vaccine every year.
There is also some fear that lockdown measures finally easing off end of summer will have entrained COVID-19 and influenza to synchronize in the Fall, earlier than influenza usually hits, and that COVID-19 will make getting flu vaccines out less successful (possibly by interfering with its production/delivery, and possibly by keeping people from coming out to get vaccinated - something being seen in pediatrics already for other immunizations).
Just for comparison for people who think Canadian healthcare is unified, I’m in Ontario where the flu shot is free for all. I can get it at my doctor or any pharmacy in the province just be showing my health card. They decided about 4-5 years ago that the health and productivity benefits out weighed just giving it to vulnerable populations.
True, that, and n agreement that frontline workers of all kinds should be given priority, although it seems likely that a large proportion of them will have already been exposed by that point because they cannot make any real effort to quarantine while working.
I would assume any vaccine that makes it to market will be safe (although whether it will be demonstrated as safe for vulnerable populations not represented in the safety trials is another issue). I would assume that there will be enough apparent mortality (most people aren’t aware of the mortality rates of seasonal influenza) that a majority of people will be willing to be inoculated, but then, I wouldn’t think that armed protesters would be trying to force their way into state legislatures like some kind of banana republic so I’m prepared to be surprised. There remains the potential that the vaccine will not provide a long-lasting protection or be effective enough to actually provide herd immunity, either; this may just be a perennial issue we have to deal with using surveillance, testing, and treatment for the foreseeable future.
That is possible, too, but I would hope that increased hygiene awareness would reduce the spread of other infectious diseases. There should certainly be an effort to convince people to get the influenza vaccine because we know that combining two infectious epidemics occurring simultaneously results in compounded mortality. Even Robert Redfield has expressed concern about this so hopefully he and Anne Schuchat (who has been on the forefront of influenza monitoring and preparation) can use the resources of the CDC to educate the public on the particular need for inoculation to avoid an influenza epidemic.
The flu vaccine is the primary example of a vaccine that may not benefit you, or people like you, or a particular class of people, but does benefit everyone, or everyone else.
The discussion doesn’t apply to older vaccines, because for something like smallpox or mumps, you, individually, get vaccinated so that you won’t die. And it’s complicated by the fact that the risk and benefit of a flu vaccination varies, year to year: one year it has a lot of dangerous side effects and doesn’t offer much protection: the next year it has almost no dangerous side effects and offers a lot of protection.
That is not a situation where “medicine” or “society” has come to a clear ethical position. But the medical establishment in countries like Canada and the USA is resistant to the idea that “a patient” should be treated (vaccinated) for the benefit of some other class of people.
Just a historical correction - there are other examples with older vaccines. The first to mind is rubella - German Measles. The main motivation behind the push to get everyone immunized for rubella was not the direct benefit to most individuals who otherwise would have contracted the disease, but to prevent pregnant women from contracting it with subsequent congenital rubella syndrome in the child.
The mass vaccination campaigns I remember were run at schools. The vaccination teams attended the schools. Further back, similar teams used to attend workplaces.
We are accustomed now to having individuals go to vaccination locations, but that’s not the only way it’s done, and for mass vaccinations, you need multiple teams, at multiple locations.
LA just rolled out widespread testing. There’s a website where you answer some questions to determine how high a priority you are (those with symptoms and those at greatest risk get first priority, though everyone is supposed to be able to get tested regardless) and also which location you should go to, and then they offer you an appointment slot. You show up at the designated time and place and stay in your car until someone comes around to swab you. That’s how I imagine they’ll handle the vaccine. Though they can probably get away with just one inoculation center for everyone west of the 110; there’s more gold than sense in them thar hills.
As of right now, I will be one of those people, at least for the first couple of years, until we know more about how it works (or doesn’t, as the case may be). I’m old enough to remember the 1976 swine flu fiasco, and my parents were right in their decision not to get vaxed, or to get it for us kids.
I haven’t seen any references to the movie “Contagion” yet. This clip explains how they did it.
The one time I remember that happening at my schools was when I was a 6th grader, in the mid 1970s, and I was one of maybe 5 kids in the class who didn’t participate. I don’t remember what the disease was, but I suspect I didn’t get the shot because I had either already had it, or had the disease. They used one of those air guns that the military still uses.
I hope so. I hope they will be able to resist the intense pressure to get a vaccine out early - look at the unrealistic expectations that some people have for the timeline.
But any vaccine will be ready after January 2021, so with any luck science and sanity will reign once more in the White House.