Medical professionals take the principal of “do no harm” pretty dang seriously. So, both.
Is there consensus among medical professionals about the ethics of leaving the placebo control arm blinded during the test of a vaccine that has demonstrated efficacy?
There is a general principle that if you get great results then yes it’s considered unethical to continue business as normal with the study. But that’s balanced with supply and actual risk.
And that’s because it’s unethical to leave those control-arm volunteers exposed to danger without a vaccine, correct?
No. Being unblinded doesn’t save you from covid.
In that case, being unblinded would mean they are offered the vaccine, as I understand it. I’m not sure what relevance your comment has.
You are talking about specific contracts they had with the testers linking unblinding to access to the vaccine. That’s not medical ethics. If there’s limited supply, 20 yr old placebo guys aren’t ahead of nursing home residents or hospital staff.
That really work, though, as the issue with having in-person classes is not primarily about the danger to the teachers. The reason places are avoiding in-person school is that kids spread the disease very well among themselves and then take it back home. Vaccinating the teachers won’t prevent that issue.
So if it’s not safe enough to have in person classes now, vaccinating the teachers won’t change that calculation in any significant way. The reason to prioritize teachers above others is that they are on the front lines. And, yes, of course, if they qualify in other categories, that makes sense, too.
I suspect the issue is just that many don’t want to deviate from the official plans. And the official plans, the ones recommended by the CDC, are assuming that there are at least some in-person classes for teachers.
Except we’re not, not at all. Those over 70 are among the first to be vaccinated. They’re in group 1B, so they go right after the healthcare workers, who need it to avoid killing patients. In my area, at least, 1B already started.
We are in fact trying to minimize deaths. The entire system is built up to give to those who are most at risk. The primary reason for stopping someone from getting sick is that they might spread it to more people and thus increase the deaths. Or, in the case of medical staff, it’s so that we have enough medical people to be able to treat people, so fewer die.
I also note that group 1C goes to people who are at risk but under 65, and anyone between 65 and 70. The whole thing is about who is at most risk. The whole thing is about minimizing deaths.
You are thus factually wrong about everything you’ve said that I’ve read up to this point.
Exactly. You guys are arguing a position that is not the one that is actually being enacted–one that’s different from what the experts decided was the best way.
They are in fact prioritizing older people, right after the healthcare workers. No one is saying “we’re not vaccinating them first because they’re less useful to society.”
They’d better, since, again, the whole reason for not having school in person has nothing to do with protecting the teachers. It’s about stopping the spread from one student to another.
If teachers go back to school simply because they’re vaccinated, when none of the kids will be, then the virus will spread much further. Schools shut down to stop spread.
I was going to wait to post this until I got further down, to make sure my points hadn’t been made by others. But my post is becoming quite long. I checked to see if anyone else was replying to these posts, so I hope I’m making points that weren’t made already.
But, just in general, it seems a lot of people are operating under false assumptions about the situation.
Earlier in this thread there was some discussion over whether it was best to vaccinate older people first (prevent death) or younger people first (prevent spread). Here is a very on point article that just came out in Science which modeled different approaches and concluded that vaccinating those over 60 first would usually save the most lives.
Of course it is more complex than that, which is why they do all of this modeling, to be able to adjust things such as R0, vaccine efficacy, demographics, and other factors to see what is the best strategy under different conditions.
Here is the abstract.
Limited initial supply of SARS-CoV-2 vaccine raises the question of how to prioritize available doses. Here, we used a mathematical model to compare five age-stratified prioritization strategies. A highly effective transmission-blocking vaccine prioritized to adults ages 20-49 years minimized cumulative incidence, but mortality and years of life lost were minimized in most scenarios when the vaccine was prioritized to adults over 60 years old. Use of individual-level serological tests to redirect doses to seronegative individuals improved the marginal impact of each dose while potentially reducing existing inequities in COVID-19 impact. While maximum impact prioritization strategies were broadly consistent across countries, transmission rates, vaccination rollout speeds, and estimates of naturally acquired immunity, this framework can be used to compare impacts of prioritization strategies across contexts.
A perspective article in the same issue concludes with:
Although vaccinating younger people prevents the most infections for both viruses, the difference is that this strategy does not also avert the most deaths for COVID-19. To vanquish a pathogen that causes such steeply divergent case fatality rates as that of SARS-CoV-2, the optimal strategy is clear: Directly vaccinate those with greatest personal risk.
Someone needs to tell the powers that be. They keep vaccinating themselves instead.
True. The only upside is that the actual number of political or financial fatcats is fairly limited, a couple tens of thousands at most nationwide.
They may well have arrogated priority 0 (the one above 1a) unto themselves. But soon enough that group will be exhausted and group 1a will get theirs in turn.
I’m not for a moment saying this is righteous. Far from it. Just that it’s small in the grand scheme of things and probably inevitable given our mostly-chimp DNA.
Now there is a group that deserves to be absolutely at the head of the line; those who volunteered for the study but were in the placebo arm. And yet some people argue that they should be inoculated with their age cohort.
If we are treating this as a health crisis then you can’t think of vaccines as rewards. They should be initially applied where they do the most good.
Lots of people have played the 5-dimensional chess, and modeled that. I don’t believe they have all gotten exactly the same answer, and there are a lot of fuzzy bits, like how to identify and round up people of type X to vaccinate them. (or just to set up the queue). Or how much vaccine will be available how fast – you make different choices with different availability. And then politics gets layered on top, of course.
But I believe the current recommendations are based on those models.
I wonder which are the models that have performed best throughout all this. Seems like most of them have really struggled to make predictions that were then borne out by reality. Maybe it’s just more complex than even the most sophisticated models we can find.
In general you would be right, however, being willing to risk your health testing a never before utilized medical technology is a special case. Or not, but throw all the vaccinators who called up 30 year old friends and relatives to get “extra” doses in jail.