How do you decide who gets vaccinated first?

75756A5E-120A-4932-810C-2FD980DB785E

As the vaccine rollout continues, some controversies have arisen over who gets priority access.

“These are challenging questions for sure and one way to break down the issues is to ask, ‘what are we primarily trying to achieve with the vaccine?’” said Dr. Aaron Kheriaty, director of medical ethics at UC Irvine.

There are two main goals at play in determining access to the vaccine: reducing severe cases and deaths, and targeting individuals who are at a higher risk of contracting and spreading the virus to more people.

“If you prioritize based on trying to reduce severe morbidity and mortality – hospitalization and death – really you’re looking at prioritizing by age, because far and away age is the strongest predictor of a bad outcome if you’re infected with COVID,” he explained.

But if policymakers are aiming to reducing the spread of the virus overall, then it may be more effective to vaccinate people based on their job and overall exposure level.

“There’s overlap between those two groups but also there’s some tension between them and that’s given rise to some questions… the folks who may be at the highest risk of dying if they get COVID may also be in a position to stay at home and reduce their risk of acquiring it.”

But determining risk level is easier said than done, especially when our understanding of COVID-19 is still evolving.

“Once you start creating these categories, who fits within those categories becomes a really complicated question.”

California health officials recently made the controversial decision to designate medical marijuana workers to the category of healthcare workers, putting them in the first phase of vaccinations ahead of groups like teachers, grocery store workers and seniors.

In other parts of the country, health officials have put smokers in the high risk category and given them priority access, which has caused a bit of an outcry on social media.

“When you start bringing in some of these other considerations then it becomes much more complex,” said Dr. Kheriaty, which is why he argues that an age-based system may be the most efficient way to reduce the impact of the pandemic while also limiting fraud.

“My own view is that from the beginning we should have said the overarching goal is to save lives and to reduce severe illness. And if you do that, then you prioritize really based on age… if you vaccinate 3% of the population, which is those over the age of 75, you already cut down severe fatalities in half. You get a lot of bang for your buck if you take that approach.”

Those 65 and older are currently eligible to get vaccinated in California, although supply may vary from county to county.