Who Should Get the First Doses?

Tech coronavirus vaccine. The approval paves the way for Justin Trudeau to begin a government campaign to vaccinate Canadians again COVID nineteen, which has killed more than twelve thousand, eight hundred people in the country. So far, Canada has secured more doses of the vaccine per person than any other country in the world. The Prime Minister said last month that a majority of the population of Canada should be

able to get their shots by September one. Some more news emerged about how well the Fiser and bio en Tech vaccine works. According to the US Food and Drug Administration, it prevents symptomatic cases of the virus, but it's not clear if the shot keeps the disease from being transmitted. The FDA published their findings in a report issued Tuesday. The risk that immunized people could still transmit the virus carries important implications for continued mask wearing and social distancing,

even among those who have been vaccinated. Finally, new tests show the coronavirus was circulating in Italy as early as the end of November. That's according to a report published by the Centers for Disease Control and Prevention, and it lends weight to other studies showing the disease appeared in Europe earlier than originally thought. The new findings shift the timeline for the beginning of the outbreak in Italy from late February, when the first cases on the continent were identified,

until late autumn. And now for today's main story. The UK began administering the first COVID nineteen vaccine this week and the US may do the same within days. But the emergence of these vaccines brings tough choices around who gets it first and how it will be distributed. Bloomberg Senior editor Jason Gale spoke with an ethics expert about the thinking behind some of these decisions and how the

current vaccines could affect how we develop future ones. Professor Arthur Kaplan says, there's a list of people who should get the vaccine first, and healthcare workers are at the top in the emergency side. I think it's pretty clear that you're trying to in the US in particular, preserve the health care system from not being tipped over. So healthcare workers are going first, not considered the greatest need, for the greatest risk, but you've got to try and

maintain the system. It will be frontline healthcare workers there, and I think that everybody agrees on that. What is the head of the Division of Medical Ethics at New York University Grossman's School of Medicine, and he's been looking at questions related to vaccine nation for the last six years. I says the second group on that list should be nursing home residents. They got beat up very badly by the virus and they still are, you know, out of two dred or so deaths here, I think a hundred

thousand or nursing homes. Says After that, there are differing views about who should be next then as more supply begins to appear, who probably then go to older over sixty people with chronic conditions and quote unquote essential workers. That's a big group, that's probably eighty million plus. But I think we'll have enough vaccine to do that. There's also another group on that list that would need the vaccine, people who have already been infected with the virus, because

reinfection is possible. Everything that I hear tells me that you're gonna have to vaccinate people who've had COVID because you don't know how strongly anybody responses or how long it was. So I think I think they're gonna have to go too, unless you had COVID last week and you know, maybe you know that your antibodies are high and maybe that. But I mean, that's a tiny handful of people. But getting people to even take the vaccine maybe a challenge. If flu is anything to go by.

New data says that only half of US residents received a flu shot this season, and more than a third of adults don't plan to get one. Poles indicate a lack of support for COVID vaccines as well. Says that may reflect concern that safety might have taken a back seat to speed in developing them. There's certainly some people out there who are just anti vacs, as there are in Australia, Britain and other parts of Europe, but I

don't think that's a big number. I think what's going to happen is as soon as the healthcare workers get vaccinated and they do well and they don't get sick, and then we see protection for nursing home residents. I think we're going to see a big shift. It's gonna move from I'm not sure I want to get this, and how come I can't get it right away. Look, some nations Australia, Taiwan, New Zealand kinda have worked their way out of this thing my behavior change, lockdowns and

strict isolation in quarantine. The US has not. It's lost control of it. It has to rely on vaccines. But I do think I do think ultimately they're going to help the states work their way out of it. Steell says mandatory vaccination is not likely, with maybe some exceptions like the military. Well, look, no one's gonna make an experimental vaccine mandatory. So emergency use the first phase of availability They're not going to mandate it. You're gonna get

an offer. You're gonna get to choose. Once the vaccine gets licensed, I think you'll see mandates all over the place. I think health care institutions, nursing homes will say you're not gonna work here unless you get vaccinated. I think you'll see airlines and trains and cruise ships saying you're not coming on board unless you show proof of vaccination. I suspect most Americans are nervous that the government's going

to tell him I have to get a vaccine. But I think you're gonna see mandates coming out of the private sector more than the government. Arts says the rollout of the vaccine will present another ethical issue. It will make it harder to test the safety and efficacy of other COVID vaccines, stealing development the way large randomized controlled studies,

so called phase three clinical trials are stretched. It means that a portion of people get an experimental COVID vaccine, while a portion get a place EBO or at least a vaccine that's not protective against the coronavirus. Art says he suspects people, especially healthcare workers and others that high risk of infection won't want to take their chances. They want to get a proven COVID vaccine, and that will

make it harder to recruit participants for these trials. There are many vaccines in the pipeline that haven't reached phase three trials, so maybe cheaper, so maybe easier to store some maybe one shot. They may have different advantages. If you have a couple of vaccines that are either out there with emergency use approval or get licensed, who's going to be in those trials? Nobody. You're gonna take the vaccines that are effective and they have no side effects.

So while it's great that we have vaccines that appe is safe and effective, the bad news is that it's going to undercut future trials. We're gonna have to decide as a world how much evidence is What kind of evidence are we going to accept to license these things, because I don't think it's gonna come from large scale, randomized trials of this sort that historically have been used

to establish the efficacy and safety of vaccines. One option is that experimental vaccines are compared head to head with proven ones, but artzies another possibility I think, and it's controversial for me to say this, but I think that's going to open the door to trying some challenge studies deliberately in affecting small numbers of people to get hard, reliable data quickly when big trials become unlikely or impossible to do, especially if we get better and better therapeutic drugs,

so we could prevent death, rescue someone who's got severely ill when they're starting to appear. They're not there yet completely. But I've tried to argue for a long time now that challenge studies are in our future, and I think this collapse of the big studies is going to make them more in our future. There's also the matter of whether people will be able to choose which vaccinet they gain. The other thing I think we've not paid enough attention

to do is everybody wants to know who's going first. Well, that's nice, but in the short run, the issues and who's going first. The issue is our place is going

to be able to administer this during vaccine fizes. Vaccine needs to be stored at ultra phreezing temperatures from where it's manufactured through to the clinics and senters potentially hundreds of miles away administering it, and that requires more careful maintenance of a rigorous cold chain than a similar vaccine ape by Maderna, which is stable at regular phrase of temperature psers is cold chain, very very cool temperatures. I don't know if I trust being able to keep everything

at the cold chain temperatures all the way through. It's hard even if you do. It comes in packages. I think of a thousand says that in order to avoid wastage, the immunization process needs to be done incredibly efficiently and at a large scale. At least for the fines vaccine. There may be more flexibility with Maderna. Shop open up the package and you've got to give him out within five or six hours. It takes a lot of people to vaccinate that many people that fast. Those people have

to be in one place to get it. Oh. I mean, it's logistically gonna be harder than I think people think. So while we're all worried about is Grandma going to get it before the healthcare worker, before the essential worker, I have a feeling there's some short term logistics issues that you're gonna have to be sorted out. For example, do I get to pick which vaccine I want. I doubt it. That was Jason Gail, and that's it for

our show today. For coverage of the outbreak from one hundred and twenty bureaus around the world, visit bloomberg dot com slash coronavirus and if you like the show, please leave us a review and a rating on Apple Podcasts or Spotify. It's the best way to help more listeners find our global reporting. The Prognosis Daily edition is produced by to for Foreheads, Jordan Gaspore, Magnus Henrickson and me Laura Carlson. Today's main story was reported by Jason Gail.

Original music by Leo Sidrin. Our editors are Rick Shine and Francesco Levi. Francesco Levi is Bloomberg's head of podcasts. Thanks for listening, l