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A needle plunging into a vial

Ohio State University researchers last week released the results of a poll conducted in May showing that 69 percent of respondents were ready to roll up their sleeves when the COVID-19 vaccine finally arrives.

It’s a more robust response than what public-health officials typically observe for the seasonal flu vaccine, says lead study author Paul Reiter, PhD, MPH, but the interest level may indicate troubling times ahead.

“You hear a lot of talk of vaccination and the benefits of herd immunity, the idea that when enough people have resistance to a virus it reduces the threat to the entire population,” Reiter notes. “At 70 percent, we may or may not get there.”

And I wonder how many of Reiter’s respondents would line up for the shot today.

It’s not just that AstraZeneca last week was forced to briefly halt its much-heralded vaccine trial after a woman in the United Kingdom was hospitalized with severe neurological side effects from the inoculation. Or that the current administration in Washington continues to push the FDA to fast-track whatever Big Pharma produces in an obvious effort to tilt the political playing field prior to the November elections. There’s also the question of cost and distribution, two factors that are gradually coming into sharper focus and will affect every American, whether they’re yearning for the shot or not.

Here in Geezerville, conventional wisdom suggests that Medicare will shield seniors like me from the rapacious prices that Big Pharma typically attach to life-saving drugs and make the vaccine available at a reasonable cost. But, as Elisabeth Rosenthal notes in the New York Times, history doesn’t offer much encouragement for such a scenario. While the elderly may not be forced into penury by a round of inoculations, she explains, the effect on the larger population may be less benign.

Because the pharmaceutical lobby has regularly fended off congressional attempts to allow Medicare to negotiate drug prices — and thus restrict the markup the industry typically charges for the private market — a COVID-19 vaccine may be affordable for me but out of reach for everyone else.

And though AstraZeneca and others have pledged to offer the vaccine on a “not-for-profit basis,” Rosenthal has her doubts. “We’ve heard such offers before,” she writes. “Pharmaceutical companies routinely provide coupons to cover patient copayments for expensive drugs, so that we don’t squawk when they charge our insurance companies tens of thousands for the medicine, driving up premiums year after year.”

My geezer counterparts have also been led to believe they’ll be graciously ushered toward the head of the inoculation line because of our heightened vulnerability to the virus, but a recent editorial in JAMA argues that government should employ a more nuanced approach. The authors, Ezekiel Emanuel, PhD; Monica Peek, MD, MPH; and Govind Persad, JD, PhD, note that prioritizing immunization for all people with “high-risk” health conditions, as the World Health Organization has advised, would mean some 200 million Americans would qualify. And even offering preferential access to the elderly doesn’t necessarily make sense.

“Prioritizing people older than 65 years without high-risk medical, work, or housing vulnerabilities . . . is ethically and legally more complex,” they write. “Prioritization should recognize that a healthy older person who can shelter in place is at a different risk from a medically vulnerable older person in crowded housing.”

And, because the goals of a vaccine program should include preventing long-term complications and preserving future life, the authors argue, it makes no sense to immunize an 80-year-old. That’s especially the case if, as some have suggested, the vaccine will be less effective in older patients. A better approach might be to “shield” octogenarians by giving precedence to the people with whom they interact on a regular basis.

No matter how you slice it, though, there will not be enough doses of the new vaccine to go around when it’s finally approved, so Emanuel and his compatriots suggest divvying it up among the most vulnerable frontline health workers and folks living and working in high-risk settings.

“Such a categorized approach would be preferable to the tiered ordering previously used for influenza vaccines, because it ensures that multiple priority groups will have initial access to vaccines,” they conclude. “Alongside thorough, evidence-based vaccine evaluation and approval, vaccine allocation that recognizes important ethical values and avoids arbitrariness, waste, and corruption can ensure that the rollout of an eventual COVID-19 vaccine is both fair and perceived as fair.”

Given our current political and cultural maelstrom, creating such a perception may be as daunting as developing a safe and effective vaccine. Some of the Ohio State survey findings, in fact, had Reiter scratching his head. Liberals and moderates were generally more receptive to the vaccine than those who identified as conservatives, and, most worrisome, only about half of Black respondents — despite the carnage the virus has inflicted among African Americans — expressed a willingness to get a shot.

“I think there are likely several factors at play,” Reiter notes, “including access to care and trust in healthcare and potential socioeconomic barriers.”

I can’t say I’m faced with the same obstacles, but that doesn’t mean I’m eager to roll up my sleeve. If and when that vaccine arrives, I’m perfectly happy to wait my turn — and maybe a little bit longer.

Thoughts to share?

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