Coronavirus: Who should get the vaccine first?

With coronavirus vaccines ready to go, the question is who should get priority. On CBS This Morning (Nov 30th), Health and Human Services Secretary Alex Azar stated the standard argument:

"We have at the CDC something called the Advisory Committee on Immunization Practices (ACIP), and they have been meeting with us to give us advice on whom — based on the data that we've got on these vaccines and the state of the case, the epidemiology around the country — should we vaccinate first," Azar said. "That's ongoing still. I hope this week we'll get greater clarity from them in terms of their recommendations and our CDC director's views. But be thinking people in nursing homes, the most vulnerable; be thinking healthcare workers who are on the frontlines of most interacting with suspected COVID cases, as the first tranches of people that we'll try to get vaccinated."

Health care workers and nursing homes first. I've also heard that, ethically, people who volunteered for the studies, but got the placebo shots should also get priority. The following Bloomberg article also reports that the U.K. and Germany have similar strategies as the CDC, but the article also makes the argument that we should target the young. 

Bloomberg via Yahoo (Nov 10th) had this:

How to ration a vaccine, though? The U.K.’s vaccination strategy, first published in the Lancet late last month, sets out tiers of prioritization, starting with getting the vaccine to the very old and to those working in care homes before moving down the age brackets. Prioritizing the most vulnerable members of society is a common approach. Germany’s strategy is to vaccinate at-risk groups first, along with nurses and doctors. An estimated 40% of the population gets first dibs on a vaccine under the German plan.

But what if vaccinating the elderly first isn’t the best way to minimize fatalities? A recently published (but not yet peer-reviewed) model from three academics at Khalifa University suggests priority should be accorded to groups with the highest number of daily in-person interactions, since that amplifies the vaccine’s effectiveness by reducing infections (and mortality) both among the vaccinated group and those they come into contact with. According to their model, proper prioritization can reduce total fatalities by up to 70%.

If we get more immunity bang for each vaccine dose by targeting those with the highest number of interactions, then we’d want to see health-care workers at the front of the queue, but perhaps next in line should be younger workers and those in the hospitality sector. 

This isn't the first time I've heard this argument. It actually makes sense to me. The problem is that even though it makes sense it might not be politically acceptable. I suspect that a lot of Millennials and Gen Z would want their grandparents to get vaccinated first. Going this route might actually result in slower vaccination as there could be resistance from many who argue that they shouldn't be first in line.