Emanuel outlines approach he'd take for distributing initial doses of COVID-19 vaccine

When a COVID-19 vaccine is approved, figuring out who will get the precious few initial doses will be a major point of controversy.

Ezekiel Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, believes the vaccine needs to be given to people who have the highest risk of transmitting the virus.

That doesn’t necessarily include front-line healthcare workers.

He predicts that there will only be tens of millions of doses of a vaccine or, at the most, about 100 million doses. That isn’t enough to give out to everyone in the U.S., despite the federal government purchasing doses in advance of several vaccine candidates still in clinical trials.

“You are going to have to prioritize, and I think that is going to be a difficult ethical decision,” he said during a livestream hosted by the Journal of the American Medical Association on Wednesday. “In that prioritization we have to keep our eye on the ball. I think people are misinterpreting the ball here.”

The primary goal is to reduce premature mortality, Emanuel said. A lot of people assume the way to do that is to give front-line healthcare workers the vaccine first.

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“That may not be the best way to reduce premature mortality,” he said. “It may be better for example to immunize people at high risk of transmitting the virus both because of jobs and living situations and other circumstances."

Emanuel, a former policy adviser to the Obama administration, said detailed modeling and the best way to reduce premature mortality should be prioritized for decision-making.

“I don’t know that front-line healthcare workers ought to be necessarily the highest priority given they can don and doff [personal protective equipment] effectively,” he said.

Emanuel noted that transmission among healthcare workers and from patients has lowered to nearly zero at Penn’s medical center.

But the risk for healthcare workers has been a major concern since the onset of the pandemic. The union National Nurses United has slammed health systems for requiring nurses to work with reused and reprocessed PPE.

He also warned of potential bottlenecks with producing and distributing a vaccine.

“Getting them into vials, shipped out, distributed and into people’s arms—each one of those steps is prone to a bottleneck,” Emanuel said.