Roosevelt Institute | Cornell University

Women and Children Last? Initial Vaccine Distribution

By Genevieve RichardsPublished December 22, 2020

As promises of a Coronavirus vaccine are set to enter reality by 2021, America is hopeful. For a country whose pandemic response has revolved around protecting private industries and trying to keep the economy open with the expectation of a vaccine, this could mean the difference of hundreds of thousands of lives. However, before we celebrate any potential return to normalcy, we must first consider what groups should receive the initial vaccines — and why.

America also now finds itself in a very unique position, having to decide who to prioritize for vaccination. Vaccinations have historically been rolled out in either very small or very large quantities; this in conjunction with the country’s emphasis on free-market distribution has usually spared the government from making the type of life-saving decisions it now grapples with. Vaccine determinations are now mainly based on risk, but it may make sense to prioritize occupation and behavior if ending the pandemic is the goal.

The CDC currently plans to have four groups receive the vaccine first: healthcare workers, other essential workers, individuals with chronic health conditions, and seniors 65 and older. There is little doubt that healthcare and essential workers should be among the first to receive the vaccine, as they have been working on the front lines of the pandemic. There are, however, questions surrounding whether the rest of society would perhaps be better served by a different order — vaccinating younger people before the elderly.

While older adults and adults with preexisting conditions have higher mortality rates from COVID-19, vaccinating them may not slow the pandemic or prevent others from getting sick. A study of the H1N1 flu found that fewer people would get sick in the long run if children ages 5 to 19 were vaccinated, as they were responsible for the majority of the spread. Although this younger age group had a much lower mortality rate and chance of complications than other at-risk groups, prioritizing them would slow the pandemic overall and protect others more effectively. The study concluded that by first vaccinating young people, thousands of deaths, and billions of dollars in economic damages, would be spared.

Coronavirus research, unlike H1N1, is lacking in information about who is spreading the virus. Due to people’s altered patterns of behavior (wearing masks, closing schools, workplaces, etc.), it’s impossible to create a model showing which demographic group is more responsible for transmitting the virus. While some suggestions are available, there is currently no definitive evidence that either children or the elderly are more responsible for the current Coronavirus spread.

However, there are other considerations besides pure, epidemiological risks for vaccine distribution. New research suggests the vaccine will not be free of side effects, and these side effects could be quite substantial for some, with flu-like symptoms potentially including body aches, fever, and headaches. Whether some groups would be better able to handle these side effects than others may be of concern as well. The same altered population behavior may be important to review as well. Society must ask: Is it more important to get children back to school in-person by vaccinating them and their teachers? Does this same logic apply to college students? Likewise, does it make sense to vaccinate workers and have them return to the workplace without also sending their kids to school? One may conclude from these questions that activities essential to a group’s lifestyle warrant receiving a vaccine more than, say, elderly people with more solitary lifestyles. Younger people with stronger immune systems may be more willing, and a safer choice, to receive an initial vaccine.

Questions also arise around whether the planned rollout even makes sense from an equity standpoint. People of color, specifically black Americans, have suffered a disproportionately high amount from coronavirus, with higher rates of hospitalizations and deaths, but there are few established proposals using race or ethnicity as a factor for early vaccination. Men have higher mortality rates from COVID-19 (as they do for most diseases), but women make up more of the long-haulers whose recovery takes longer. Yet, there are virtually no proposals that use sex as a factor for a vaccination group.

Currently, there is no perfect answer to support any group receiving a vaccine first. While epidemiological research as to the efficacy and equity of prioritizing certain groups over others is incomplete, science alone cannot answer the question of who we value more. Before a vaccine is made widely available to the entire population, we should not blindly consider the present CDC recommendations for initial groups as the inherent best. Instead, we must continue to critically consider population behavior in conjunction with scientific models while making future decisions, and to be more transparent about the goals of the vaccine.