Perhaps unpopular opinion, but the US vaccination system is about the worst when it comes to preventing spread. Instead, it seems to be attempting to prevent death.
I've always argued that preventing spread would as a byproduct prevent death, but I'm obviously not studied in the field.
Put shortly, I would have vaccinated college kids and working age folks first. They are not likely to die from it, but are far more likely to spread it than elderly and severely diseased folks.
> Perhaps unpopular opinion, but the US vaccination system is about the worst when it comes to preventing spread. Instead, it seems to be attempting to prevent death.
This is by far the most common approach around the world - the same approach is taken in the UK, for example. It's in place for three reasons:
1. We worked out that about 90% of deaths in the first wave would have been prevented if we had been able to vaccinate the most vulnerable groups. This is A Good Thing, both in ite own terms, but also in terms of preventing healthcare systems being overwhelmed.
2. There was no evidence at the beginning that the vaccine prevented transmissibility - only that it prevented serious illness. So the preventing deaths strategy made sense.
3. It's simple to organise and roll-out at speed - and speed is of the essence. Doctors have people's ages and medical vulnerability on record, so you can very quickly draw up lists of who is eligible for vaccination in each cohort. Compare this with trying to arrange vaccination by (say) profession.
I don't understand the relevance of #1, as we have no time machine.
Regarding #2, I think no one seriously thinks the vaccine could fail to prevent spread (it surely is not 100% sterilizing, but everyone acts under the assumption it will vastly reduce spread). "There is no evidence for X" can be said for the vast majority of values of X, since most X are impossible and/or too time consuming to study. This includes, for example, X = "the best way to use the vaccine is to give a first round of second doses before a second round of first doses". But we often have to make decisions in the face of imperfect data.
#3 is ridiculous because the logic appears to be, "the best rollout plan is the one that's easiest to enforce". By this logic, we should line up by height, like we did in elementary school when heading to the toilet.
Preventing deaths and reducing the load on the medical system is absolutely necessary to move forward. If we have vaccinated a good chunk of the elderly and have guaranteed vaccine availability for them, we could open up the economy without fear of the medical system being overloaded. The main reason we shutdown was to prevent the load on hospitals. It has a cascading effect on anyone seeking care.
(Personally know someone who’d have gotten a diagnosis and treatment earlier by at least a couple of months if not for Covid)
Minimizing death at the expense of a slightly longer pandemic doesn't seem like an unreasonable choice in a situation that lacks any perfect solutions.
> the US vaccination system is about the worst when it comes to preventing spread
You have to take a few factors into account when deciding if preventing the spread is your objective. Given the staggering number of cases already out there, the time it takes to vaccinate so many people, and the number of people not willing to be vaccinated, your preferred strategy would be slow (if it worked at all, due to some people refusing to be vaccinated).
In addition, people in the high-risk groups are not fully isolated. Some work, some walk around without masks, some travel. People tend to cluster in age groups, so if one person in the 65+ group gets it, they're going to interact with others in that age group. If a college student gets it, the probability of sustained interaction with someone over 65 is much lower.
That's an argument that can be made with numbers. The problem is we don't really have any. Your assertion that young adults are most likely to spread certainly seems plausible, but the truth is we just don't know. So we made a relatively conservative policy choice and chose to take the low hanging fruit of reducing severe cases at the potential cost of a longer pandemic. It seems reasonable to me, given the facts on the ground.
If you want to pick a nit with US vaccination policy with better grounding, aim at the fact that, with the two-dose mRNA vaccines, we're prioritizing the second dose much more heavily than we should. Numbers after a first dose show something like 70% effectiveness[1]. We should be getting everyone their first dose NOW and not wasting all that effectiveness on the comparatively less impactful booster.
[1] Which is to say, a "1-dose" Pfizer or Moderna vaccine is almost exactly equivalent to the actually-single-dose J&J vaccine.
It will certainly be interesting to follow the studies that will come out on this over the coming years. There are numerous different approaches being taken to vaccination that can be compared. Most of Canada is giving first doses to essentially the entire adult population (which is expected to take a few months) before beginning second doses. Indonesia is focusing on vaccinating young and active people - those most likely to spread the virus - before those most likely to die from it. It will be interesting to see how results compare.
By the way, I've seen that the mRNA vaccines are even more effective than that after the first dose, if you just consider the period from about 10 days onward, ie after it has had a chance to kick in. Here in BC they're quoting a demonstrated efficacy of "up to 90%" from 10 days through to at least 3 months.
Agreed. Before I was vaccinated I read all the numbers I could find. Apparently all 3 show something like 90 percent effectiveness after 3 weeks, even without a second dose for those that ask for it. Seems much more effective to let everyone sit at 90ish, rather than halving the supply for an extra few percent.
Setting aside the topical question of whether it's young adults or younger/older demos that drive the spread, we do have data and modeling to suggest that superspreading events have driven most of the infections [1]. If that's the case, then I think there's a question to be asked about which cohort is more likely than others (if any) to drive super-spreading events.
Well no one -likes- getting covid but there's a far cry from dying from it as the groups who are more apt to want to get it first. If you want to use a more statistics based approach like "well we're going to vaccinate those who are most likely to spread it" (say 20 somethings or republicans who won't wear masks) the general public is not going to go along with that and start making calls to congress critters really quickly since they are afraid memaw is gonna die because she can't get a vaccine while all the college kids throwing ragers on the street are now effectively just a bit safer than before (they were already highly unlikely to die from the disease). Americans by and large do not understand statistics (or even the scientific approach in general) to minimize spreading but "getting shots in arms of those most likely to die" has an undeniable "folksy" logic. The most important thing (the 90% problem) is to get vaccines cranking out as fast as possible and into people, everything else is background noise. I would have been fine with a randomized system based on a voluntary signup list.
It’s not a scientific problem. The scientific solution to contain the pandemic would be a full 21 day absolute shutdown of everything with people surviving on rations. It becomes a political problem if you try to do that in any functioning democracy.
Decisions made about people must have a feedback loop to learn from how people react to it. For example, the lockdown became ineffective when it was extended too long. People were initially very compliant. We were told it’s only till we can prepare our hospitals and prepare a contact tracing strategy. It was convenient for politicians to extend the lockdown than solve those two problems. Net result was that people started ignoring the lockdown more and more. Police can enforce bans on outdoor gatherings; people simply gather at home.
It’s precisely because we ignore the human element that we keep dragging this.
> The scientific solution to contain the pandemic would be a full 21 day absolute shutdown of everything with people surviving on rations.
It is not even a guaranteed solution. It will bring back cases to almost zero. In some rare cases, incubation time can be way longer than 21 days, you are also going to have people with weak immune systems that can contain the infection but not eliminate it completely, plus all the bad things that can happen: mutations, animal transmission, etc...
Then, if we just go back to business as usual after the super-lockdown, it will spread again, just as it started. As long as R>1 there is no way to win. And for now the only way to keep R<1 is to make our lives more or less miserable (today's solution), herd immunity through infections (and let millions die), and herd immunity though vaccines (our goal).
There was no lockdown in any state in the USA. There were instead these totally unenforced “stay at home” orders which people ignored with no consequences. Emergency public health directives during a catastrophe do not need a feedback loop: they need to be enforced, regularly and visibly. That never happened on the USA, and the results have been tragic and predictable.
I agree it's a political problem - a political solution is proven by Asian democracies and Australasian democracies. As you say, it was pretty obvious that a 21-day lockdown with appropriate testing and follow-up would have resolved this issue in any country.
The people's right to have an opinion does not change the truth, that an indefinitely long half-lockdown is a bad compromise between opinions.
Why not? Just because a bunch of people hold that opinion? Political change happens despite groups of people not wanting it - that's almost the definition of politics.
Scientists working for the UK government at Imperial College rejected lockdown as a plan (even what we have now in the UK) because they found it not politically viable: that's a danger to everyone.
> Put shortly, I would have vaccinated college kids and working age folks first. They are not likely to die from it, but are far more likely to spread it than elderly and severely diseased folks.
Many people agree with you. Vaccinating the most mobile people and isolating the most "immobile" (retirees, children, sick) is very logical.
My guess is politicians know it but they would never make such a decision. It'd be a political suicide.
(Also, sorry for the vaguely propagandist source -- I originally heard about this on a podcast and am having trouble determining which, and this doesn't seem to be getting much coverage in English-language print media.)
Countries that have stopped or at least controlled the spread can prioritise vaccinating younger population as that is unlikely to result in more deaths. Singapore has vaccinated its medical personnel (anyone working in a hospital or clinic) then 70 years old and above. Now it is moving to 60 year and above and all the front line workers like teachers, bank tellers, shop attendants, taxi/private drivers etc. They are not facing thousands of deaths so can prioritise protecting the most vulnerable as well as cut off the most likely high spread events.
Fair, but no other country(admittedly) save perhaps Brazil or Italy has had anywhere near the spread of the disease, either. In places the disease isn't rampant, I think the approach makes more sense.
The issue is, something like 80% of the deaths and hospitalizations come from about 20% of the people. It is far quicker to vaccinate 20% of the population than it is to vaccinate the 80% (will less than 80 but more than 20) that covers the group you mentioned.
If course the us didn't do that...
I've always argued that preventing spread would as a byproduct prevent death, but I'm obviously not studied in the field.
Put shortly, I would have vaccinated college kids and working age folks first. They are not likely to die from it, but are far more likely to spread it than elderly and severely diseased folks.