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The Great Dilemma: Who Should be Next in Line for the COVID-19 Vaccine?

NHS COVID-19 vaccine centre
Source: AP

There are now nine COVID-19 vaccine variants approved for use. Governments around the world have begun inoculating their citizens, sparking off the largest vaccine drive in human history. With new variants of the coronavirus now popping up, this is truly a race against time. 

There is no disagreement that everyone should receive the COVID-19 vaccine. But in reality, that is going to take much longer than the ambitious timelines many governments have announced. With the supply of vaccine doses quickly drying up, there’s now a huge scramble by both governments and manufacturers to roll out as many doses as possible.

It’s a universally agreed concept that frontline workers should be amongst those first in line to receive their dose. The big question though, is who should be next? Determining that has massive implications for the number of doses we need, and how quickly we are able to end the pandemic. It is indeed the “great dilemma”. 

Who is a Frontline Worker?

There is no question that frontline workers should be the first to receive the dose. As of February 2, the global death toll stood at 2.24 million. Without frontline workers literally putting their lives on the line, that number could have been much higher. The question many governments are dealing with is who exactly is classified as a frontline worker?

Doctors putting their lives at risk without the COVID-19 vaccine
A team of doctors puts on protective suits before they meet a patient with suspected COVID-19, Istanbul May 2020. ©2020 Yasin Akgu/picture-alliance/dpa/AP Images

There’s no doubt hospital staff are. From doctors to ambulance drivers, and cleaning staff to admin staff, hospitals have been running non-stop. But they aren’t the only one. Armed forces personnel have aided efforts in countries like the UK, India, Italy, and Spain. Police forces too have been on the frontline, enforcing quarantine rules. Municipal workers and other government officials have also been forced to put themselves at risk to ensure cities and nations continue running smoothly. 

Yet, not all of them will be first in line to be vaccinated. Due to supply constraints, not all frontline workers are scheduled to receive the COVID-19 vaccine under “Phase 1”. Right now, the priority in almost every country is hospital staff – doctors, nurses, paramedics and other medical staff. In many nations, other “essential” workers are being left out. That includes law enforcement officials, military personnel, grocery store workers, municipal staff and government officials to name a few. 

Law Enforcement Officials Left Behind

In the UK, police officers are currently scheduled to get their jabs as part of “Phase 2”. Despite pressure from unions and police personnel, the government has so far refused to include them as part of Phase 1. While there are no national statistics available for total deaths of police officers due to COVID-19, the Metropolitan Police has confirmed nine of its officers have succumbed to the virus. 

Read More: Sweden and Japan are Paying the Price for COVID-19 Exceptionalism

In the US, the situation is more dire. Due to its patchwork approach of vaccination under the Trump administration, each state has a different approach to when police personnel will be vaccinated. As a result, of the 264 law enforcement officers who have lost their lives in 2020, 145 of them have died of COVID-19. Data from the National Law Enforcement Officers Memorial Fund found that 2020 saw the highest number of deaths of law enforcement officials since 1974. 

The deadly nature of policing puts law enforcement officials at very high risk of exposure. The same can be said for grocery store workers, delivery workers, and staff who clear bins and maintain critical infrastructure. Despite the very physical nature of their role, they aren’t all going to be receiving a vaccination any time soon. 

Law enforcement officials have put their lives at risk to ensure protocols are being followed, despite a summer of protests and violence in 2020. Source: EPA

What About Teachers?

There’s also a huge debate around where teachers should fall. Labour leader Keir Starmer has called for the government to vaccinate teachers during the half term. Health Secretary Matt Hancock has indicated his support for bumping teachers up the list. In an appearance on Good Morning Britain, he said: “I think that teachers and police officers and shop workers have got a good case that they should be next, as opposed to just carrying on through the age range. It is certainly something that we are looking at but we haven’t made a final decision on it yet.”

In the US, there is a similar sentiment playing out. A teachers union in Chicago has voted against reopening schools, despite threats of disciplinary action. The debate has caught national attention, with President Joe Biden weighing in. “It’s not so much about the idea of teachers aren’t going to work,” Biden told reporters. “The teachers I know, they want to work. They just want to work in a safe environment and…as safe as we can rationally make it. And we can do that.”

Getting teachers vaccinated so kids can return to schools seems like an obvious decision, but it’s not so straightforward. There’s little data about how schools contribute to COVID outbreaks. In a study published on JAMA Network, researchers said: “there has been little evidence that schools have contributed meaningfully to increased community transmission.” That is predominantly because children have so far avoided getting seriously ill from the virus. 

Schools have resumed in some countries, with strict protocols. Source: Halfpoint / Shutterstock

But just because they do not fall sick, does not mean children are carriers of the virus. A World Health Organization report said that “the role of children in transmission is not yet fully understood”. It is clear that they and schools do have some role to play, but what exactly that role is, we are yet to know.  

The Nature of the COVID-19 Vaccine

Economics aside, the very nature of the COVID-19 vaccine should determine who is next in line to receive their shot. So far all the vaccines developed do not prevent an individual from contracting COVID-19, they simply prevent serious illness. That means that a vaccinated individual can still catch the virus, and spread it to others. It also takes up to four weeks for immunity to build up after being vaccinated. A good example of this is US Congressman. Stephen Lynch. Lynch has received both doses of the COVID-19 vaccine but announced he had tested positive on January 29. 

Read More: Whilst Rich Countries Hoard COVID-19 Vaccines, Herbs Remain The Only Option For Desperate Africans

Right now, there’s no evidence that any of the vaccines stop transmission. That is why governments have decided to vaccinate senior citizens first. Since they are the most likely to fall seriously ill and die, the COVID-19 vaccine is a much-needed shield for them. By following the current system, governments can ensure fatality rates drop, as do cases requiring hospitalisation. 

That is why the top priority groups are those who are likely to suffer the worst effects of COVID-19. There’s no debate about it. The limited amount of vaccines available means we must follow the science. If the science says the COVID-19 vaccine helps curb transmission, then we will have to rethink the order. For now, though, it is important that governments vaccinate those at greatest risk, so hospitals can return to some sense of normalcy. 

COVID-19 vaccine drive
Nations have begun vaccinating the elderly. Here, a senior citizen waits for her shot at a site in Cardiff. Source: AP

We cannot let panic determine the order of whose turn it is next. With increased community spread, ensuring people aren’t hospitalised is the right priority. That way, hospitals can return to performing much-needed care like surgeries, which have been greatly delayed. It is also a vital step to reopening our schools, workplaces, malls and restaurants. If the virus can’t kill or seriously hospitalise, then it will allow us to return to some sense of normalcy, at least in the short term. The long term effects can be far more serious, but we won’t know how until more studies are available. 

Following Protocols a Must

To get to that point though, the road ahead is still very long. The world is currently running short of vaccines, with mismanagement during the Trump administration a prime example of valuable doses wasted or gone missing. Another issue is the lack of access to vaccines for developing nations. Canada has ordered enough vaccines to vaccinate its population five times, whereas one low-income country has received just 25 doses. “Not 25 million, not 25,000, just 25,” WHO head Dr Tedros Ghebreyesus said without saying which country. 

As we reported back in November, there is a tricky path ahead to vaccinating the world from COVID-19. That’s why it is absolutely vital you follow the protocols. Even if you have been vaccinated, the advice is to wear a mask, maintain social distancing and wash your hands frequently. The COVID vaccine doesn’t give you a free pass, you can still infect others. 

If you haven’t been vaccinated, it is important you wait for your turn. Young health individuals suffer from mostly mild cases, as you would even after being vaccinated. That is why you shouldn’t skip the queue. Your profession shouldn’t determine when you get the vaccine, your health condition should. That’s what most nations are doing, and it is the best way to deal with the pandemic.

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