Age will be a key factor, but demographics and employment are also parts of the equation.
It’s an unmapped road, one that members of the state’s COVID-19 vaccine prioritization advisory group can’t yet see clearly. The informal panel of more than 30 leaders and experts in multiple fields will be giving recommendations to the Utah Department of Health and the governor’s office.
“It gets a little more in focus the closer you get to it,” said Rep. Raymond Ward, R-Bountiful, a state legislator and physician. “People are wanting levels of detail, and it’s like we’ve just got to get three more steps down the road with the first part [of the rollout] before we can even conceive the second part.”
The advisory group has met three times, all in December, all by teleconference. The group’s last meeting was Tuesday, and some recommendations were sent to Gov. Gary Herbert’s Unified Command, which is handling the state’s COVID-19 response. The panel has no formal deadline for finishing its recommendations to the governor, who will make the final decision, a UDOH spokesman said last week.
“Nothing is really set in stone yet,” said Arlen Jarrett, regional chief medical officer for Steward Health Care, which operates five hospitals in Utah. “They’re developing a skeleton for how the state wants to recommend the Phase 2 rollout should go.”
The panel considering the order of those groups includes health care professionals, staff from UDOH and other agencies, representatives of county health departments, members of the Utah Legislature, and leaders in business, education and civic groups.
“It’s been a very thoughtful group,” said Heidi Matthews, president of the Utah Education Association, the state’s largest teachers’ union, who is on the panel. “It’s been very organized, with a lot of time for people to raise concerns and clarifications. I feel a great consensus out of this.”
Trying to strike a balance between groups — one that’s both fair and workable — is a tricky task.
Phase 2, which is forecast to start in March and run into early summer, covers a wider swath of the state’s population, including: People over 65, people with underlying medical conditions, people who work in food industries or otherwise can’t work from home, tribal communities, minority and ethnic communities, people experiencing homelessness, and the incarcerated.
“There’s a danger when you get a large group together, and … somebody happens to think [that] this group’s important [or] that group’s important — and you make this big chart about rankings and categories and things,” Ward said. That can happen, he added, “without stopping to say, ‘We don’t have a way to exactly measure all those things.’”
Any system set up to distribute the vaccine, Ward said, “needs to be relatively simple, otherwise you can’t hardly even follow it. It falls apart when you try to implement it.”
Jarrett agreed. “It quickly becomes apparent that if we make it too complex, no one will understand it and no one will know when it’s their turn,” Jarrett said.
That complex problem, Jarrett said, is “complicated by not really knowing a timetable for when the vaccine will be available. … If we had this many [doses], we’d do it this way, and if we had that many, we’d do it that way.”
In Phase 1, Ward said, the groups of people getting the vaccine were relatively easy to find. “Say it’s a hospital staff. That all happens at the hospital,” Ward said. “How about a nursing home? We have teams of vaccinators [to go into nursing homes], and even that is more complicated than you think.”
In Phase 2, Ward said, “you can’t do that. Those pipelines are way too small to get to a larger group that’s spread throughout the community.”
‘How complicated do we want to make it?’
Ward and Jarrett said there is one thread emerging from the panel’s discussions, one factor that could cut through all the considerations of demographics, employment and pre-existing conditions: Age.
“Largely, it’s just going to be by age,” Ward said. “To say, ‘How complicated do we want to make it?’ This is a way, at least, we know we can implement it this way and that it really will work, and largely we’ll get the highest risk of death and hospitalization first.”
A person’s age, Jarrett said, “certainly takes into consideration who’s at most risk, and it takes into consideration who’s most likely to get admitted to the hospital if they get COVID. If we vaccinate those people first, we’re probably saving more lives and easing up the hospitals’ burden so that they’re not overwhelmed.”
Matthews — who pushed a recommendation, one Herbert implemented earlier this month, to move teachers and school staff into Phase 1 — pointed out that the difference between being at the front of the Phase 2 line and the back of the pack may not be too long if the state gets sufficient doses of the vaccine.
“Focusing on our high-risk groups, there’s still going to be other phases that are being implemented at the same time,” Matthews said. “Things are going to be happening simultaneously.
Jarrett reiterated that “no one has decided yet,” and the members of the panel — and the Unified Command who will act on their recommendations “certainly feel stressed.”
“It’s an awesome responsibility,” Jarrett said. “Everybody is asking to be first, and everybody is wanting to know why someone was chosen ahead of them.” Ward added, “no matter what decision is made, almost everybody will be mad.”
Two panel members, doctors with Intermountain Healthcare and University of Utah Health, declined to comment through spokespeople at their respective hospital systems, deferring to UDOH.
Jarrett said it’s been exciting to be involved in helping Utah through “a once-in-a-century event.” “The pandemic tunnel has been long, and this light is shining bright at the end of that tunnel, with the vaccinations,” Jarrett said. “It’s a very historic event, and we’re part of that.”
Making recommendations about the vaccine rollout, Jarrett said, beats the alternative.
“This is a good thing we get to do, to figure how to get the vaccine out,” Jarrett said. “It’s better than figuring out how to take care of overwhelmed hospitals.”