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What is the single most important question about COVID-19 you think needs to be answered? Submit it for a special Idaho Matters Doctors Roundtable in English and Spanish.

What Happens Once A Coronavirus Vaccine Is Ready To Distribute?

DAVID GREENE, HOST:

We are all in this together - that's President-elect Joe Biden's message as the country enters into a Thanksgiving holiday unlike any other.

(SOUNDBITE OF ARCHIVED RECORDING)

JOE BIDEN: I know the country has grown weary of the fight. We need to remember we're at war with a virus, not with one another, not with each other.

GREENE: As cases surge across the country, we're also getting closer to having a vaccine or vaccines. So what happens once a vaccine is ready? What does the rollout look like? And how will it be determined who gets the first doses? Well, Angela Shen has thought about this a lot. She's a vaccine and immunization scientist and used to serve on the little-known but very important Advisory Committee on Immunization Practices. Dr. Shen, good morning. Thanks for being here.

ANGELA SHEN: Thanks so much, David. Glad to be here.

GREENE: Well, so this committee I'm talking about falls within the CDC. They met earlier this week to talk about initial priorities, first doses. I mean, this is just a huge task with so much at stake. Can you just tell us, broadly, what they're thinking about and taking into consideration?

SHEN: Sure. What the committee and the people who think about this a lot - what they're trying to do in prioritizing is maximizing benefit and equally distributing that benefit across all communities. And they want to - and the committee wants folks to be transparent about it. So they've been talking about it for a really long time and - ever since spring, around April and May. And every month, they're meeting. The meetings are public.

And they're talking about the first tranche of vaccines and health care workers, those with essential jobs like first responders and grocery store clerks, and then following in line with the elderly and those with chronic medical conditions. So, essentially, kind of cut up by your job, your age and your medical condition. And this kind of takes into account risk as well as equity.

GREENE: I'm just trying to think through the priorities you mentioned. I mean, people who are older and might have comorbidities would get the vaccines relatively early. But grocery store clerks, hospital workers would be first. I presume that's because they are out there in the world potentially exposing a lot of other people.

SHEN: Yeah. I think that's really a good way to think about it. I mean, the first tranche of vaccine is going to be really limited. And so, generally, folks understand that, you know, health care workers taking care of folks in COVID wards and things like that are kind of first in line. And then so those other jobs are really essential because they keep our community and our society running and working.

GREENE: We all need to go to the grocery store. I mean, there's no way around that if we're going to be eating.

SHEN: Particularly today on Thanksgiving.

GREENE: Yeah, very true. You mentioned equity. What - can you talk more about that and what that means and why that should be such a priority?

SHEN: Sure. So I think that, you know, there are - you know, in order to end this pandemic, you know, you really kind of need to look at ensuring access and - to all communities, not just to some. And so we want to, inherently, ethically, kind of spread and maximize its benefit, distribute it across all communities. And so in this way, folks have been thinking of a long time as to, you know, who are the ones that are most impacted by the disease?

However, as you pointed out earlier, around grocery store clerks, bus drivers and the like, those folks that are essential to kind of keeping the community together and so - and thinking about how to prioritize. Ultimately, for the first set of doses that we're having in the next month, there's really not even going to be enough for health care workers themselves. And so thereafter, we want to kind of balance all of these pieces around justice, principles of equity, about minimizing disparities and inherent - distribution of equitable justice across kind of the diverse communities that we have in the United States.

GREENE: So I know this advisory committee hasn't voted or issued any formal guidance yet, but it sounds like you're saying they're both looking at numbers. I mean, like, how - you know, what priorities will have the most benefit. But there are questions of philosophy and morality that they're really considering as well.

SHEN: There's a lot of pieces to put together. And I think there's one thing that folks also have to appreciate - that there's the reality around implementation as well. And so, you know, it's really important to have concrete information for planning. You know, states have allocation - need allocation information. They need to know the number of doses they're getting. They need to know which vaccines because the vaccines are handled differently. They have different storage and handling requirements. And so the more concrete information they have, the better they can to kind of move forward in planning for vaccination programs. There's a lot of moving parts here, and it's really complicated.

GREENE: How worried are you about the question of trust and building enough trust? There are a lot of people who don't necessarily have trust in the government, don't necessarily say they want vaccines for a variety of reasons. I mean, how big a challenge is that going to be?

SHEN: That is a spot-on question. It's an uphill battle in a way, in that - you've talked a lot and asked a lot about equitable distribution, but that doesn't mean much if we don't have uptake or if we don't have acceptance. And so for kind of vaccines as strategy to work, the community has to be protected. We need herd protection or herd immunity. And that only happens in two ways. It happens if people get the disease, and that's a real kind of catastrophic way to get to herd protection.

And the second way is to have large proportions of the population getting vaccinated. So you need trusted messages from trusted sources. You need a transparent process. People need to understand how we got from A to Z or at least A to L. And trust in government, you've nailed down, you know, is very inherently - it's a sore spot with a lot of communities, particularly underserved communities, vulnerable communities, Black and brown communities, if you will.

GREENE: Angela Shen is a vaccine and immunization scientist, visiting researcher at Children's Hospital of Philadelphia. Thank you so much and hope you have a lovely Thanksgiving.

SHEN: Oh, you too. Cheers. Thanks so much. Transcript provided by NPR, Copyright NPR.