proper corona admin, vol 94 - vaccines, part 2 (mandates)

I was surprised to learn that my employer (a health care organization) was NOT mandating a COVID-19 vaccine for all employees. I acknowledge that this may reflect my opinion on the vaccine (I'll take a shot in both arms, please, and another one directly in my forehead) but I also raise this point in the context of my employer's broader vaccine strategy - when I signed my offer letter, I did so with an understanding that I would need to catch up on any missing immunizations, and also prove that I was free of tuberculosis, for which I'm vaccinated; each winter, the entire staff is administered a flu vaccine (1). In other words, what they say goes, and what they say roughly translates to "an extreme overabundance of caution".

A few days after my initial reaction, I realized that there was a logical explanation - shortage. I'm not going to collect the numbers, which vary across a range depending on the news source, but it seems that the rosiest estimate suggests all Americans will have access to a vaccine by the summer. If this feels like a long time, it is - long enough to encounter any number of obstacles regarding effectiveness, distribution, and production; in my mind, the end of 2021 is a more appropriate estimate for a fully vaccinated America.

Those guesses, entertaining though they may be, are beside the point. The current strategy of eradicating COVID-19 via vaccination is constrained by two basic facts - it requires enough doses to protect a huge proportion of the world, but we only have enough doses for a small percentage of the population. Those of us sitting around and jumping to conclusions about the pandemic - which is you and I, reader - might look at this situation and think about ways to rank-order every person in the world based on vaccine benefit, then administer shots in sequence. No matter the specific criteria of such a process, my colleagues - and particularly those on the front line - should be first in the queue. However, for now I think the economics of a shortage still carry more decision-making weight, so as long as there remain hundreds of millions of people considered "high risk" I expect organizations - and governments - to continue allowing the hesitant to step back in the line.

Footnotes

1) I looked up mortality rates to get a better sense of how my pre-employment tuberculosis testing reflects the risk implied in population-wide mortality rates. It seems that tuberculosis is around 0.2 deaths per 100K - by contrast, heart disease is eight hundred and eighteen times more deadly; the flu is eighty times more deadly.

The numbers for COVID-19 suggest a challenger for the top spot on the 2020 mortality table. This dataset gives 101 deaths per 100K, which would make it the third-leading cause of death in the USA if the rates from other causes held steady in 2020. Once again, if you don't consider the shortage my employer's flu vaccine mandate seems inconsistent with the decision to "strongly recommend" the COVID-19 vaccine.