The world is eagerly looking forward to a COVID-19 vaccine. It is anticipated that the vaccines will be available by the end of this year, then everyone will hopefully regain their freedom after vaccination. There will be no more fear of infection during gatherings or travel, and no need to wear masks. At present, different places like the Chinese mainland and Hong Kong have participated in the COVID-19 Vaccine Global Access Facility (COVAX Facility). How to distribute vaccines fairly and effectively among countries and among different communities has become an important topic. There are billions of people around the world who need vaccines; how can such a huge demand be met in a short period of time? How should the distribution be fair and just, regardless of social status? These are the questions that deserve attention.
Earlier, a group of 19 scholars from nine countries jointly contributed an article in the academic journal Science, discussing vaccine distribution. According to the article, the World Health Organization recommends that countries receive doses in proportion to the size of their population in phase I, which begins with 3 percent of each participating country’s population receiving vaccines, and population-proportional allocation continues until every country has vaccinated 20 percent of its population.
Another suggestion, however, is not based on the size of population but on the actual needs of the country; it distributes vaccines to countries according to the number of front-line health care workers, the proportion of population over 65, and the number of people with morbidities in the country. This proposal is very controversial because many developing countries have less medical care and a shorter life expectancy, resulting in poor countries being entitled to fewer vaccines under this criterion.
As a wealthy economy, Hong Kong can be assured of buying the vaccines on the open market. However, if the above-mentioned WHO plan is deployed, only 3 percent of the population will be able to get the vaccines in the early stage. Hong Kong’s population is 7.5 million in mid-2020; 3 percent means 225,000. How to decide who gets the vaccination first and how to implement large-scale vaccination effectively all require detailed consideration.
First of all, the current rationale based mainly on age may not be applicable. Take the seasonal influenza vaccination programs as an example. By the end of August 2020, the number of people who were vaccinated free or by government subsidization had exceeded 1.3 million. The target groups include: children aged 6 months to under 6, children aged 6 to 12, people aged 50 to 64, and aged 65 years or above. The fifth category consists of people with physical conditions (pregnancy, chronic illness), or people working in high-risk industries (medical care, poultry industry, or pig slaughter).
In case that the age division mechanism is not applicable, what about the importance of their occupations in running the community? According to the latest guidelines of the Centers for Disease Control and Prevention (CDC) of the United States, the limited vaccines will be distributed according to the priority below:
1. Front-line healthcare workers;
2. Essential workers, who do crucial work in jobs that cannot work from home. This includes firefighters, police, food packaging and distribution workers, teachers/school staff, child-care providers, nursing home workers;
3. People 65 years of age or older in long-term care facilities.
Do these criteria of vaccine distribution meet public expectations? We need to collect different opinions. I personally agree with certain parts of the CDC guidelines, such as front-line staff who maintain the city’s operations and who have a high risk of being infected such as the elderly in nursing homes should be given priority to be vaccinated. The high-risk group should also include all elders aged 65 or above with chronic diseases such as cancer or diabetes.
There is a group we might miss out easily and has a high chance of being infected and spreading the virus which is the street sleepers.
How to reach these target groups and distribute the vaccines in an efficient manner is another critical issue. Therefore, once the target groups are identified, the authority should create visual maps of these populations, and arrange corresponding measures and vaccination sites to avoid people from not going for vaccinations because of, say, difficulty in transportation. The geographic information system (GIS) will be useful in such cases. It can mark the distribution of different groups on an electronic map, and give a full picture of how many people can reach a vaccination site by a 15-minute walk or a short drive, so as to facilitate estimation of the number of vaccines needed in each site.
In addition, some vaccines may require two doses, and products from different pharmaceutical companies cannot be used interchangeably. Who receives a certain vaccine and when will the second dose be required? The staff need a fast and accurate system to record each person’s vaccination information, consisting of the bar code of the vaccine package box, expiry date, possible side effects or potential incidents and more, to facilitate follow-up work. The information can also be displayed on an interactive map dashboard, so that the decision-making authority can view the constantly updated status in real time.
Further, the WHO pointed out last year that vaccine hesitancy, i.e., the reluctance or distrust of vaccination, is one of the top ten threats to global medical health. This may stem from many rumors on the internet. A recent poll in the U.S. found that more than 30% of adults were not sure if they opted for being vaccinated, and 20 percent said they would decline the COVID-19 vaccination.
To eliminate the myth about vaccines, we should increase transparency and strengthen communication.
Firstly, the government should explain the principles and measures of vaccine distribution to the public. Information like distribution of each group, number of vaccines assigned to each group, daily number of those vaccinated, and the cases of abnormalities found after vaccinations should be listed and displayed on the interactive map dashboard for the public to assess their risk level.
A COVID-19 vaccination priority list and implementation plan will surely attract the public’s attention. Therefore, the government must strengthen communication with the public and private corporations, and the general public to improve transparency, reduce suspicion, and stop rumors. Only in this way can all kinds of measures be implemented smoothly.
Dr. Winnie Tang
Adjunct Professor, Department of Computer Science, Faculty of Engineering; Department of Geography, Faculty of Social Sciences; and Faculty of Architecture, The University of Hong Kong