Debate begins over who should get COVID-19 vaccine first

City health officials warn it could be summer or fall before most people can gain access

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On Thursday afternoon a Food and Drug Administration advisory panel recommended approval of a COVID-19 vaccine produced by Pfizer and BioNTech, which is said to be 95 percent effective against the disease in trials. The FDA still has to give final approval, but that is now expected to happen in a matter of days. The companies have said that they plan to produce 50 million doses of the vaccine before the end of 2020, half of which will be distributed around the U.S.

If all goes according to plan, San Francisco is days away from receiving its first 12,000 doses, which means 6,000 people will receive access to the two-dose vaccine. As the valuable supply makes its way to our city, the argument over who should be prioritized for the first wave of vaccines has begun.

Dr. Grant Colfax, head of the San Francisco Department of Public Health, said in a press conference Wednesday that the city would adhere to California’s prioritization plan. According to a series of tweets from Gov. Gavin Newsom, the first vaccines will be earmarked for healthcare workers, who are separated into three tiers.

The first tier includes those who work in acute care hospitals, psychiatric institutions, or jail and prison hospitals. It also encompasses staff in skilled nursing facilities or seniors homes, paramedics, and staff at dialysis centers.

The second tier encompasses home health aides public health field staff, such as those who work in shelter-in-place hotels or on street outreach.

And the final medical tier is lab workers, dentists and hygienists, and pharmacists.

But who comes next is still being determined. At a press conference on Thursday, Supervisor Hillary Ronen and several local educators collectively urged Newsom and the California Department of Public Health to prioritize teachers and school staff in the vaccine rollout plan.

“Schools have been closed for nearly nine months now, and yet state officials have failed to prioritize enough resources to support safe school reopening,” Ronen said. “If we don’t act now, these indefinite school closures will have a lasting impact on our students’ learning and development, further widening racial achievement gaps.”

The educators’ press conference was the first to openly advocate for vaccine access in San Francisco, but it likely won’t be the last — especially as other states and jurisdictions handle things differently.

In Nebraska, for example, people who are currently incarcerated are included in the first three rollout tiers, along with those experiencing homelessness.

In Hawaii, the initial rollout plan includes maps of where the most vulnerable populations are, and how close they are to hospitals. The more vulnerable and farther away you are from medical facilities, the sooner you’ll receive the vaccine.

And the health departments in Ohio and Wisconsin are creating algorithms that will prioritize countries with the highest infection rates per population.

In San Francisco, where issues of equity have dominated the conversation around COVID-19 tests and infection rates, all of the above approaches could be attractive on a local level. It became clear early on in the pandemic that low-income areas and communities of color were disproportionately affected by the disease, in part due to a workforce that was deemed essential despite the shelter-in-place orders including restaurant workers, nurses, and bus drivers. Prioritizing hard-hit areas like the Mission and Bayview would make sense.

So would vaccinating people who are in prison or jail. A mere 40 minutes outside of San Francisco, San Quentin State Prison saw a massive COVID-19 outbreak, with more than 2,200 cases reported and 28 deaths.

The city’s Department of Public Health is faced with a gargantuan task in determining tiers of access. But one thing is clear, however: most people in the city should not expect to receive their first doses until well into 2021.

“The general population will not likely have access until the vaccine supply is no longer limited – expected to be a summer or early fall 2021,” a Department of Public Health spokesperson told the Examiner Thursday. “The distribution of a national vaccine during a pandemic is an unprecedented event. San Francisco is planning as best it can and will work with all our partners to ensure the safe delivery of vaccines.”

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