Don’t Vaccinate Health Workers First

The following is an excerpt of an opinion piece written by Joel Zivot, MD and published December 10 in MedPageToday. Zivot is an ICU doctor and Assistant Professor of Anesthesiology/Critical Care at Emory University School of Medicine.

We are on the verge of a COVID-19 vaccine rollout and the current reality is that the on-hand supply will fall short. Healthcare workers have been put in the CDC's very first priority group, along with nursing home residents. I am puzzled by this. The question is, what is the expected result with this first wave of vaccinations?

From the public perspective, one can imagine the desired result would be to reduce morbidity and mortality as fast as possible...

When one considers the plan to start with vaccinating healthcare workers, the reality is the death rate will likely not slow in any appreciable way. This first wave of vaccinations is actually not configured to have a substantial impact on the current COVID-19 mortality rate….

The best way to reduce mortality is to staunch the flood of hospital admissions. If the hospital had fewer COVID admissions, this would accomplish two things. First, it would ease the burden on the healthcare workers. I speak from experience as an ICU doctor working this from the beginning. So much of what we do is COVID and we have had to expand services in a way that has stretched us very thin…

Second, if we target the high-risk group for serious COVID-19 morbidity and mortality, we will begin to also reduce morbidity and mortality overall...

The idea behind vaccinating healthcare workers is to avoid a crippling level of healthcare worker absenteeism. This sounds reasonable. In my experience, yes, healthcare workers have gotten sick with COVID-19, but on the whole, this group has actually done well in protecting itself and is not the population at the crest of the wave of mortality. Until we target the highest risk groups, we will continue to lose lives to COVID-19…

That's why I respectfully disagree with the CDC that healthcare workers be among the first in line to receive the COVID-19 vaccine.

Recently in the U.K., the National Health Service reconsidered its original plan to vaccinate healthcare workers first, and instead will focus on nursing home residents and staff. It is true that healthcare workers have fallen sick and some have died, yet they make up a very small proportion of patients in ICUs and of deaths.

Vaccinating healthcare workers won't unclog the ICU and thus will not make healthcare workers' jobs any easier…

But what if we started with Medicare and Medicaid recipients, a group that covers the populations at highest risk: the elderly, the disabled and the poor? The vaccine program could be administered by family doctors who can reach out directly to their Medicare/Medicaid patients and ask them to come in to the office or the clinic...

The hospital is clogged with patients and empty of families. This combination is eroding the resolve of the healthcare worker. When the hospital begins to unclog as we target the real priority populations -- those at highest risk of otherwise becoming hospital patients -- the clog will give way and the families will return. When this happens, ICUs will return to something closer to normal for healthcare workers -- to the benefit of all.