Who gets the vaccine next?

I’m losing track of calls for vaccine priority for one group or another. Teachers, police, this morning port workers – one might logically add the whole food supply chain of 4 or 5 million people. Unpaid carers have been raised (currently in group 6 of phase 1 ahead of 60-64 year olds in group 7).

And while everybody surely agrees with the priority given to health and care workers, some health workers are demanding the second dose on the original schedule. Not something I’m qualified to judge.

Occupational priorities are likely to be part of phase 2 of the rollout. The JCVI statement reads

Vaccination of those at increased risk of exposure to SARS-CoV-2 due to their occupation could also be a priority in the next phase. This could include first responders, the military, those involved in the justice system, teachers, transport workers, and public servants essential to the pandemic response. Priority occupations for vaccination are considered an issue of policy, rather than for JCVI to advise on. JCVI asks that the Department of Health and Social Care consider occupational vaccination in collaboration with other government departments.

The problem is not so much finding people who merit priority vaccination but finding people to move down the queue to make way for them. Two groups do come to mind: 1. People like me who don’t need to go out to work. 2. People who have already had covid-19 and therefore have a good degree of natural immunity. Ireland is reportedly considering this. They have even worse case numbers than the UK and are behind in vaccine rollout. There is some doubt how good natural immunity is but this study of healthcare workers in Newcastle is promising.

And prioritising certain occupations is only one aspect of a more precise risk model that could be used to determine vaccine priority and would doubtless save lives.

What other factors could be used in such a model? Well they start to get controversial. Gender. Ethnicity. Body Mass Index. Socio-economic status. There are both technical and political minefields here. Take Ethnicity: people are on a continuum not in discrete boxes, and there are likely to be heated arguments about whether it is fair to take ethnicity into account at all.

So I can understand the reason for the simple 9 group model used for phase 1. But with case numbers as high as they are, a priority list that more accurately reflects risk would save many lives.

Now a multivariate regression that predicted risk as best we can would be incomprehensible to voters and politicians alike. So here’s the compromise that I would suggest:

Start with your age. Add 8 years if you are male. Add 8 years if you are black or Asian. Subtract 15 years if you don’t have to leave your home to work. Subtract 25 years if you have already had covid. Add 12 years for priority occupation. The result is your ‘effective age’ and determines your vaccine priority.

My numbers are illustrative, the actuaries can correct them, and calculate adjustments for other ethnic groups, health conditions etc.

It would be controversial, but it would save lives. If they can delay second doses in a crisis to save lives, then the government can take a bit of controversy on the chin to save lives.

* Joe Otten was the candidate for Sheffield Heeley in June 2017 and Doncaster North in December 2019 and is a councillor in Sheffield.