How could the coronavirus vaccine be distributed?
One possibility, if and when we have an effective Covid-19 vaccine, is the so-called "weighted lottery", with which a certain probability of treatment is distributed to each one. Let's try to understand how and on what basis
(photo: Getty Images) There is a dystopian story published in 1948. It is titled The Lottery and was written by Shirley Jackson, author and journalist of the New Yorker. The story is set in a placid and idyllic village, where 364 days a year life flows calmly and motionless. On June 27, things are different: the inhabitants are called to participate in a disturbing lottery that is the arbiter of everyone's life and death. And lottery has returned to talk just in these days, in a context (fortunately) completely different, but somehow still linked to health, both personal and global. The theme, of course, is the Covid-19 pandemic and the administration of a vaccine (which, of course, despite several encouraging signs, we still don't have available) to stop it. The question, in small terms, is the following: given that we will be able to develop an effective and safe vaccine, it will certainly not be possible - at least in a short time - to produce it in sufficient quantities to administer it to all those who need it. So somehow we will have to choose. We had already talked about it some time ago, fearing the fear that, as happened in the past, the most disadvantaged nations and the poorest sections of the population could remain cut off from the distribution of the life-saving vaccine. The question, therefore, is not only scientific in the strict sense, but also political, economic, social and ethical.ranking
The Centers for Disease Control and Prevention (Cdc) in the united states, truth, in April, had already begun to work on the issue, developing a “classification, preliminary” (lottery, rank, et similia, may seem terms of raw. But if there is to make choices – and this is inevitably the case – you have to also call things with their names) pursuant to which the first to receive the vaccine would have been the doctors and those responsible for national security, followed by workers in the supply chains most essential and the most vulnerable, including the elderly and patients with previous pathologies. Side note: another category of protection (on which, however, the Cdc does not yet expressed) would be the blacks and hispanics, including communities where the virus has claimed many more victims than elsewhere . Then came into play the lottery.The concept is contained in a document published by the Department of Critical Care Medicine of the School of Medicine at the University of Pittsburgh , entitled " A policy model hospital for an equitable allocation of medicines to treat Covid-19 and it was recently revived by the New York Times . “If the reserves are insufficient to treat all patients,” it says in job, “should I use a lottery, weighted or a system of reserve category to ensure that resources are allocated in the fairest way possible. The groups that should have priority are: 1) individuals from disadvantaged areas [defined according to the so-called Area Deprivation Index , ed], and 2) workers are essential, defined by the essential areas necessary to the state not to stop the physical operations during the pandemic. It is important to emphasize that this category does not include only health care workers but also the low-paid workers who may be socially and economically vulnerable, as the salespeople of supermarkets, the drivers of public transport, farmers and keepers. People with a life expectancy of less than a year should not be excluded from access to treatment, but should receive a lower priority compared to individuals that are not in the terminal phase” .
The lottery remdesivir
With the lottery system weighted, substantially, the vaccine (or other treatment) is put in the palio, just like the prize money in a lottery. But not all patients have equal probability of winning: to continue with the analogy, it is as if the people were to receive a number of tickets weighted in relation to membership of a category of people at risk or disadvantaged. In these conditions, anyone can potentially win a treatment, but those who are worse off has more chances of getting it. The system has already been tested at the Department of Critical Medicine at Pittsburgh for the distribution of the remdesivir : “It's all very new,” said Douglas White , deputy director of the department, and bioethicist. “We have noticed that patients have accepted the results of the lottery, even when they have lost and have been denied the treatments. I think that happened because we are very transparent about the reasons for and the ethical framework that applies the same way to all the hospitals, whether it is the president of the hospital or the homeless” . In that situation, the health decided to “assign tickets” for health professionals, to medical emergencies and patients from more deprived areas (especially black and Latin); to persons with prior pathology, and lower life expectancy, as people with terminal cancer were assigned lower probability of victory.The algorithm did not take into account factors such as age, ethnic group membership, quality of life, socioeconomic status, and presence of disability. “We had 64 patients to be treated,” continues White, “and we had to make the last stocks of remdesivir at least two weeks and, in practice, we stock to treat only one patient out of four.” After a few days of respite, thanks to a decline in infections, things returned to get ugly. And at that point it was necessary to resort to the lottery. Similar cases have occurred, in other structures, for the fans , even if you never got to the point of actually having to draw the name of the winners .
How a clinical trial
The group of Pittsburgh, in the document, has compiled a list also of the precise rules on how to make the distribution of tickets and the draw, with a lot of tables, and step by step guide.References: University of Pittsburgh The draw, in particular, “you can run with a generator of random numbers as that of random.org extraction should take place in the presence of two witnesses and video recorded” . The system, among other things, he would have another side benefit : with the lottery, it would be possible for researchers to discover, in a rigorous way, as to which subgroup of patients it works better to have a vaccine or a drug, from the moment that administration conduct with this policy would be equivalent more or less to a controlled clinical trial and randomised.
