The vaccines from the pharmaceutical companies Pfizer and Moderna are hailed as a game-changing weapon in the fight against COVID-19, which has killed more than 180 Alaskans and infected tens of thousands more.
But in the next few months, there will be far fewer vaccine doses available than people who want to receive them. And that presents the difficult question of who should get shots first.
GOP government Mike Dunleavy has the ultimate authority to decide, according to officials from his administration. But so far, the state has followed recommendations from a new advisory committee made up largely of health care providers, saying they are best placed to consider the science and data surrounding the vaccine.
The committee’s initial task of administering vaccines to different groups of healthcare professionals was narrow, and it has attracted relatively little public scrutiny as the first shipment of 35,000 doses arrives from the pharmaceutical companies Pfizer and BioNTech.
But its work is now entering a more delicate phase when additional doses become available. And letters are pouring in, underscoring efforts for tough dilemmas that some committee members were unaware they would be asked to consider.
Those seeking to secure their place in Alaska’s vaccine line include nonprofits, industry associations, and even government agencies.
State legislators want legislators and staff to be named significant workers, citing their importance to the state’s economic recovery and the reputation of the aging Capitol building as a “petri dish” for infectious diseases.
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These requests represent only a fraction of those received by the committee so far, and it is set to demand more public testimony at a meeting later this month.
Alaskans should know that the committee is approaching the job of humanity and sincerity, said Mark Carr, a regional ethicist with Providence Health & Services Alaska and one of the committee’s 24 members. He stressed that members do not make value judgments or use any kind of “moral algorithm.”
“Northing could be further away from the truth,” he said. “We need to identify a specific part of our structural system that we need to keep running so that we have a community left, so that we have a structure left that allows groceries to be on the shelf and allows people to drive to the hospital. “
Not what they signed up for
A separate federal committee had recommended frontline health care workers and residents of nursing home facilities be the first to receive the vaccine in the so-called “Phase 1a.”
But the state wanted advice on how to apply the recommendations to Alaska, and help decide exactly which health care professionals should go first, as there was not enough vaccine for all of them.
Committee members include hospital executives, physicians, nursing home administrators, Fred Meyer pharmacists, and executives from Alaska Tribal Health Providers. They eventually recommended, and Dunleavy’s administration agreed to start with two levels of phase 1 vaccination.
The first level is residents and staff in nursing homes as well as hospital-based health professionals on the front line “at greatest risk.” The second level includes emergency medical responders, people administering the vaccines, and community health assistants.
At a meeting on Sunday, the federal advisory committee voted that the next phase, 1b, will include the 19 million Americans aged 75 and over along with about 30 million frontline workers in places like schools, grocery stores, prisons and public transportation networks. It also said that Phase 1c would include another, broader group of essential workers plus adults with pre-existing medical conditions and people aged 65-74.
The Alaska Allocation Committee will now consider how to translate the national guidelines into state-specific recommendations.
Of several committee members recently reached by phone, all except Carr refused to be interviewed. Kosin said it’s probably because the group’s role has gained a much higher profile than many of its volunteer members originally expected.
“People did not necessarily sign up for it, nor did we anticipate it,” Kosin said. “It’s people doing rounds in hospitals, nursing home nurses, GPs and others who have jobs who just come together to try to help the public good and give advice.”
Navigating an “impossible task”
Now that the vaccine has arrived in Alaska, the committee has received two dozen letters of award, according to a list from Kosin. Lawyers for various organizations also spoke at the committee’s first round of public testimony Thursday night.
Among them was the Office of Children’s Services, part of Dunleavy’s administration, which wants its staff to be considered first responders. The Alaska branch of the American Civil Liberties Union, meanwhile, has called for prisoners to be given priority, citing the huge COVID-19 outbreaks in state-owned military buildings.
Then there is the Coastal Villages Region Fund, a nonprofit that owns fishing rights in the Bering Sea, which it uses to pay for social and economic programs in 20 villages in southwest Alaska, some of which have seen a large number of COVID-19 infections.
The CVRF has asked the award committee to recognize the region’s unique challenges, such as dense multi-family housing, few health clinics and the lack of pipeline water and sewer systems in some places. The idea is not without precedent: In Tennessee, the state’s draft vaccination plan called for allocating 5% of doses to areas that score high on a CDC “social vulnerability index.”
So perhaps farmers in southwest Alaska should be vaccinated around the same time as Alaska’s assigned doses due to medical conditions that place them at higher risk for serious disease from COVID-19, said Eric Deakin, CVRF’s CEO.
“I think most of our society is in danger,” Deakin said in an interview. “We do not think population centers should have priority over rural areas when making this vaccine distribution.”
Committee members are aware of the challenges facing Alaska in rural areas, said ethicist Carr. But the distribution dilemma remains particularly troubling because Alaskans and other Americans are not used to struggling with scarce resources, he added.
“It simply came to our notice then. That’s not who we are, ”Carr said. “Alaskans believe our resources are absolutely limitless.”
The committee tries to avoid using the word “prioritize” because it suggests members value certain groups over others, Carr said. Instead, the overall goal of the award process is to maximize Alaska’s health and well-being, said Dr. Anne Zink, Alaska’s Chief Medical Officer.
That’s one of the reasons the first round of vaccinations goes to the people who run Alaska’s hospitals and to facilities like nursing homes, Zink said.
It is not that these workers and residents are more valuable than others in the health care system, she said.
It is that if hospitals become overwhelmed because staff are sick, deaths among the public begin to rise much faster, Zink added. Vaccination of nursing home residents means fewer of them also end up being seriously ill and stressful hospitals, and this will allow the state to focus its virus testing efforts away from these facilities and towards places like schools and restaurants, she said.
Nevertheless, Zink acknowledged that many Alaskans are unlikely to be satisfied with the state’s allocation decisions.
“I wish I had better words to comfort the Alaskans by saying that we are trying to make this as fair and just as possible. But it is an impossible task and I know it does not feel reasonable to many, ”she said. “I have complete sympathy for it and can understand why people wanted it that way. But I can not do much else about it other than look at data and science and try to be as transparent as we can. ”