I am writing this by popular demand and thank you to those who have spurred me into action by your questions. Read to the end if you want to know why I am “pissed off”.

First, am I going to be vaccinated when offered-YES.

Should you-YES

Now, let me share some thoughts and facts regarding the COVID-19 vaccine(s):

Yes vaccines. We now have 2 and are anticipating more. This is as a result of parallel efforts to develop a vaccine coming to fruition. Think Pfizer, Moderna, Astra Zeneca, Johnson and Johnson…… This is due to a wise approach by the federal government investing dollars into vaccine development. However, nothing comes without conditions which is why Pfizer, whose vaccine was the first to be authorized for use, did not accept federal support for vaccine development.

These vaccines have raced through the developmental stage to deployment in a thankfully record time. This is not solely as a result of “Operation Warp Speed” but rather as part of an effort that began more than a decade ago with the recognition of a biological (read respiratory virus pandemic) threat and in anticipation of this basic science efforts to meet the perceived threat-read Bush administration.



“Which vaccine should I take?” As if there will be a choice for several months. We are currently in a time of inadequate supply of vaccine(s) and uncertainty of delivery and urgent need to mitigate the pandemic. We will ultimately enter a time of oversupply of vaccines. When is this likely to be-who knows? Oversupply may/will translate to choice. Also, it is likely that one vaccine will not fit all. Will the same vaccine be most effective in the elderly, the young, the pregnant, with various underlying medical conditions? Will the virus constantly mutate in a way like influenza that a yearly vaccination will be necessary, or will it be like mumps or measles where one vaccine is good for years? These are all questions that cannot be answered during clinical trials but may be more apparent during widespread deployment. Think the flu vaccine and the difference in dosing and vaccine type for 65+ year old vs under 65 vs children. Time and experience will refine vaccine recommendations as to type, timing, dose. We will better understand side effects as they occur and are reported.

When will I get my vaccination?

Not sure but hopefully soon. The first vaccinations are going to people easy to identify and distribute vaccines to-nursing home residents and their caretakers, frontline healthcare workers (still waiting for a precise definition of this one) and government officials (keep an eye on your TV). I suspect that the military is somewhere in this group. What do all these people have in common besides high risk? They are easily to identify and locate and thus vaccinate. What about everyone else? Would be nice to have a fully worked out plan to inform us all yesterday. I have no idea how the invitations to vaccinate will be delivered.

“What is the risk of getting vaccinated?”

Remember that the current vaccines are being deployed and administered under Emergency Use Authorizations (EUAs) which means they have been deemed safe and effective based on clinical trials that involved tens of thousands of vaccinated people. We are now expanding that to millions, tens of millions and finally hundreds of millions of vaccinations both domestically and internationally. Think making chocolate chip cookies for your family during the pandemic to acclaim leading to making cookies for friends again to acclaim and now thinking that you have a business possibility by selling your cookies to anyone who wants them. At first your recipe and home kitchen and local market are all enough to meet your needs. But demand for your cookies expands and so you need to scale up your recipe, expand your raw material suppliers and establish delivery and distribution networks. What could go wrong? Who would have thought that one of your critical ingredients causes an allergic reaction in 0.1% of the population? (0.1% of 10 is 0.01 people, of 100 is 0.1 person, of 1000 is 1 person, of 10,000 is 10 people and a mention in the local media, of 100,000 is 100 people and a visit from the Department of Public Health, 1,000,000 is 1,000 people…you get the idea. So, use math to inform your own thoughts about taking a vaccine where 30 to 40,000 people were involved in clinical trials to vaccinating the majority of the US’s 330 million people or the world’s 7.8 billion.

Now a comment on “us vs them” by which I mean our family versus other families, our community versus other communities, our state versus other states, our country versus other countries, old versus young, blue versus red, nice versus mean, rich versus poor, employed versus unemployed….. and who should be the first to be vaccinated in a time of limited resources. Let us start with the easiest in my opinion which is restricting vaccine availability to the US before the rest of the world by US companies or those vaccine producing companies that received federal funding. This may create enough of a problem for those international companies that supply raw materials for the vaccines to consider diverting their resources to other countries especially if the materials we speak of are in short supply. I will save the moral argument for another time-actually it is one I hope not to have to put in print believing it to be obvious.

Why I am “pissed off.”

I am pissed off because we still do not know the full details of vaccine distribution. The CDC just came out yesterday with further details regarding the hierarchy of vaccination. Why has this not been a public dialogue? The pandemic began a year ago. The pattern of infection and at-risk populations have been known for months. That we were going to have a vaccine someday was a given-after all what was “operation warp speed” referring to? Why are we still waiting to find out when each of us will have a vaccination? Why don’t we know how we are going to be informed?

I am pissed off that vaccine delivery to “low lying fruit” such as nursing home inhabitants and health care workers was publicized early and clearly. “Low lying fruit” means to me those that can be identified and located. How are the rest of us going to be vaccinated (I know “us” does not literally mean me because I am a healthcare worker)? Will we be notified/selected via our health insurance? What about the uninsured? Through work? What about the unemployed? Through voter registration? What about the unregistered? Through some governmental list? What about those not on the list? If we need to vaccinate 70-80% to reach “herd immunity” then that means 70-80% of everyone not just those that can be found on some list or registry. Did I miss the public discussion on this topic? If so, I apologize. The fact that so many have asked me these and many more questions means that I am not alone.

I am pissed off because we do not speak enough of essential versus essentially working people and although there is overlap between the two groups, they are not the same. Will we discriminate between those that are able to work at home versus those that cannot when it comes to vaccine availability? Is age truly the way to define vaccine delivery after we have decided who is “essential”? I am not arguing with age as a criterion for vaccination and I do understand the age-related severity of the pandemic morbidity and mortality. I am just frustrated by the blunt instrument used by our officials to make decisions that do not always make sense to me. Maybe better put that blunt instruments allow for the avoidance of making and explaining decisions.

I am really pissed off by what I perceive as a lack of public discourse and cohesion from our elected officials regarding the approach to the pandemic. I am personally appalled at the current administration and its handling of the worst public health disaster in my lifetime. The current situation regarding the pandemic is, in my view, an indictment against our approach as a country and as individuals.