the elderly, the essential – or both?

California is on the verge of making a difficult and controversial choice amid the limited supply of the coronavirus vaccine: to prioritize workers essential for vaccination over the elderly.

Such a measure, which will be debated on Wednesday by a state advisory committee, would help return schools and many businesses to a semblance of normalcy.

But it would delay the protection of those most at risk of dying.

The deliberation comes as the state must decide how to divide the second round of vaccines, following the current campaign to protect 2.4 million healthcare workers as a top priority.

These next groups are much larger, which makes prioritization much more difficult.

Only 2 million new doses of the vaccine are expected to arrive in January, although supplies will increase each month.

California has 11.9 million essential workers, of which 5.9 million are considered a priority, not counting healthcare workers. About 6 million people are over 65.

“These are tough decisions. And the best hope is that this shortage phase will be as short as possible, ”said Anthony Wright, executive director of the Sacramento Health Access-based consumer advocacy organization and a member of the state’s Community Vaccine Advisory Committee, a group of 60 communities. organizations that help guide state policies.

From all sides, “there are very strong arguments,” he said. “There is no right answer here.”

As currently written, the California guidelines state that the vaccine should be sent to workers in three groups: education and child care workers (1.4 million), service workers emergency (1.1 million) and people working in high-priority essential businesses (3.4 million), ranging from agriculture and grocery services to nurseries and sawmills.

Other criteria – such as age and underlying medical conditions – are “sub-priorities” of these three main groups.

This differs from the U.S. Centers for Disease Control and Prevention’s recommendation on Sunday that adults 75 and older, as well as essential frontline workers, both belong to the next vaccination group.

California has two task forces to ensure vaccines are distributed and administered fairly. The Guidelines Writing Working Group is developing California-specific guidelines for prioritizing and assigning vaccines when stocks are tight. The Community Vaccine Advisory Committee provides feedback and feedback on planning efforts and removes barriers to equitable vaccine implementation and decision making.

Once the recommendations are finalized, the California Department of Public Health provides the list of recommendations to local health departments. Local health departments will adjust the recommendations as needed for their area, and will also work on setting up sites – such as clinics, doctor’s offices, and pharmacies – where vaccination will take place in their area. These vaccination sites will be selected according to the priority groups in the region.

So far, the guideline writing task force has focused on essential workers, said Dr Robert Schechter, head of the California Department of Public Health’s division of immunizations and co-chair of the group. But over the next few days and weeks, the committee will be looking at people with health conditions, including advanced age, that put them at higher risk, he added.

On Wednesday, the state will discuss whether to adjust its criteria to also include elders, reflecting the new CDC recommendation. Wright expects California to align with CDC guidelines.

The risk of serious illness with COVID-19 increases with age, with older people being the most at risk. And some medical conditions, more common in older people, can also increase the risk of serious illness.

But many seniors are retired, so it is easier for them to stay at home.

If not included in this second phase of immunization, the elderly and people with high risk health conditions, as well as additional essential workers, will almost certainly be included in the third phase.

Across the country, there is a near universal consensus about who belonged to the first round, called “1a”: frontline health workers and residents of nursing homes. Only Florida included adults over 65 in its first wave of vaccinations.

But states are divided on who belongs to this next phase, officially called “1b”.

Alabama, Delaware, Florida, Maryland, North Carolina and Tennessee prioritize seniors and people with high-risk health conditions over non-essential health workers. According to an analysis by the Kaiser Family Foundation, North Carolina and Tennessee prioritize people with high-risk health conditions over people 65 and older.

The compromise depends on what a state is trying to achieve, according to Dr. Scott Gottlieb, former commissioner of the Food and Drug Administration. To reduce deaths, he said, you would prioritize the elderly. To reduce the infection rate and support the economy, you would prioritize essential workers.

In California, parents and educators celebrated the addition of teachers to the proposed “1b” list.

“There is a need to move forward with plans to reopen schools,” said Stacy Newsom Kerr, a teacher in Santa Cruz. “In my district, something like 97% of teachers feel that going back to class is not safe right now.”

Members of the justice system also applauded their inclusion.

“It was treacherous. During all this time, we have never stopped going to court, ”said Molly O’Neal, public defender for Santa Clara County. “The hallways were really crowded, with members of the public coming in, and no one did any kind of mask application.”

But others, including businesses, unions and industry trade associations, were frustrated at having to wait.

“We are everywhere. We come into contact with a very large number of people, ”said David Chandler of the California Association of Licensed Security Agencies, Guards & Associates, which represents 600,000 security officers. “We are in all types of businesses, whether it is a retail establishment, hospital, distribution centers, transportation hubs or financial institutions.”

Amazon has already made an agreement with a licensed healthcare provider to administer COVID-19 vaccines to its employees on site at its facilities. He just needs permission to get the vaccine.

Among those not on the list: Space X scientists who look after the four astronauts currently on the space station; Lyft and Uber drivers; the people who collect and treat municipal solid waste; longshoremen and other Pacific marine workers and employees of the California Independent System Operator, responsible for maintaining the reliability of one of the largest and most modern power systems in the world.

And although transit workers are on the CDC’s list, they are not on the state’s proposed list. “Our frontline workers sit alongside other essential workers: grocery clerks, healthcare workers, caregivers and emergency service personnel and therefore deserve equal priority to receive the COVID-19 vaccine,” says Robert Lyles of AC Transit.

Wright argues that now is the time to think about the common good. Even though others are vaccinated before us, we all benefit.

“It is in my interest to educate my children. It is in my best interests to have access to an intensive care bed. It’s in my best interests to have groceries delivered and to have emergency services, ”he said.