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1. | parent_author | "" |
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parent_permlink | covid |
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author | zafrada |
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permlink | weighing-the-impact-of-vaccinating-the-oldest-first |
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title | "Weighing the impact of vaccinating the oldest first. " |
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body | "
![image.png](https://files.peakd.com/file/peakd-hive/zafrada/dvJje5XN-image.png)
I agreed that we should vaccinate the old first, but the way some states/countries have tried to rigidly give the vaccine to only the oldest people is a mistake.
If vaccinating an 80 year-old were 100x as impactful as vaccinating a 65 year-old, then it would make sense to slow down the process and accept throwing out expired vaccine stock in order to reach the oldest folks first.
But in reality the ratio is more like 3x than 100x — so we should try to vaccinate the old first, but not be obsessive about it.
To see that we need to break down the benefits of a vaccination into two components:
1. Helping protect the person vaccinated
2. Helping prevent transmission to others
Older people are much more likely to die of COVID, though they each lose fewer life years when they do. An 80 yo who is vaccinated directly gains something like 10x as many quality-adjusted life years as would a 30 yo receiving the same vaccine.
But the second benefit — preventing someone from transmitting the illness to others — is closer to equal for both groups.
On the one hand, younger people are less bubbled, and so are more likely to pass COVID to others if they get it. On the other hand, older people are more likely to directly pass the disease to other older people, and they experience worse symptoms, making them more contagious.
Properly estimating the relative benefit of giving the vaccine to a 30 yo, 60 yo and 90 yo requires a complex model that considers different scenarios of COVID exponential growth, rate of vaccine scale-up, contagiousness parameters, who infects who, etc, etc.
But we can see that they can't be wildly different using this incredibly simplified picture of things:
- R0 was initially 3
- R is now ~1 and prevalence is 2%, so we're further away from herd immunity through illness than we are from mass vaccination
- Everyone over 70 has a 3% chance of dying if they get COVID
- Everyone under 70 suffers no health impact, but passes on the disease as normal
In this scenario there's two ways to completely end the COVID pandemic:
- Vaccinate the ~20% of the population that's over 70.
- Vaccinate any 66% of the population and achieve herd immunity.
By the time you've gotten all the way to either of those end points, we can see that the benefit of vaccinating someone over 70 was (1/0.2 + 1/0.66) while the benefit of vaccinating someone under 70 was (1/0.66) — a difference of about 4x.
Is 4x a great estimate? Not sure. This model is maximally rough, and the marginal benefits at different stages of the process could deviate more than that.
But the point is that because one important stream of benefit is similar whatever the age of the recipient, the ratio isn't so wide that you should accept a big slow-down in the process to vaccinate exactly the best people first.
If you're struggling to fill appointments with people over 80 (or folks who meet whatever Byzantine requirements you've established), just lower the age cut-off to 70 or 60, or whatever ensures you can get vaccinations into arms at the maximum possible clip." |
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