With multiple Covid-19 vaccines now approved having received Emergency Use Authorization (EUA), and with others on the way, two big questions keep resurfacing. One is on the prioritization of who should be offered the vaccines first, the other is about the willingness of people to be vaccinated at all. The first is a very valid debate, with quite a bit of tension in the system. Should we focus first on those with a high risk of exposure (i.e., healthcare workers) or high risk of death (i.e., pre-existing conditions)? Should we prioritize minorities who have historically been underserved by the medical community? Or is that too much of a throwback to the days when Black Americans were the subjects of medical experimentation? This later point intersects with the second question, because Black Americans are one of the most wary groups when it comes to being vaccinated against Covid-19.

On the prioritization front there are two camps. The first camp believes we should focus on healthcare workers so that our ability to care for Covid-19 and other patients is not diminished by those healthcare workers contracting Covid-19. We may feel good about rewarding them for their heroic efforts throughout 2020, but it is keeping them in the fight that justifies prioritization over the second camp. The second camp is simple, prioritization based purely on reducing death. A healthy young healthcare worker is very unlikely to experience more than mild illness, so why are they being prioritized over others who would likely experience severe illness or death? This is, of course, a vicious cycle of argument since even a mildly ill (or asymptomatic) healthcare worker is out of the healthcare business for weeks. And if we have enough of those, then people will die from lack of adequate care. But it is still a good philosophical argument to have. I have even talked to healthcare workers who are in no rush to be vaccinated, in part, because they believe it would be more valuable for others to get the vaccine first. For all the debate underway, and the variation between states since they decide the detailed vaccination strategy (based on CDC guidance), prioritization is quickly becoming the less interesting point simply because it is getting to be too late to alter the strategy.

So we switch focus to the second question, will people (and I’m U.S. focused here obvious) actually get vaccinated? Before delving into this more broadly I’ll talk about my personal position. I am one of the most pro-vaccine people on the planet. I know this comes from my parents, in addition to my scientific viewpoint. I grew up with stories about the horrors of Polio, starting from the days when I asked my mother why one of our cousins needed a brace to walk. During the AIDS Crisis my mother really opened up about Polio as it triggered memories of her youth, and the fear that they lived with. And one of my earliest childhood memories? Lining up for blocks to get into a polio vaccination clinic. Hours waiting in line so that I could eat a sugar cube that had a drop of the newly introduced Sabin Polio Vaccine on it. Recently I’d asked my mother if her mother had told stories about the Spanish Flu, and instead she revealed that the pockmark on my Grandmother’s face was the result of Smallpox. Polio and Smallpox, two horrific scourges of humanity that only a few remaining Americans have any personal knowledge of. Two that I haven’t had to worry about my entire life because of vaccines. Despite that, I’m not in a rush to get the Covid-19 vaccine even though I deeply desire one.

My reluctance to get the Covid-19 vaccine is simple. Since it will not materially alter my life if I get it in January versus March, April, or even June, I’d rather wait and make sure we don’t discover a different side-effect profile in broad use than was found during trials. And that is partially a reflection of age. I’m on the cusp of being in one of the riskier groups, both by age and pre-existing conditions, but not actually there. So I don’t feel the full pressure of the high probability of severe illness should I contract Covid-19. On the other hand, I am not as much of a risk taker as I was in my 20s or even 30s when I not only would be jumping up and down for the vaccine I would likely have applied to be in a trial. So the risk/reward evaluation is, I want it soon but I’m not in a rush. Now if there were lifestyle benefits, like being able to visit my mother (who I have only seen once in a year, and who will be receiving the vaccine very shortly) then the risk/reward balance would change and I’d be in more of a rush. But so far no one is suggesting being vaccinated exempts you from all the restrictions on life. That is probably not something we see until the summer.

It’s not just me of course. The general conversation I have with people reveals similar thinking to mine. Even others who very much want to be vaccinated are in no rush. Then there are the skeptics for various reasons. Finally there are those who are either broadly anti-vaccine, or have been convinced there are issues with these. We will ignore those who are broadly anti-vaccine because that’s a different topic. We should be addressing those with “other issues” by addressing those issues. Yet I had to do faceplant the other day as Colorado’s State Epidemiologist tried to address the question of the use of abortive fetal cell lines in the development of Covid-19 vaccines. She well addressed that the vaccines don’t contain any fetal cells, but botched the overall answer by obfuscating whether the cell lines used in development of the vaccines originated from abortive fetal tissue. This obfuscation is certain to fuel the fire of many morally opposed to the use of abortive fetal tissue in medical research, and cause them to avoid vaccines where this is the case. I think North Dakota handles this question much better, pointing out that many key authorities have rules there is no moral conflict. Even the Catholic Church is supporting the use of these vaccines. Still, many are likely to avoid the vaccine over this moral dilemma. And as you’ll see in a minute, that’s ok.

As for some of the other objections, well I just can’t deal with the “Bill Gates trying to inject us all with tracking chips” people. I will admit that actually knowing Bill, not that we are buddies or anything, causes me to get pretty emotional about irrational attacks on him. I think that most people who have worked with Bill over the years have the same kind of reaction. So we will ignore those people. Oh, and as you’ll see in a minute, their irrationality doesn’t matter.

Right now we are supply limited on Covid-19 vaccine. That means many of these debates just don’t matter. If people in the artificially determined higher priority groups delay being vaccinated when initially offered there are plenty of people in the next priority group ready to step in a little earlier. I’ve been predicting that the vaccines will be made available to anyone who wants them much earlier than the official timeline specifically because of this. That’s not failure, that’s success. There are many paths to get to the endpoint we are seeking, which is very high percentage of the population being vaccinated. You can try as much as you want to come up with the optimal path to get there, but that was never going to be fully agreed to or realistically executed upon. What’s important is every dose available being deployed as quickly as possible.

What about all those resisting for one reason or another? With a few small exceptions it doesn’t matter because their objections will fall by the wayside as vaccination proceeds. Myself, and all those with a little reluctance? I’m not that reluctant. If my doctor calls in March and says “go” I’ll go for it. Actually, I think February would be ok. My wife commented she wanted 6 months of data, and I pointed out that we’ve already passed that mark for trial participants. We will soon have 10s of millions of Americans, and many more worldwide, who have been vaccinated and that will remove a lot of doubts. There are vaccines in the pipeline with absolutely no taint of the abortive fetal tissue issue. By the time we need to get those with remaining moral concerns on board at least one of those should be available. Even the “tracking chip” people will eventually find a vaccine available which Bill Gates had absolutely no involvement in, and so perhaps many can be convinced to be vaccinated with those. This all goes back to my point, that no grand plan survives (as in the military, no battle plan survives the first encounter with the enemy). And that’s ok.

Everyone who is vaccinated is a step in breaking the back of Covid-19. No we don’t have data on if these people can still transmit the SARS-Cov-2 virus, but that’s just a lack of data. It is one of those things that we gave up by starting vaccinations under EUAs rather than full approvals. That data will come in as we go, but it seems very likely that vaccination will at least reduce (if not eliminate) transmission. And if we get those most likely to suffer from severe illness vaccinated early, it may not even matter. We live our daily lives with the threat of mild to moderate illness as a constant, and if we reduce the Covid-19 threat to the level of other constant threats then life as normal can return.

When asked about return to normal spectator sports the other day Colorado Governor Polis said he expects some people to be in the stands for the Colorado Rockies’s season opener at Coors Field in April, and that by the last (regular season) game at Coors Field in September the stands will be full. That’s a really fun timeline to be working with, especially if you are a baseball fan like me.

The bottom line for me is that most of the debates about the Covid-19 vaccines themselves, the prioritization of offering them, the willingness to be vaccinated, etc. are pretty much meaningless. All that is important is that we get on with vaccinating people as quickly as we possibly can, the rest will take care of itself.

Less talk, more pokes.