As vaccination campaigns pick up speed globally, one thing has remained common across the board: the people getting inoculated are all adults. More specifically, the elderly and those with pre-existing conditions have been at the front of the line for their COVID-19 shots, with countries aiming to protect them from the deadly disease first.
The logic behind such an approach is pretty straightforward and hardly new. Ever since (at least) the 1957-58 influenza pandemic, shielding the frailest members of society—who are at the highest risk of severe complications or even death—as a top priority, and therefore slashing mortality rates in the midst of a raging public health crisis has been common practice. And the COVID-19 pandemic has been no different. During its onset, it was clear that the novel coronavirus had lethal implications for individuals above the age of 65 and those with health problems such as obesity, diabetes, and asthma, among others. At the same time, however, the virus was rapidly spreading through healthy young adults who, despite contracting it, were seemingly more likely to recover. In such circumstances, when vaccines finally became available, most countries (who had access to the jabs) opted to administer the shots to the highest risk individuals first, while keeping the younger population confined to their homes through lockdowns.
Though this is a strategy that makes intuitive (and perhaps more ethical) sense, a surge in COVID-19 infections through debilitating second waves in recent months and the propping up of a number of variants, all in the face of limited vaccine supplies, has raised calls for nations to now swiftly vaccinate young people around the world to curb the reach and intensity of the virus. Though young adults are less likely to die from COVID-19 (which is also constantly changing due to the emergence of variants) than older people, experts claim that they are significantly more prone to develop long-term health complications if they become infected. “I cannot tell you how many people I’ve taken care of in the ER—who are in their 20s, 30s, and 40s—who are never sick enough to end up in the ER with COVID but who now have long-lasting respiratory difficulties,” Dr. Megan Ranney, an emergency physician and director of the Brown-Lifespan Centre for Digital Health in the US told ABC17 News earlier this month.
Now, in an ideal scenario (which includes an unlimited supply of COVID-19 vaccines), countries would probably undertake a “vaccine for all” approach to inoculate everyone who was able and willing) to do so. However, with the supply and global capacity to produce shots severely limited, experts have argued in favour of focusing on the younger population first, in an effort to get back to “normal.” While some have based this on the idea that it is better to use a scarce resource (vaccines) to protect young persons who have a long and productive life ahead of them, others have also pointed to the practical considerations of such an approach. Vaccines not only provide direct protection to those who get the shot but also usually prevent the vaccinated individual from passing the infection onto others (indirect protection). Though it is presently unclear whether the COVID-19 vaccines on the market protect against this kind of transmission, such blocking features are a common characteristic of most licensed vaccines.
With this in mind, numerous studies have shown that prioritising the younger population does not necessarily adversely impact older people. Indirect protection was crucial in globally eradicating smallpox in 1977, and even today, youngsters are vaccinated against the flu first in an effort to adequately protect the elderly from its effects. Older people are generally less immunocompetent, and given that the efficacy of vaccinations is lower in older people, it makes more sense to vaccinate the younger population (that is more capable of driving infections), which can also enhance the effectiveness of the overall campaigns by making optimal use of limited resources.
Vaccinating young people is also essential to keep the economy running, by ensuring their protection and allowing them to return to work. Indonesia, for instance, first vaccinated its working-age adults after frontline health workers and public servants, in an effort to help revive the country’s struggling economy, which experienced its first recession in two decades in 2020. While it’s worth noting that the decision to inoculate 18-59-year-olds first was also driven by the fact that the vaccines available in the country at the time (China’s Sinovac CoronaVac) did not have enough data on their efficacy in elderly people, economists argued that the 18-59 age group’s high consumption needs would help jumpstart the economy. “They could jack up the economic recovery faster because household consumption contributes more than 50% to Indonesia’s economy,” Faisal Rachman, an economist with Bank Mandiri had told Reuters in January. Whether this approach reaps significant rewards though, only time will tell.
Of course, older people (age 65 and above) form only about 5% of Indonesia’s total population, which made its decision to focus on youngsters a less risky move. Meanwhile, countries like Britain and Japan have drastically different age structures (with the elderly respectively making up 20 and 28% of their populations), so a strategy like Jakarta’s would have probably not been as popular in those nations. In India, where only 6.38% of people are over 65, inoculating young, mobile, working people first could have probably helped to contain the current second wave of infections that is ravaging the country, and experts are now calling on authorities to reimagine their vaccination strategies and scale up shots for young people to reduce the burden on the healthcare infrastructure, save lives, and improve economic activity. Officials in Canada have also raised similar concerns, noting the importance of vaccinating young adults to get ahead of the variants.
Ultimately, there is no one-size-fits-all approach, and countries will have to take measures based on their own needs, capabilities, and demographics. What is certain, though, is that it would be a grave mistake to sideline the youth from any strategy completely. Given their higher levels of mobility and social interactions (which will only increase as lockdown restrictions are eased and economies open up), young adults are more likely to be superspreaders, which can in turn facilitate the emergence of variants that can be more infective and virulent, especially for older populations. If achieving herd immunity and eradicating the pandemic is the final goal, it will be impossible to do so unless young people are looked at as part of the solution, rather than the problem.
The Case For Prioritising Young People in Vaccination Campaigns
If achieving herd immunity and eradicating the pandemic is the final goal, it will be impossible to do so unless young people are looked at as part of the solution, rather than the problem.
May 12, 2021
SOURCE: THE WASHINGTON POST