My second COVID-19 booster and the general vaccine rollout have made me think about a moment in Haiti a decade ago. Memories there have blurred, but I still vividly recall a fairly small crowd hovering behind a truck in Port-au-Prince. From the back of the truck small baggies of water were being handed out. There was no way the water being distributed was making its way to the truly parched. It was finding the tallest and strongest. Maybe some were totting baggies home to needy relatives, but most seemed to be topping their own tanks to get on with their days.

Fast forward now to COVID-19. Distributing a few precious, fragile droplets to millions is not an easy task. While I’m truly grateful to be amongst the first group of recipients, I’ll admit to feeling twinges of guilt as well; like sitting on a roomy, heated life raft drifting calmly from the Titanic.

As an aside, what’s bigger? 500,000 or half million? I just listened to a podcast that talks about psychological numbing that happens with big numbers. I’ll admit to it and I can see it all around me too. I’m also reminded about my previous post on survivor bias, or what I call “skydiver bias.” I’ve met numerous people who say their COVID infection wasn’t bad at all. In some cases they didn’t know they were infected. Because their voices are more audible than the half million newly silenced, there lies the bias.

Have you ever met someone who had a bad time sky diving? 

Survivor bias, or what I call “skydiver bias“.

Back to vaccine distribution. Elderly folks are driving for miles and waiting in lines in some cases for the jab. I’m getting emails from patients with comorbidities to see what options they may have. Schools are opening up soon with unvaccinated teachers getting anxious.

How best to distribute vaccine, I’m not certain. But I do feel sympathy for decision makers. Here are some competing arguments for who gets the jab when

• Frontline healthcare workers: Keep them/us healthy so we can keep helping others to stay alive.
• Frail and elderly with comorbidities: They’re at highest risk, but also perhaps less likely to be super spreaders. “Life years” added per jab are less as well for this group.
• Poor, unemployed minorities: They’re getting hit from all angles by COVID-19 and likely to live in tighter quarters.
• Employers, employees and other middle aged “essential” people: Keeping them alive helps keep others and the economy alive too.
• Teachers: They’re exposed to every respiratory illness available thanks to student nebulizers.
• Kids: They seem to be lowest risk overall, but life years added per jab are the most for them.
• Mask “deniers”: Maybe vaccines should be distributed at bars or other super spreader settings? Is the goal of the vaccine to save people we like, or to eradicate a virus?

My point being, no one answer is most equitable, appropriate, or correct. Nobody’s asking, but if distribution were up to me, I’d be guided by the following:

• Every extra day that vaccine spends in freezers is a small failure. I got my second dose 30mins after the 10 dose vial expired. Two more doses left inside the vial went down the drain. That’s tragic.
• Deep freezing vaccine and transporting thousands of miles to get to preferred groups seems crazy as well. I’d bump up populations living closest to vaccine manufacture sites with progressively increasing concentric rings. Weird right?

– – I’d also empower nurses in particular to make the decisions. Turn distribution into a competition. Who can give the most doses in a day. Give them as many vials as they want and then say “now go!” Some will start with their families and then branch out. But to me, that’s just fine. Nurses I know are exasperated by the rollout.For hydrating the parched, back of the truck water baggies may be suboptimal. But for vaccinating a planet, I think the Haitian distribution model may have some merit. Go fast and empower those doing the jabs.These next few months are going to be hard to watch. But I do feel somewhat hopeful… despite my bias.