Principle #3: Send Life-Saving Vaccines to the Places Where People are Most Likely to Die

My patients might not appreciate my advocacy for this position, but it stands to reason that if forced to allocate a scarce vaccine to different regions in the midst of a peaking pandemic, it makes sense to focus on those regions where people are most likely to die. Hawaii’s case load is stable, and we are averaging 1 death/day per million residents over the past week; while a state like Kansas is seeing a rise in cases and is already averaging 14 deaths/day per million. In the immediate future, those vaccines are 14X more likely to save a life in Kansas than Hawaii.

Assuming we might not want to start a civil war with vaccine allotments, there is still room for efficiency of allocation within states. Los Angeles County is averaging 55 deaths per day, while San Francisco County, at about 8% the population, is at 0.4. If current trends hold, that would imply a vaccine administered to an elder in LA is about 11 times more likely to save a life than one in San Francisco. I don’t want northern California to secede from their statehood. I do, however, want to save as many lives as possible with this vaccine. My napkin-back tells me we might have enough vaccine right now to immunize 50-60% of those Los Angelenos who will otherwise die next month, preventing about 700 deaths. Devote those vaccines to 10 million Northern Californians instead and we might prevent 60 deaths. Expand this regional math to all 50 states and the numbers could be considerable.