OPINION: Ageist COVID-19 Vaccine Policies Could Kill
Why this sociologist says it's wrong to prioritize young over old
When I read about the proposed "Fair Priority Model" for allocating COVID-19 vaccines in Science magazine recently — from University of Pennsylvania medical ethicist Ezekiel Emanuel and 18 others — I realized that ageist policies might just kill older people like me.
Central to their model of deciding who would have access to a vaccine is the goal of reducing what they call "premature deaths." In case you're thinking that a premature death is one that occurs before someone is ready to die, you're missing the point of the Fair Priority model.
The 'Fair Priority' Model for COVID-19 Vaccines
Its authors say a premature death is one that prevents someone from exercising their skills or realizing their goals later in life. In sum, this model assumes that lives of young people are worth more than those of older people because a young person has more years to live and those years are going to be productive.
Before our governments start implementing coronavirus allocation strategies, we need a major reset in our thinking about their older residents.
Meantime, medical professionals in COVID-19 hotspots such as Utah are considering the possibility of rationing health care to favor younger hospitalized patients over older ones. This is called instituting Crisis Standards of Care, which Arizona implemented in July when it was in the throes of a pandemic emergency.
Reading about the Fair Priority vaccine model made me realize that before our governments start implementing coronavirus allocation strategies, we need a major reset in our thinking about their older residents.
Since the onset of COVID-19, we have learned to equate being older with being vulnerable and in need of care.
Internalizing Ageism in the Pandemic
These past months have primed us to internalize ageism. For example, early in the pandemic, when cruise ships were looking for ports of refuge, a pulmonologist explained that the patients on the Princess Cruise were not like the average septuagenarian because they were not bedridden. The New England Journal of Medicine felt compelled to respond to this comment in an article clarifying that the average seventysomething is not bedridden.
The journal article stated, by way of illustration, that people in their 70s are running two of the three branches of the U.S. government and are the most rapidly growing segment of the U.S. labor force.
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We need to appreciate that, far from being on the receiving end of care during the pandemic, many older adults have carried on with jobs they had before COVID-19 in full-time or part-time employment.
Many are performing critical roles as essential frontline workers, including some retired health care professionals who answered the call to return to duty. Others have stepped in as volunteers to meet urgent needs in their neighborhoods and communities.
On the home front, they're often providing critical support to their families and friends, face-to-face and remotely.
Many are providing essential child support, with some moving into their sons' and daughters' homes to provide daily child care. Others are helping remotely with online learning and storytelling at a distance. In some cases, they're cooking food to drop off at the homes of over-stretched families or ordering groceries and meals to be delivered to them.
And many people in their 70s and 80s are supporting one another.
When my 78-year-old friend developed brain cancer, it was her 80-year-old best buddy who became one of two primary caregivers, driving her to medical appointments and grocery shopping.
Premature Deaths of Older Adults
Where I live, in Canada, COVID-19 deaths have occurred mainly in long-term care homes. If you lived in one or a retirement home, you had a 74 times greater chance of dying from COVID-19 than if you were the same age and living in your own home. What these COVID-19 victims died from was not their advanced age; they died of failed public policies.
Their deaths were not timely, they were premature. They had unknown years ahead of them and many were making contributions to society and to their families. Just ask their grieving loved ones who testify daily to the priceless time unfairly stolen from them.
Moving forward, our governments must resist the use of chronological age as a baseline for determining policy and avoid assumptions about someone's quality of life based on their age.
Making medical decisions this way is unacceptable in general, but especially so because older adults are a heterogeneous group.
Take two men I wrote about for my books on aging, both recommended to me as role models for aging well.
One man was over 100 and living in his own home with minimal support. Another was 66 and living in the assisted care section of a retirement residence. What those bare facts fail to capture was their creativity, wisdom, sense of humor and resilience — all characteristics which are critical to successfully maneuvering a pandemic.
If either of them had died from COVID-19, their deaths would have been premature.
Age Discrimination in COVID-19 Vaccine Testing
We're already seeing age discrimination in vaccine testing.
As Dr. Sharon Inouye wrote for Next Avenue, when she and her research team reviewed COVID-19 clinical trials registered at Clinicaltrials.gov as of June 1, 2020, they found that people over 65 were highly likely to be excluded from 53% of 847 COVID-19 clinical trials that qualified for detailed review. And older adults were highly likely to be excluded from 100% of 18 vaccine trials.
We keep hearing the pandemic mantra that we're all in this together. This means that vaccination policies must start from the principle that every single one of us deserves to be kept as safe as possible.