State health officials turn to vaccine ‘ethics guide’ it created decade ago to decide who gets first COVID-19 shots

The first people to receive shots of a potentially life-saving COVID-19 vaccine will earn their spots in line based on the critical work they do, their age tor underlying conditions.

The Centers for Disease Control voted Tuesday on the guidance it will offer to states, and Gov. Tim Walz has indicated will likely follow that guidance.

But exactly who receives priority is an ethical dilemma each state must finalize in the weeks to come. In Minnesota, that heavy debate actually started more than a decade ago in preparation for a pandemic one day.

And that time is now.

“I knew it was a possibility, but I didn’t know that I would experience it in my lifetime,” said Dr. Dorothy Vawter, who was part of the team that began working on the ethical considerations of a pandemic in Minnesota in 2010.

“Our project focused on planning for a serious pandemic,” she said. “A lot of other groups that were looking at this kind of work were thinking more about a moderate pandemic.”

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Vawter, who is the Associate Director of the Minnesota Center for Health Care Ethics, worked for months with other doctors, scientists and ethicists to develop a guide for government officials who would be making difficult decisions about scarce supplies.

The nearly 200-page report, titled For The Good Of Us All, predicted that the state’s stockpile of N-95 masks would dry up fast.

They forecasted a dire lack of ventilators.

They expected a need to ration a short supply of medications, just like the state had to do with remdesever.

“We were told by people who know about these things that, ‘Yes, this is to be expected.’ We don’t know if it’s going to happen next month, or ten years or in 30 years but it will happen,” Vawter said.

The next phase of this pandemic is the fair and ethical distribution of vaccines, assuming one is approved. Vawter said this is the exact reason why the group started planning.

“The state was saying please, give us some guidance,” she said.

The team developed a matrix framework for rationing a vaccine, based on two tracks, key workers and the general population. Groups of people at the highest risk of exposure at work took priority over those in the general population who have a high risk of dying from the virus.

“We actually made some fine distinctions between health care workers. It’s those who work with the people who have the infectious disease, so it’s not all healthcare workers stand in line in front of the public,” Vawter said. “We then turn to those in the public who are at highest risk of very serious consequences.”

Officials at the Minnesota Department of Health confirmed to 5 INVESTIGATES that it has drawn from the group’s work since the beginning of the pandemic.

Commissioner Jan Malcolm even applauded the early work during a call with reporters earlier this summer.

“This is something Minnesota has really been leading the nation on for probably 20 years now. Tthere’s been really robust discussions between the clinical community and the ethics community,” Malcolm said.

On Monday, Walz told reporters that the state will largely follow the guidance that comes from the CDC. A working group plans to meet and discuss the federal guidance on Friday and soon after it’s expected to issue its rollout plan.

“Planning ahead is always valuable,” Vawter said. “I’m proud. I think the work stands up well.”