On January 15, 2021, the Oregon Governor announced a revised Covid-19 vaccination sequencing plan that includes vaccination of Oregon’s seniors. Phase 1a of the State’s plan qualified health care workers to receive vaccines, as well as those in long-term care settings. Individuals in this phase are currently being vaccinated.
The first group to qualify under Phase 1b of the plan will be teachers and childcare providers, on January 25th. Beginning Feb. 8, seniors are scheduled to be eligible for vaccination in four additional groups: seniors 80 and older first; followed later by seniors who are 75 and older; then seniors who are 70 and older; and lastly, Oregonians 65 and older.
According to the latest information from the Oregon Health Administration, due to vaccine supply constraints, it will take 15 or more weeks (instead of the planned 5 weeks) to vaccinate the five Phase 1b groups—assuming supplies materialize.
Given the uncertainty of vaccine supplies, it is crucial that the focus of vaccination reflect accurately the Covid-19 mortality risk faced by seniors. Unfortunately, the current plan implicitly assumes that the risk of death from Covid-19 for seniors increases only with age. Thus, the vaccination sequencing focusses on the most elderly first. This ignores completely the fact that gender is far more important, in terms of focusing on relative risk exposure, than simply age per se.
Although men and women are at similar risks of infection by Covid-19, men are far more likely to be killed by it. For example, a recent worldwide meta-analysis of over 3 million Covid-19 cases found that men are almost 3 times more likely than women to require admission to an intensive care unit (ICU). The same study found men to be 1.4 times as likely to die from Covid-19, on average across all age groups.
Age-Specific Relative Risks
But such average risk measures conceal the higher risks that gender adds at every age cohort. There are approximately 600,000 Oregon men in the 4 senior cohorts tabulated below. As the table indicates, male seniors face a mortality risk that is as much as 3.3 times that of their female counterparts. This pattern is true nationally, but is especially stark in the Oregon data.
Benefits of Gender Adjustment of Mortality Rates
At present, there is implicitly higher priority given to lower-risk individuals because of the reliance on age-based prioritization alone. Correcting this gender-based disparity will improve the focus on some of the most at-risk Oregonians, which is the objective of the immunization plan.
Doing so will benefit not, however, benefit just the vaccinated men. For example, vaccinating senior men will benefit all users of hospital and ICU capacity. Since men are almost 3 times more likely to require scarce and costly hospital ICU services, a vaccine that eliminates men’s risk of infection and hospitalization will reduce these burdens.
Everything else being equal, vaccination of a senior male will reduce ICU and hospital services demand by three times that of a vaccinated female of similar age. This benefits all potential hospital patients—both Covid-19 and non-Covid-19 patients, and affected ethnic males who also may comprise the senior male group.
Incorporating gender in the prioritization process will help to address another health disparity. There are several biological reasons that Covid-19 is more dangerous to men. These same factors appear to be associated with men’s relatively short life expectancy. On average men have a 5-year disadvantage in life-span over women, independent of Covid-19. Indeed, there are already about 90,000 fewer Oregon men than women in the senior cohorts identified in this study. Prioritizing men for Covid-19 helps to offset that health disparity to some degree.
Ideally, the rationing of vaccines and associated sequencing of vaccinations would be unnecessary. However, there are long delays anticipated for receipt of vaccine supplies. Elderly men will pay the price of the poor design of the vaccination plan.
