On December 8, 2020, the first Pfizer Covid-19 vaccine went into the arm of a 90-year-old woman, Margaret Keenan, with the second delivered to an 81-year-old man. Health care workers and people over the age of 80 years are first in line to be vaccinated in the UK. As we see vaccination protocols begin to roll out, several people have asked: why should such old people, people who are going to die soon anyway, be given the vaccine first? Ageism in our society has been exposed more clearly than usual during this pandemic, and this is another example. We tend to devalue older people; so it is easy to deprioritize older human beings when medical supplies are in demand — ICU beds, ventilators, and now vaccinations. As an accurate generalization, older people have less life ahead, but our ageist beliefs add to this “certainly less valuable life ahead” than a younger person. So why should older people get the vaccine?
There are several reasons. The simplest and most straightforward answer is because data tell us that older people are the most likely to be severely ill and die from the virus. As a group, they are most at-risk of morbidity and mortality. So, it makes sense that more suffering will be relieved and more lives will be saved if we target this group for vaccination. And once we identify and prioritize an at-risk group, whether it be frontline health care workers, people with certain health conditions or older people, we can’t decide who within those groups are most “worthy” — the most important or skilled health care worker, the most deserving or contributing older adult. That would be an impossible and immoral effort.
Beyond this straightforward reason, here are some others.
Yes, older people may have less years of life ahead than behind, but there is life ahead. Older people are survivors…they have made it into the 8th, 9th, and 10th decade of life! And life expectancy works this way: the longer you live, the longer you live. According to the Social Security Administration actuarial tables, an 80-year-old in this country can expect to live another 10 years; and on average, a 100-year-old person has another two to three years of life ahead. As seen by Ms. Keenen, she was excited and grateful to get the vaccine and looking forward to more life, to reconnecting with family and friends, to being with her grandchildren. Like any older person (really, like a person of any age,) she may die tomorrow; but she may have more years to take part in life, to enjoy and be enjoyed by family and friends.
Thinking beyond the individual older adult — the benefits of vaccination don’t stop at improving the chances of any one person living longer. Getting vaccinated has greater impact; just like wearing a mask: it is to protect others, not just oneself. We stay home to break the transmission, not just to be safe ourselves. Same for the vaccine. As an example, the nursing home industry has been devastated by the virus: 40% of deaths in this country are among nursing home residents; and staff members face high exposure for themselves and their families. Further, family members of the residents have been devastated by their exclusion from the facilities. If nursing home residents (the majority of whom are over the age of 80) are vaccinated, all people in those communities will be safer, staff can do their high-touch jobs much more safely and easily, and family members will be relieved to be able to rejoin their older relatives. In other words, the community, not just the older adults who got vaccinated, benefits. In this sense, the vaccine is a common good.
Another way of thinking about the common good of older adults getting vaccinated is this: in general, older people who get sick have more complex medical conditions and higher health care needs than younger people who get sick.1 In other words, hospitalization rates are higher among older adults and older patients use more intense hospital resources (before, during, and probably after COVID). So, older adults who are protected from COVID will provide more relief to the overburdened health care system than other populations who may be vaccinated. Older adults are at higher risk for hospitalization when they contract the virus, so if fewer older adults need hospitalization, more resources, including human ones, will be made available for other purposes and other populations. And at this point in the pandemic, we sure need this relief.
Eventually, there will be enough vaccines for everyone who wants one to get one. In the meantime, it makes sense to prioritize older adults, including the oldest people in our population.
- Statistical Brief #235. Healthcare Cost and Utilization Project (HCUP). January 2018. Agency for Healthcare Research and Quality, Rockville, MD.
Nancy Morrow-Howell, PhD is director of the Harvey A. Friedman Center for Aging at the Institute for Public Health. The center works toward a global society where all older adults have maximum opportunity for health, security and engagement.