Prioritizing The Vaccine — A Dilemma Playing Out As You Read This
Who gets it when?
You are in charge and need to make a decision: There is a limited number of vaccines in your area of jurisdiction. There is universal agreement that frontline healthcare workers should get the vaccine but which group should be next in line — first responders like police and fire or elderly residents of long-term care facilities? How about the nonclinical caregivers in those same long-term care facilities?
What about the teachers? Should they get it before people who are in prison? How about the elderly with existing medical conditions that make them particularly susceptible to the virus (comorbidities)?
What order of priority did you choose and what was your rationale?
There is not likely a one-best answer to the above situation and there will almost certainly be people who end up on different sides of the issue and who also feel passionately correct about their choice. Welcome to the current dilemma in the vaccination roll-out.
Dilemma: A situation in which a difficult choice has to be made between two or more alternatives, and where there are adverse consequences for whatever choice is made.
We face dilemmas in our personal and professional lives regularly. Should I move my family for this promotion I’ve been offered? What do we do about the manager who has great domain and industry knowledge but who has terrible people skills which drive good people away? Should the elderly parent with dementia come and live with us or be put into a care facility?
Like in Olympic competition, the “degree of difficulty” for making a choice is what elevates a simple and straightforward decision to the level of a true dilemma. What kind of latte to order from Starbucks is a simple choice based on preference and can only be considered a dilemma to a truly obsessive and coffee geeky individual.
This past weekend (December 13) the first batches of the Pfizer vaccine were released for transportation to U.S. destinations. While there are CDC guidelines for what the vaccine priorities should be, they are just that — guidelines. Click here for an interesting visual view for where YOU might be standing in line based on the CDC recommendations based on your age and other factors. Difficult choices will need to be made at the state and county levels for who gets it when. There will be dilemmas.
While many of those choices will be made by political and administrative leaders in the public arena, leaders of private organizations will also need to make some difficult choices. For hospital leaders, for instance, what does triage look like for a healthcare center? For example, how should support staff be prioritized who might not be patient-facing but without whom a hospital would grind to a halt? What about pediatric docs and nurses who don’t have any/many covid cases because of the nature of their specialty?
It’s reported in the Wall Street Journal that the hospitals and clinics affiliated with the University of Nebraska Medical Center will likely use some kind of lottery. Mayo Clinic is analyzing occupational risks among their clinical positions to help identify the queue. People are trying to figure this out on the fly.
Private industry business leaders will also play a part in deciding who in their companies is eligible for the vaccine and when. For the food industry, for instance, what’s the priority for people at different points in the all-important food supply chain, such as farm workers and meat plant employees? How about workers in food processing facilities, food distribution centers, and truck drivers? If they get sick and cannot work, the supply chain gets interrupted and we don’t eat. Widespread civil strive could ensue. There’s much at stake if there’s not much steak…
Over time there will likely be a sufficient supply for all, but for the next few months, there is not enough to go around even with additional suppliers being approved. Assuming there is great interest in people wanting to be vaccinated, there will be winners and losers in the short term. So, if you are in charge, how do you choose? What are the factors and considerations that you would weigh? Whom would you consult? How do you take into account both the head (science; practicality; critical mass, etc.) and heart (compassion; empathy; personal emotions) in decisions?
We talk a lot about “essential” and “non-essential” workers but the distinction is more like a continuum rather than a simple binary yes-no distinction. Two different studies were recently referenced in the press regarding the number of essential workers in the U.S. Interestingly, one study suggested 55 million, the other 74 million. Different criteria for defining “essential” will produce different results. Or as one article noted, “ You can be essential in New York but not in Texas.”
The Lifeboat Case
In the business training world, there is an activity usually called the Lifeboat Case or similar which forces participants to make life and death decisions based on a fictional situation. It goes something like this:
The ship is sinking far out at sea and there is one lifeboat left which can only accommodate 6 people. But there are 8 remaining people on board the boat, all who want to get into that lifeboat. How should it be decided who gets into the boat other than by drawing straws? It is a diverse group — there is a world class medical researcher; an unemployed ex-convict who won the boat trip in a contest; a mother of 6 children traveling to see her dying mother; a young couple on their honeymoon; a sick elderly man; a rabbi or priest; a decorated veteran. Who should be saved and what are the most important factors in making that determination?
There’s obviously not a “right” answer to this situation. Rather, it is an exercise designed to help participants identify their own values and assumptions and what the impact those values and assumptions might have not just for the lifeboat exercise but for everyday decision making.
With the lifeboat exercise, the choice about whom to save can be about someone’s clearly stated preferences (“A medical researcher is more valuable to society than someone who is sick and elderly”). But sometimes choices are about unspoken and perhaps unacknowledged unconscious biases (“ The ex-con must have done something bad to be in prison so he/she is probably a bad person and doesn’t deserve to be prioritized ahead of others who are more likely ‘good’ people.”).
Also, there is no additional information about the 8 people beyond how they have been identified. And in decision making, the absence or paucity of relevant data make values and principles all that much more important. Massive amounts of common sense can also be quite valuable.
When used as a training exercise, the greatest value comes in not just asking participants to make individual choices of which six to save, but to share choices and rationale with others in a small group (3–6 people) and asking them to try to reach agreement on the choices in a given time frame like 15–20 minutes. That can be very difficult because of the different assumptions and values which might have helped drive the choices that people made.
The lifeboat exercise can make for lively conversation at a social gathering (remember what those are?). By the way, who were the six you would choose and why?
Hence, there are often competing assumptions, values and criteria in play for important decisions, whether it is lifeboat survival or the very real dilemma of vaccine distribution. For the vaccine, almost everyone agrees that healthcare workers on the front-lines should be among the first. And the vulnerable elderly probably next. And the young and very young are in the back of the line because of their relatively low risk of becoming seriously ill from the virus.
But beyond that overall and incomplete sequencing, there are more conversations to be had and more tough choices to be made.
About the author: Mike Hoban is a leadership coach and advisor who also writes about business topics, sometimes in a whimsical way. He is actively working at becoming a world-class grandpa to his five young granddaughters. In addition to his 35+ years experience as a leader, consultant and business owner he has also published extensively in Fast Company and also wrote a business column for 12 years. Many of his recent commentaries — including several about leading during the COVID crisis — can be found on his LinkedIn page: https://www.linkedin.com/in/mike-hoban-b5756b6/ He can also be reached at mjhoban99@gmail.com.
Originally published at https://www.linkedin.com.
