Who Gets the Covid-19 Vaccine First? Here’s One Idea

To allocate the drug, Pittsburg doctors decided that the lottery would give preference to health care workers and emergency medical workers. The doctors also weighted the odds to favor people from economically disadvantaged areas, who tend to be mostly Black and Hispanic.

People with other illnesses and limited life spans, like end-stage cancer patients, had the odds weighted against them, giving them a smaller chance to win in the lottery. The system did not consider age, race, ethnicity, quality of life, ability to pay or whether a patient has a disability.

The lottery began in early June, Dr. White said: “We had 64 patients. We had to make the supply of remdesivir last at least two weeks. We only had enough to treat one in four patients.”

They had a brief respite from the lottery when cases began falling and supplies of remdesivir seemed adequate. But on Sunday, with cases rising again and enough remdesivir for only about half the patients who could be helped by taking it, the hospital system was forced to go back to a lottery.

A weighted lottery will be used in South Carolina if the swelling number of patients causes a shortage, said Dr. Dee Ford, an infectious disease specialist at the Medical University of South Carolina and a member of an advisory group to the state health department. So far, she said, the state’s supply of remdesivir remains adequate.

Dr. White and his colleagues were considering a weighted lottery before the remdesivir shortage began. And so were other ethicists, like Dr. Robert Truog at Harvard Medical School who had learned about the system when he’d feared a ventilator shortage in March.

He consulted with Dr. White, who had developed a system that awarded points to severely ill coronavirus patients depending on their estimated likelihood of surviving. After Dr. Truog and his colleagues published a paper on ventilator distribution, Dr. Truog said, “we got a call from an economist at M.I.T.”