BRAND NEW BEGINNINGS

 Beginnings are always messy. ~ John Galsworthy 

Greetings from the very near future – 1/21/21, only 21 days from now, and a world apart from yesterday.

Let me introduce myself. I’m Lefty Solomon, outside the newly-occupied White House, with Joseph R. Biden, Jr. (aka, Joe), in residence as our 46th president of the United States. Hooray! I’m loosely connected with several very liberal groups like Progressive Majority and People’s Action.

Actually, I came here yesterday, Jan. 20th, hoping to see #45 slunk southward to Palm Beach, but alas he must have cowardly used Harry Potter’s invisibility cloak and disappeared like a faux, manic King Lear. No surprise at all, really.

Because on last November 3rd we helped President Biden be able to move into 1600 Pennsylvania Avenue yesterday, strongly Liberal Progressives (SLPs) want Joe to initiate big changes without delay. For example, it’s way beyond time for all of us to adopt pandemic-induced social re-arrangements and priorities to assist the oppressed.

Starting with SLPs, we will all adopt universal immigrant status. The president should mandate everyone to do so as well. We’re all immigrants; at some point in the recent or deeper past, everyone’s ancestors came from another country (even Native-Americans way, way, way long ago who likely came from Asia). Such immigrant-status is positively crucial (see this story) for all to adopt so we can better see the world as filled with prejudice that must be slayed ASAP.

Likewise, “privileged” and “elite” status should become woebegone negatives. If your background or foreground involves being connected with at least “upper middle-class”, this status should be tentative. Upper middle class includes people whose earned income roughly exceeds $107,000. Remember, over 80% of Americans have called themselves “middle class.” Upper middle-class folks are about 15% of the population. Privileged, elite status should be quickly discharged.

Is it time to cancel all facets of inequality? We certainly think so. I present 33 “flavors” of inequality below that NYTimesters and other compatriots in the media have identified. This list is not meant to be all-inclusive. These facets of inequality include the old standbys of income and wealth disparity, as well as the environmental inequality of wild fires, inequities faced by being left-handed and discriminated farmers of color.

Strongly Liberal Progressives believe former privileged folks must mythologize their past far more adeptly. Therapy may help. They should perhaps consider themselves as children of hard-working, underpaid single-mothers joining with newly-adopted immigrants to rectify our inequality-filled world. Feels totally different, right? That’s a step in the right (or is it left) direction.

Time is of the essence, which raises two questions. Where are our not already-tainted “non-elites,” that we soooo desperately need to run the nation in a totally equitable fashion? And how will we get to true Total Equality without their and others’ help?

Regarding the second question, as you may recall in early January President Biden finally acceded to our SLPs’ demand to “equalize our society, now.” He tentatively agreed to create a new White House Office of Equity (WHOE) after we SLPs lodged our 54th major objection to his wishy-washy cabinet-level appointees that, in our eyes are undecided supporters of Total Equality and justice for all. I mean, how come Retired Gen. Lloyd Austin, President Biden’s pick for Secretary of Defense, has yet to announce he will defund the Military Police Corps?

Diana Moon Glampers, D.E. (Doctor of Equity), the soon-to-be appointed Handicapper General will be running the WHOE. She will rally her team to rapidly achieve Total Equity. And no, the new president has decided this “cabinet-level” position doesn’t need Sour Mitch’s or the Senate’s approval. Whew.

Finding funding for the WHOE is a slightly different matter, that we’re sure the president can surmount. After all, he will immediately cancel all contracts to build The Wall.

Dr. Glampers will properly handicap each and every above-average person in our great nation and “revert them to the mean.” And what a mean that will be; remember Joe the Plumber; remember Harrison Bergeron?

Clearly, Dr. Glampers will have her work cut out for her. She will be guiding us to secure a lot more equality in the US. Each of President Biden’s cabinet members will be strained by overwhelming public expectations to achieve significant accomplishments in record time. The Senate Repubs will joust against them. Not only that; he and his cabinet will be expected to interact with key Congressional Repubs, of all people, to follow the president’s strong direction for “meaningful dialog” with the enemy members across the aisle.

Less economic inequity means the US Gini Index, a measure of income inequality, will need to fall. The Gini Index has steadily increased since the 1970’s, indicating more inequality. Recently the US Gini Index was 41.5, securing a rank of 51st worst (highest) in the world. Dr. Glampers will want to push our Gini way back into its bottle towards a value of 25.0, which is equal to Ukraine’s, the most income-equal nation.

Who would have guessed Ukraine as being the nation with most-equally-distributed income of the 159 listed by IndexMundi? Not me and not likely Hunter. Nevertheless, let me be clear; even with this accolade, I’m not yet ready to move to Kiev.

Getting the US anywhere within a proverbial block of Ukraine’s Gini will be a fully-burdened political expedition on unknown, hazardous trails. Why? Because it will involve significant amounts of take-away by the government for many formally-privileged, elite people. It will certainly serve the interests of reducing inequality, but even I realize I’d better hold my political breath as long as possible.

Dr. Glampers also will be kept very busy creating new, needed policies beyond income and wealth redistribution, to staunch the spread of many other facets of inequality. I expect it will be a thoroughly fraught, but needed journey.

I hope your New Year’s was happy Diana because your days will now be super stressful and surrounded by many upset folks. We SLPs hope Themis, the Greek god of fairness, will be close at your side. Still, we stand right behind you in wishing you all the luck you can find; you’ll need it. Onward to utopian Total Equality. Here below is my list of inequalities, before my last comments.  

LIST OF INEQUALITIES

Here are 33 inequalities that have been identified in the media.  

#	Inequality Type
1	Income. Ye old faithful granddaddy measure of inequality. See Chartbook of Economic Inequality for actual #s over time for the US and other nations.
2	Wealth. The grandmommy of inequalities; where the real $$ are. See Chartbook
3	Left-Handed discrimination. Tell me about it.
4	High-school grads. We provide way more monetary support to college students; not enough for just high-school grads, over 70% of whom don’t go to college.
5	Inequitable environmentalism. Is environmentalism just for rich people? So it appears for environmental justice warriors.
6	Unequal joints. Smaller, independent marijuana growers can’t compete with “corporate” producers’ lower prices, squandering legal weed’s promise of a more equitable society.
7	Kids in poor communities often lack opportunities to play, unlike richer-families, e.g., sing, run free, and immerse themselves in imaginary worlds.
8	Environmental inequality of wild fires. Richer folks move back in, poorer folks can’t/don’t.
9	Health care. Even with the ACA, and the Repubs’ serious continuing efforts to eliminate it, 9.1% of people had no care (30M people).
10	Inequities connected with care and access for disabled people
11	Data-driven medicine “threatens to make a crushingly unequal system even more so.”
12	Economic growth. Dems’ legislation, never-to-see-daylight (until 1/21/21?), that would mandate the govt to calculate a new measure of quarterly economic GDP growth for each income decile in the US.
13	Inequality made worse by K-12 long summer vacations. But of courses.
14	Berkeley makes its libraries more “egalitarian,” and poorer, by eliminating overdue late fees that were judged inequitably paid by lower-income users.
15	Parents’ benefits at hi-tech and other firms; they get more benefits than non-parents.
16	Student debt crisis as ever-more young people attend post-HS education (college) they do it by borrowing. Total student loan debt is $1.59T. Median BA-holder debt= $32k (in 2019). Not strictly “inequality”, but hey.
17	Nannies/Domestic workers/Babysitters. These folks virtually always get compensated in cash. Thus, their income doesn’t include payment of any employment taxes, like FICA.
18	Criminal Justice. Blacks are arrested and jailed disproportionately more than other races. Such Inequities in criminal justice system for people of color have been noted since before the 18th century.
19	Employment. More young people, Blacks and Hispanics are unemployed than others. Higher unemployment for people with less than HS education and just a HS education than a college education, as always.
20	Executive employment. A disproportionately small share of S&P500 firms’ Board members (as well as other firms’) are women.
21	Generational inequities. More millennials are living with their parents that’s not always a happy place for anyone. And more Boomers are retiring and/or being subject to employers’ ageist policies.
22	Gender discrimination. Women have forever had unequal access to public buildings’ bathrooms, just eyeball the queues for the loo at any event. Build more of ‘em, and they will come.
23	Dental inequality. We need better gum control. Medicaid does not offer dental care, which harms people’s health.
24	Cellphone gender gap. Women’s usage of cellphones in low- and middle-income nations lags behind that of men causing economic harm.
25	Property tax inequity. Hispanic and Black homeowners often face higher property tax assessment rates than White homeowners in the same tax jurisdiction.
26	Psychology of inequality. It had to be: it's human nature to compare ourselves to others. But that instinct can cause psychological stress. Where we think we stand on that ladder tells you a lot about a person's life and their life outcomes. Psychologists to the rescue? If only.
27	Farmers of color. Apparently young farmers and farmers of color have been “shut out” of govt ag aid programs.
28	Mobile inequality. Being able or unable to move from one location (say in a dense, urban, “super-star” city’s core) to another location is unequally available.
29	Vintage inequality. Income inequality has erased your chance to drink exalted wines.
30	Age discrimination. Age discrimination remains a significant and costly problem for workers, their families and our economy, says the EEOC.
31	Educational expenditures Community colleges and other non-“elite” colleges spend far less per student than other schools, exacerbating inequality.
32	Japanese skateboarders are nastily discriminated against. They dare not skate on the streets.
33	The covid-19 Pandemic’s unequal effects on people’s income, health, access to childcare and other aspects of modern life.

 

I admit, there’s a potential downside of identifying the many types of inequality that we SLPs and media stalwarts like the NYTimes continuingly add to. Honestly, I’m not at all sure that tallying ever-more specific examples of inequality will actually facilitate federal policies to be enacted that can remediate the consequences for victims.

Once there are dozens of inequality types to deal with, overall perspective maybe lost. Also, diminishing returns about the relative importance of each type will come into play as evermore types of inequality are found. Sort of like what’s now happening with allocating very scarce coronavirus vaccine to 330 million of us; where nearly everyone believes themselves to be essential.

When there are dozens of specific types of inequality, each with an identified group(s) of people who’ve suffered, the Biden administration may not be able to simply change income tax rates or inheritance taxes as a remedy. Even those policy changes will require huge amounts of political capital to enact. For us SLPs though, no matter how difficult it may be to increase income and inheritance taxes on privileged people, such changes should be very high on Diana’s and Joe’s list of things to do, no matter how many peachy victories we get next week on January 5.

Income and wealth inequality and their remedies have been kicked around by economists and politicians (mostly down the road) for a very long time. But still, it’s something that has a shred of clear corrective possibility at least theoretically. Now, with many newly-identified individual victim groups for many types of inequality, unique policy remedies will likely require specific remediations. Oh my. Such are the challenges in the future world of Strong Liberal Progressives.

 

DON’T MESS WITH THE SOLSTICE

‘Twas the day before solstice and all through the town people wore masks…  

Happy Winter Solstice. In this leap-year the shortest day of the year – with the longest period of night - happens on Monday December 21,2020 (at 2:02a in Northern California). Thank goodness. Astronomically speaking, the winter solstice ensues in our Northern Hemisphere when the sun is at its lowest daily maximum elevation in the sky; when the sun is directly over the Tropic of Capricorn.

Amid the never-ending reminders of how many more tragic cases and deaths from the coronavirus occurred every yesterday, I’m ready to celebrate that each day will now gain a minute or two of sunshine. My celebration, and perhaps yours, is not new. Humanity has been solstice reveling for thousands of years.

Since before written human history, many late Neolithic and Bronze Age cultures observed the winter solstice as an important time of the year, punctuated by festivals, rituals and ceremonies. They marked the symbolic death and rebirth of the sun.

Physical examples include Newgrange (built in ~3200BCE) in Ireland and Stonehenge (built in ~3000BCE) in England – both constructed before the Pyramids of Giza – that are oriented for the winter solstice.

This astronomical event was often used to guide activities, such as the mating and slaughter of animals, the sowing of crops and the managing of winter food reserves. Starvation was common during the bare winter months. Scores of cultural practices are derived from the winter solstice time, eventually including Christmas. But Christmas festivities on December 25 were a long time coming.

Centuries before, Romans had been feasting during solstice-inspired Saturnalia. This festival honored Saturn, the god of plenty and liberation. Emperor Caligula extended Saturnalia’s party-filled celebrations to five days ending on December 23, as depicted below. Saturnalia included banquets, carnivals, merriment, gift-giving and no doubt debauchery. 

Happy Saturnalians

Christian authorities took over 300 years to decide that December 25 was their savior’s actual birthday. This date conveniently coincided with centuries-old Saturnalia party time. Christianity cleverly co-opted this ancient winter festival. It was easier to convert people into a growing, newish religion if the measures of daily life didn’t really change much. These early Christians partially succeeded even though they originally promoted the idea that the Messiah’s birthday was a serious time to be marked by reflection and abstinence. Their opposition to pagan customs like placing wreaths on front doors and carousing was an utter failure. Putting time-worn festivities back into the bottle proved to be a lost cause.

Nevertheless, over the centuries other fervent authorities have ignored the early Christians’ mistake of attempted eradication what they saw as citizens’ solstice-Christmas licentiousness. These authorities include the revolutionary anti-monarchist Oliver Cromwell, who as lord protector of England and leader of the English Parliament abolished Christmas in 1644. That’s right, he and his MPs agreed that if the people where not going to celebrate contemplatively, they shouldn’t celebrate at all. Partying was forbidden.

Cromwell’s subjects disagreed with riots ensuing across England. Revelry endured on the sly during the solstice and beyond. English Puritans and Calvinists continued to preserve their tightly-straightlaced, alcohol-free Christmases. Those must have been fun-filled times in the English Commonwealth republic.

But after the death of Cromwell (from malarial fever), Charles II, a mead-loving 30-year-old royal, became king in 1660. He forced the puritans to re-learn the lesson of history: Politicians who niggle with the holidays do so at their own peril. Mulled wine, ale and hard cider were joyfully served once again during the solstice. That, fortunately, continues.

However, some 360 years later, the coronavirus’ incessant spread has egged on authorities to consider strict injunctions on our social behavior during the solstice-holiday season to preserve public health. They certainly have justification; daily US coronavirus cases now exceed 240,000, an all-time high. But cancelling Christmas merriment remains an unpopular option.

Presidents, Prime Ministers, Governors and other heads of state have often, but not always, cut the public some slack regarding this year’s Covid-filled holiday restrictions to mitigate public backlash. Shown below are a few examples.

The US.  We’ve had no real president since the evening of November 3 (actually 1/20/17, but whatever). Nonetheless, the CDC’s current guidelines actively discourage holiday gatherings and travel. The guidelines state: The safest way to celebrate winter holidays is at home with the people who live with you. Travel and gatherings with family and friends who do not live with you can increase your chances of getting or spreading Covid-19 or the flu. Ta da, you’ve been forewarned once again.

California.  Governor Gavin Newsom has tightened restrictions, based on the percent of available capacity in local hospitals’ intensive care units (ICUs). Counties need at least 15% available ICU capacity to avoid stronger restrictions.

On December 17, the SF Bay Area’s ICU availability dropped to 12.6%, leading to an immediate, tighter stay-at-home order. This regional order prohibits private gatherings of any size, requires closure of all commercial operations except for critical infrastructure and selected retail operations and mandates 100% masking and physical distancing. Once triggered, these orders will remain in effect for 3 weeks (through January 7) at least. Santa and his widely-located elves will not be happy.

The United Kingdom.  Temporary “Christmas Bubbles” are allowed. A brief four-day respite around Christmas day will be allowed, has been introduced to allow people to celebrate in some fashion. There will be no travel restrictions and people will be able to mix indoors and stay overnight. The number of people who can mix is limited, nevertheless.

Italy.  The government has announced strict limits. Many Italian regions already have partial lockdowns. A 2½ week  ban on inter-regional travel beginning on December 21 has been announced. In addition, people will not be allowed to leave their homes on Christmas Day and New Year’s Day, with some exceptions. A curfew from 10p to 5a will also be in place. In a meager attempt to assuage his upset citizens, the Italian PM Giuseppe Conte has reassured children of all ages that Babbo Natale (Father Christmas) will definitely be visiting them on the 25th, as he is exempt from travel restrictions. Good luck with that Mr. Conte, and thanks for tiny favors.

France.  Travel restrictions are somewhat eased over Christmas. France has issued a nationwide curfew from 8p to 6a, which will be lifted on Christmas Eve, when the French celebrate, but not on New Year's Eve. Restaurants, bars, theatres and movies will stay closed. The flames of resentment are mounting and should be brighter by December 31.

Such restrictions are neither surprising nor inappropriate, given Covid’s onslaught. But still, siding with Saturnalians on Monday seems worthy as more light begins shining on us. Just don’t mess too much with our festivities, please. 

     Addendum. You may have heard that the Saturnalians have struck again and are providing a rare, additional celestial highlight for Monday’s Winter Solstice. Actually, it’s both the Saturnalians and the Jupiterians.

During this solstice Saturn and Jupiter will be visibly dancing together in our heavens the closest they have been in a very long time. It’s called their Grand Conjunction, the likes of which hasn’t been noticeable at night, nor this close, since Saint Francis of Assisi died. For those of you, like me, who haven’t kept up with Francis’ life, he passed 794 years ago in 1226. 

The media has dubbed this Grand Saturn-Jupiter Conjunction “the Christmas Star” to draw popular attention to it. Perhaps you remember singing the We Three Kings carol that mentions the Westward-leading still-proceeding three kings of Orient following the “star of wonder, star of night.” Yup, this time around it’s no longer the star of wonder, but a much less poetically-labelled Grand Conjunction.

If you’re in the San Francisco area on the solstice, go outside on Monday, look fairly close to the horizon after sunset, probably between 7p and 8p (Saturn and Jupiter set at about 8:27p) in Western sky (~249° W) to see this solstice’s unique “double-header”; the Grand Conjunction during the solstice itself. Onward through the stars… 

 

 

HOW TO DISTRIBUTE HOPE

Hope is the pillar that hold up the world. ~ Pliny the Elder  

Was I surprised when American voters cancelled #45’s next “season” at 1600 Pennsylvania Ave? No; the 75 million majority of us weren’t surprised; we were thankful and thrilled. But true to form, he certainly was surprised; saying in his mediocre Barnum-style, “How could they? I’m the greatest.”

But how could he not be surprised with his team of sub-single-A leaguers, led by the indomitably pathetic Rudi Giuliani preaching Lawn and Order at the Four Seasons Total Landscaping back parking lot. Coach Rudi later continued talking gibberish to judges in several states.

These vacuous pranks confirmed my belief that the president’s high-exposure maneuvers to reverse the election via 30 or so zombie lawsuits scattered among seven states have no legal purpose – as judges have substantiated. No, #45’s legal actions, and the media’s fawning coverage, have everything to do with keeping his base upset at the voters’ results and, most importantly, keep them contributing to his campaign slush fund. They’re purely political anti-democratic bleats of the worst kind, with Rudi as co-bleater-in-chief.

Rudi expounding on their vacuous victory at Total Landscaping.

The president’s infantile post-election anger antics echo his long-standing disregard for a key issue that if resolved can restore the physical (and mental) health of the public: how are we going to distribute hope?

The hope I’m referring to is the vaccines that hopefully will be soon available on an “emergency use” basis to mitigate the coronavirus’ onslaught that has now claimed over 268,000 US lives.

This issue encompasses the last of the three “basic questions” that any economic system must address: for whom will the scarce output, here coronavirus vaccine, be distributed? The first two questions are: what will be produced and how will it be produced.

Regarding the “how” question, the federal government decided in late April to initiate Operation Warp Speed (OWS) that has provided substantial public funding – about $10 billion – to accelerate the vaccine’s development and production. Even deceitful, fiscally-recalcitrant Repubs were in favor of providing this government support to the vaccine-developers.

The demand for a covid vaccine will far exceed the available production for the foreseeable future. There are seven major vaccine developers in the US, shown in the table below, five of which have received OWS funding.

Because of the sizeable public funding, the federal government has priority to order significant dosages of these vaccines should their Phase 3 efficacy trials prove the vaccines’ effectiveness to the CDC and FDA. Currently there are 13 vaccines in Phase 3 trials. The government has pre-ordered these OWS vaccines, and also has options to purchase more dosages in the future.

US Covid Vaccine Developers 

Vaccine Developer	Vaccine Type	Required Doses Per-Person	Doses Pre-Ordered+ (Trillions)
AstraZeneca/Oxford*	Viral vector	2	2.40
Johnson & Johnson*	Viral vector	1	0.10
Merck/IAVI*	Viral vector	2	NA
Moderna*	mRNA	2	0.10
Novavax	Inactivated	2	1.30
Pfizer/BioNTech	mRNA	2	0.53
Sanofi/GSK*	rDNA	2	0.73

Sourcist, CD FSources: Economist, CDC, FDA. *Received OWS funds. +Ordered plus options.

The covid-19 vaccine rush has been on since January, when the coronavirus’ genome was first provided by Chinese scientists, less than a month after the first reported case in Wuhan. As noted in the media, the development of these vaccines has been at light-speed, compared to any previous ones. Vaccine development time has been reduced because of a series of important biological and institutional progressions, including vastly improved virological knowledge, accelerated clinical development and more efficient regulatory processes.

The world’s first vaccine was administered by Edward Jenner in 1796 to combat smallpox. Dr. Jenner practiced medicine where he grew up in Berkeley, England. He inoculated an eight-year-old local boy with his pioneering cowpox vaccine. Dr. Jenner’s vaccine successfully prevented the boy from succumbing to smallpox.

It wasn’t until 44 years later (1840) that the British government provided the smallpox vaccine – originally devised by Dr. Jenner – free of charge to the British public. After killing possibly 900 million people over the ages, and thanks to the success of vaccination, the World Health Organization WHO declared smallpox totally eradicated in 1980. Smallpox is the only infectious human disease to date to be completely eliminated.

The 1918-20 Spanish Flu produced many of the 675,000 American fatalities by causing pneumonia in its victims. The flu (and its accompanying pneumonia) was nicknamed the captain of death. The first pneumococcal vaccine was licensed in 1977, after more than 60 years of on and off efforts.

More recently, other diseases’ vaccines have similarly taken quite some time to develop and be utilized. The Salk polio vaccine took nearly 30 years. The Diphtheria/Tetanus/Pertussis (DTaP) vaccine took 20 years. The mumps vaccine was more quickly developed in just four years, relying on medical understanding established during WWII. The FDA approved the mumps vaccine in 1967, and recommended it for general public use a decade later in 1977. The MMR vaccine is routinely administered to protect children and adults from mumps, measles, and rubella.

None of these prior vaccines have faced the challenges that now befall the covid-19 vaccine and its distribution.

Both the need and scope of the tasks surrounding this vaccine distinguish it. In theory, each of the 7.7 billion people now alive on Earth need the vaccine. Let me simplify by focusing only on each of the 330.6 million folks now in the US. We need the vaccine yesterday. This scope and need, as well as development and production realities, creates the inevitable shortage of the covid vaccine, which in turn requires a necessary prioritization for whom receives the vaccine when.

Every public authority has performed “word songs” about this prioritization, in an attempt to sweet-talk the vaccine shortages. They initially sound melodically pleasing, but turn out to be off key. Why? Because their lyrics provide negligible substance. For example, no public official has used the term “vaccine rationing.” It is never sung in their word songs. Rationing sounds negative and presumes a production shortage.

Dr. Francis Collins, director of the National Institutes of Health, referred to the process of establishing priorities more realistically. He spoke last summer at the kickoff meeting of a committee of experts helping to plan the country’s vaccination efforts, “There will be many people who feel that they should have been at the top of the list, and not everybody can be.”

The president’s words have always sung a fantasy, no matter what he’s talking about. Regarding the vaccine, he said in September the government could start distributing a coronavirus vaccine as early as October or right after the November 3^rd election. A reality reminder: both dates have come and gone without any vaccines being shot into the public’s arms. His viral word songs have nothing to do with real life, yet too many people somehow believe them.

Other prominent public experts like Dr. Anthony Fauci of the CDC have also crooned songs, although not nearly as exaggerated as #45. Dr. Fauci said in September that the covid-19 vaccine might be ready by the end of 2020, but he warned that availability will not be widespread at first. Dr. Robert Redfield, the director of the CDC, mouthed an aria before Congress in September saying he expects vaccinations to begin in November or December, but in limited quantities with those most in need getting the first doses, such as health-care workers and the elderly. With some luck, he and Dr. Fauci may be right about December.

It’s December 1. None of the US vaccines shown in the above table have completed their Phase 3 trials. But on November 20 Pfizer/BioNTech applied to the FDA for an “emergency-use” authorization for their vaccine. Ten days later, Moderna also applied to the FDA for an emergency-use approval. Interestingly, Moderna has never before fabricated a vaccine for the market.

These two companies estimated they will have 45 million doses, or enough to vaccinate 22.5 million Americans, by January assuming quick FDA authorization and no unexpected delays. Prior estimates by the government as well as the companies of year-end vaccine production were much higher.

Operation Warp Speed set an initial target of producing 300 million doses this year. Now we’re all hoping for just 15% of that idealistic objective. Manufacturing biologic materials like vaccines always is challenging and often erratic.

Pfizer/BioNTech and Moderna hope to meet such eased production levels, but recognize even 45 million doses is by no means not a sure thing. Rapid upscaling of vaccine assembly is a complex often temperamental process that relies on many inputs and continuously precise management 24/7.

When produced, 45 million doses basically would be provided just to highest-priority healthcare personnel. Vaccine production will continue to expand throughout the winter and spring, as more firms gain FDA approval. These firms, and others, expect they can each produce one billion dosages by the end of 2021. Let’s hope so.

Thus, believing that each and every one of the 331 million American will be vaccinated by next June, as Dr. Redfield stated in September, is very doubtful. In other words, keep wearing your masks for a long time to come.

Drs. Redfield and Fauci are certainly correct that there will be a shortage of vaccine. It will be rationed for quite some time to impatient, awaiting arms. The CDC has developed an Interim Plan for providing the vaccine’s short-supply to all of us. It has identified four generic “populations of focus for initial Covid-19 vaccination”:

1.       Healthcare personnel;

2.       Non-healthcare essential workers;

3.       Adults with high-risk medical conditions; and

4.       People 65 years of age and older, including those living in long-term care facilities.

It’s worth remembering that the CDC itself will not be making any final judgements about the sequence of who will receive the vaccines. The CDC’s Advisory Committee on Immunization Practices (Committee) has been considering these implicit prioritizations. The ultimate distribution decisions will be made by Biden administration staff at the White House, HHS, FDA as well as the CDC.

President-elect Biden already has formed a special transition Coronavirus Team (CTeam) dedicated to coordinating the coronavirus response for the post-January 20th government. The Team will be co-chaired by David Kessler, former FDA Commissioner, former Surgeon General Vivek Murthy and Marcella Nunez-Smith, an associate professor of medicine and epidemiology at the Yale School of Medicine.

The government’s decisions about vaccine dispersal will rest heavily on exactly how each of these population cohorts will be defined. I expect several of these definitions will be hotly disputed because various people’s health will be directly affected amid vaccine shortages.

The CDCs Interim Plan purposefully makes no statement about the ordering of these four groups’ access to the vaccines, but the arrangement of each group’s listing likely reflects the expected sequencing of availability, with healthcare personnel getting the vaccines first.

The first CDC category, presumably highest-priority, is healthcare personnel. Healthcare personnel already have been included in each of the 13 vaccines’ large-scale Phase 3 test samples. It’s very unlikely that there will be any major disputes about first providing vaccines to healthcare personnel. But no one knows; should epidemiologists be incorporated in this category? They (and their models) are prominent prognosticators of the pandemic. But epidemiologists are not usually considered healthcare professionals. Time will tell. The CDC Interim Plan identifies healthcare personnel as paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials.

How many people can be classified as healthcare personnel? The Department of Labor categorizes people employed into 22 “detailed occupations” (and a myriad of more detailed occupations) including healthcare practitioners and related technical occupations. I made several adjustments to the DOL healthcare personal categorization. For example, I did not include veterinarians or dieticians.

My healthcare personnel totals 16.6 million workers, which is 9.8% of our workforce. Healthcare personnel consist of doctors, nurses, pharmacists, EMTs, health technologists and home healthcare providers among others. That is a whole bunch of people’s arms to vaccinate ASAP.

But let’s be clear about the trials and tribulations for counting how many folks are in each of the four CDC’s “populations of focus.” Depending on one’s persuasion and purpose, you can pick within a wide range of numbers for Healthcare Personnel, the presumed highest-priority group. Their numbers have increased almost exponentially in various public statements. Here are several other estimates of healthcare personnel, beyond mine, that show the impressive numeric “spread”:

1.       12 million (M) from a recent Washington Post story about healthcare and essential workers.

2.       Over 18M people, according to the CDC.

3.       20.5M from the Census, although this number includes social assistance workers.

The CDC’s second group, non-healthcare essential workers, is far more nebulous and open to debate. “Essential” has never been tightly defined. This band of folks could include essential folks like: police, firefighters, primary/secondary school teachers, airline pilots/mechanics (airlifting the vaccines hither and yon), funeral arrangers & morticians, power plant operators, public transit drivers and grocery store clerks. Employed persons in just these eight professions totals 10.9 million workers. Many more “essential” professions will undoubtedly be identified. One media group stated without documentation that this group was 87M strong.

The third CDC cohort, Adults with high-risk medical conditions, also is imprecise. Diabetes is but one example of a high-risk medical condition that’s listed in groupings of immunodeficiency disorders. Recent medical information about the coronavirus’ dangerous ability to induce hyperglycemia (high blood glucose) in its victims confirms the potential threat the coronavirus has for diabetics. There are more than 34 million people who have diabetes. Other immunodeficiency disorders include HIV/AIDS and cancer. Over 1.2 million people are living with HIV in the US. There are 16.9 million cancer survivors in the US. About 1.8 million people will be diagnosed with cancer this year. About 37 million US adults have chronic kidney disorders. The number of people with the above-mentioned diseases totals 89.1 million. There are many other high-risk medical conditions not mentioned here. At least one estimate of this cohort’s size was 100M.

The last CDC category of vaccine recipients is people over 65 years old, including those living in long-term care facilities. According to the Census, there are 54.2 million elders 65 years or older now living in the US. Because this group’s population is demographically determined, it’s not nearly as disputed. But where elders rest in the CDC’s four categories is very much in play.

Scott Gottlieb, a former FDA commissioner, properly stated that vaccine prioritization depends on the overall stated goal of the distribution. If the goal of vaccine prioritization is to reduce the rate of infection, he said “you would prioritize essential workers. But if your goal is to maximize the preservation of human life with a vaccine, then you would bias the vaccine toward older Americans.” Thus, determining and agreeing to the overall objective of the prioritization process significantly influences the ordering. Because human lives and hopes are at stake, this determination will be laden and fraught, especially if it’s publicly stated.

The sum total of all people in the four CDC population cohorts that I enumerated above is 170.8 million, 67% of the adult population. This number includes some double-entries, like me who is a 65+ year-old and a diabetic. So it goes...

The CDC’s four cohorts’ prioritizations are already being challenged, as expected. In addition to the “essential workers” (cohort #2), spokespeople are pressing the Committee and the CTeam to prioritize certain categorizes of citizens: those who have been “most affected by health disparities,” participating volunteers who were given placebos in the clinical trials, geographic locations where the virus has been “most active” and military personnel.

Also, a recent news article advocated that obesity be included as a “high-risk medical condition.” Over 70 million people are obese in the US. With every tick of the clock, more backers of specific groups of people will be pressing for higher ranking. Virtually everyone hopes to be at the tippy top of the highest-priority cohort possible. The incentives for expanding the numbers of each population group are strong, except bigger numbers ahead of your group means you’ll be waiting longer for a vaccine. Such are the trade-offs.

Adding additional friction to the question of who’s going to receive the vaccines when is that states – New York and California, so far – have also created committees to review the vaccines’ efficacy and will determine who gets the vaccines. Dr. Fauci said on November 30 that states will be shipped a certain amount of the vaccine and ultimately make final distribution decisions “with strong recommendations from the CDC.” Who knew he was such a strong states-rights advocate?

Ultimately, it’s hard to believe the federal government, that has spent vast sums on their development, will not have a determinative say about the vaccines’ prioritization. Also, the CDC will be providing a “recommendation,” not anything close to an order. The federal government’s formidable say and influence will certainly be reflected in its calculation of the “certain amount of the vaccine” that will be shipped to each state.

How many dosages of will be available? The honest answer to this crucial question is one too often used concerning questions about the coronavirus since it first appeared last December: We Don’t Know Yet. Adm. Brett Giroir, an assistant secretary of HHS, declared “The nation will probably have enough doses for about 20 million people by the end of the year. Given that the two leading vaccines for FDA approval require two doses, that’s 40M dosages by year-end. Other authorities have provided widely-varying dosage guestimates.

Here’s hoping, really hoping that amid the foggy fray the impending coronavirus vaccines can be sufficiently produced, will provide maximum positive effect for all of us and most importantly, can indeed severely wound our current captain of death.