GPs in moral conundrum: 'better to vaccinate 50 to 75-year-olds first'

The call to vaccinate younger seniors first is getting louder. Various general practitioners argue for this in Trouw, a newspaper. Letting the elders go first is not in line with their oath, they say.

The debate about the Dutch vaccination strategy remains heated. Eight GPs are calling for younger seniors to take precedence. They are stuck in a conundrum because of the Dutch vaccination policy, writes the group around the Rotterdam GP Charlotte van Sassen in an opinion piece on the Trouw website.

According to the doctors, vaccinating the oldest population is contrary to their doctor’s oath. “The oath in which we swear to put our patients’ interests first and pledge to take good care of our patients and to inform them properly,” they write. The intention is that GPs will administer some of the vaccinations, but the eight doctors want a more substantiated policy before they commit to help. The doctors have also sent their letter to Health Minister Hugo de Jonge and the Health Council.

They say it would be better to vaccinate 50 to 75-year-olds first, starting with the men. Because they have a higher life expectancy than the over-90s, this results in a more significant health gain, they write. Moreover, this is the group most at risk for ending up in intensive care. If they are vaccinated, this will lift significant pressure off the healthcare system so that the corona measures can be phased out and regular care can resume, say the doctors. And according to them, that provides physical and psychological benefits for citizens of all ages.

Peter van der Voort, head of intensive care at the UMC Groningen, made a similar plea last week in talk show Jinek. According to the IC doctor, overweight men between the ages of 50 and 75 should be the first to receive a vaccine. Then the pressure in intensive care will drop by 60 percent, repeats Van der Voort this week in a news article in NRC.

The Health Council did not only look at IC occupancy when they devised the vaccination strategy. Additionally, they look at the number of healthy life years that can be gained on average with vaccination. Because people over 90 run such a high risk of death with covid, they weighed heavily in that calculation.

“In the oldest groups, we as GPs often have a conversation with the patient about the question: is this treatment still useful?”, Says Van Sassen. “Does it make sense to vaccinate people with poor health, who are likely to die quickly? Many of the oldest elders I speak to say, “Give my vaccine to my son. I have to die of something, right?“

“Elderly union Anbo is annoyed by the debate. “We rely on the advice of the Health Council, which employs exceptionally skilled specialists. We are afraid that this discussion will slow the vaccination process down,” said spokesman Ewald van Kouwen.

Health Minister Hugo De Jonge previously made exceptions to the vaccination strategy for healthcare personnel and GPs. In addition, he wants to use the AstraZeneca vaccine first for 60 to 65-year-olds because it may be less effective in older groups. But the aim to vaccinate the most senior citizens first remains intact.