The U.S. Advisory Committee on Immunization Practices (ACIP) voted 13 to 1 to recommend giving priority to health care workers and nursing home patients in Phase 1, when doses are expected to be very limited.
This panel of experts recommends who to vaccinate and when, and Tuesday’s meeting focused on the initial supply of COVID-19 vaccine, which is expected to be scarce.
“Vaccinating healthcare personnel supports the principle of maximizing benefits and minimizing harms through what we are calling the multiplier effect. In other words, protection of healthcare personnel leads to preservation of healthcare capacity and better health outcomes for all,” said panel member Dr. Kathleen Dooling.
The ACIP discussed their concerns during the open-to-the-public, virtual meeting to vote on the vaccine proposal and also accepted public comments.
The two groups together represent around 23 million Americans out of a U.S. population of about 330 million.
Later this month, the Food and Drug Administration will consider approval of two vaccines made by Pfizer and Moderna. Current estimates project that no more than 20 million doses of each vaccine will be available by the end of 2020. And each product requires two doses.
As a result, the shots will be rationed in the early stages.
The panel will meet again at some point to decide who should be next in line. Among the possibilities: teachers, police, firefighters and workers in other essential fields such as food production and transportation; the elderly; and people with underlying medical conditions.
Experts say the vaccine will probably not become widely available in the U.S. until the spring.
The panel of outside experts, created in 1964, makes recommendations to the director of the Centers for Disease Control and Prevention, who almost always approves them. It normally has 15 voting members, but one seat is vacant.
The recommendations are not binding, but for decades they have been widely heeded by doctors, and they have determined the scope and funding of U.S. vaccination programs.
It will be up to state authorities whether to follow the guidance. It will also be left to them to make further, more detailed decisions if necessary — for example, whether to put emergency room doctors and nurses ahead of other health care workers if vaccine supplies are low.
The outbreak in the U.S. has killed nearly 270,000 people and caused more than 13.5 million confirmed infections, with deaths, hospitalizations and cases rocketing in recent weeks.
As the virtual meeting got underway, panel member Dr. Beth Bell of the University of Washington noted that on average, one person is dying of COVID-19 per minute in the U.S. right now, “so I guess we are acting none too soon.”
About 3 million people are living in nursing homes, long-term chronic care hospitals, and other U.S. long-term care facilities. Those patients and the staff members who care for them have accounted for 6% of the nation’s coronavirus cases and a staggering 39% of the deaths, CDC officials say.
Despite the toll, some board members at Tuesday’s meeting said they hesitated to include such patients in the first group getting shots. They wanted more information about the safety and effectiveness of new vaccines on the old and fragile people living in such facilities. And some noted research that suggested that if the staff at such facilities are fully vaccinated, that would likely have a greater impact of stopping spread of the virus in those places.
But committee members were unanimous in voicing support for vaccinating health care workers — about 21 million people, according to CDC officials.
That broad category includes medical staff who care for — or come in contact with — patients in hospitals, nursing homes, clinics and doctor’s offices. It also includes home health care workers and paramedics. Depending on how state officials apply the panel’s recommendations, it could also encompass janitorial staff, food service employees and medical records clerks.
Panel members also say vaccinating healthcare workers has the potential to mitigate health inequities because the group includes a broad range of occupations, including racial and ethnic minorities, as well as low-wage earners.
The government estimates people working in health care account for 12% of U.S. COVID-19 cases but only about 0.5% of deaths. Experts say it’s imperative to keep health care workers on their feet so that they can administer the shots and tend to the booming number of infected Americans.
As for the rationale on vaccinating long-term care facility residents, Dr. Dooling said, “Vaccinating long-term care residents maximizes benefits by directly preventing disease in a high-risk group and minimizes harms by potentially reducing the burden on hospitals.”
For months, members of the immunization panel had said they wouldn’t take a vote until the FDA approved a vaccine. That is customary procedure for the panel, with some exceptions, such as during a flu outbreak in 2009. But late last week, the group suddenly scheduled an emergency meeting for Tuesday.
The panel’s chairman, Dr. Jose Romero, said the decision stemmed from a realization that the states are facing a Friday deadline to place initial orders for the Pfizer vaccine and determine where they should be delivered. The committee decided to meet now to give state and local officials guidance, he said.
“We expect a constrained supply environment for some months and need to make the best use of available vaccine. We anticipate 5 to 10 million doses per week post-authorization which could lead to a need for sub-prioritization on the initial populations at least for the first several weeks,” said panel expert Dr. Sara Oliver.
But some panel members and other experts had also grown concerned by comments from Trump administration officials that suggested differing vaccine priorities.
Dr. Deborah Birx of the White House coronavirus task force said in a meeting with CDC officials last month that people 65 and older should go to the head of the line, according to a federal official who was not authorized to discuss the matter and spoke to The Associated Press on condition of anonymity.
Then last week U.S. Health and Human Services Secretary Alex Azar stressed that ultimately governors will decide who in their states gets the shots. Vice President Mike Pence echoed that view.
The comments churned up long-standing concerns during the Trump administration that vaccination decisions would be dictated by political concerns instead of science.
Asked whether Azar’s comment played a role in the scheduling of the meeting, Romero said; “We don’t live in a bubble. We know what he said. But that wasn’t the primary reason this is being done.”
Jason Schwartz, a professor of health policy at the Yale School of Public Health, said it makes sense for the panel to take the unusual step of getting its recommendation out first.
“Without that formal recommendation, it does create a void from which states could go off in all sorts of different directions,” said Schwartz, who is not on the panel.
HHS officials have said they will distribute initial doses to states based on population, and it’s possible some states won’t receive enough to cover all of their health care workers and nursing home residents.
As a result, governors may have to decide which health care workers or which regions get shots first, Schwartz said.
“It’s up to states to figure out the more granular detail,” he said.
The advisory group will eventually make recommendations for the next phases of vaccine rollout. Tuesday’s lone vote against the recommendations came from a doctor who said she’s worried the vaccine hasn’t been studied in long-term care facility residents.