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UPDATED // The original text has been modified to clarify the groups included in phase 1c.
An influential federal advisory panel voted Sunday to recommend that seniors and certain essential workers be the next American group to have access to limited doses of COVID-19 vaccine.
The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted 13-1 for the recommendation. This is based on ACIP’s initial recommendation on which groups should be part of the first wave of vaccinations, described as phase 1a.
ACIP previously recommended that Phase 1 include U.S. health workers, a group of about 21 million people, and residents of long-term care facilities, a group of about 3 million.
On Sunday, ACIP said the next priority group, Phase 1b, should consist of what it called front-line essential workers, a group of about 30 million, and adults aged 75 and over, a group of about 21 millions. When overlapping between groups is considered, Phase 1b covers about 49 million people, according to the CDC.
Phase 1c would then include adults aged 65 to 74 (a group of about 32 million), adults aged 16 to 64 with high-risk medical conditions (a group of about 110 million) and essential workers who could not include in phase 1b (a group of about 57 million). With the overlay, phase 1c would cover about 129 million.
This month, the FDA has granted emergency use authorizations for two COVID-19 vaccines, one developed by Pfizer-BioNTech and another by Moderna. Other companies, including Johnson & Johnson, have advanced their potential rival COVID-19 vaccines into final stages of testing. To date, some 2.83 million doses of Pfizer’s COVID-19 vaccine have been distributed and 556,208 doses have been administered, according to the CDC.
But there will probably still be a period of months in which competition for limited doses of COVID-19 vaccine will trigger difficult decisions. Current estimates indicate there will be enough supply to provide COVID-19 vaccines to 20 million people in December, 30 million people in January and 50 million people in February, said Nancy Messonnier, MD, director of the National Center for the CDC Vaccination and Respiration. Diseases.
State governments and health systems will take ACIP recommendations into account when deploying the initial supply of COVID-19 vaccines.
There is clearly a great deal of latitude in these decisions. Last week, for example, many members of Congress tweeted photos of themselves receiving vaccines against COVID-19, despite not falling into the ACIP description of the first-phase group.
Difficult options
All ACIP members described Sunday’s vote as a difficult decision. It forced them to choose between segments of the American population that could benefit from early access to the limited supply of COVID-19 vaccines.
“For every group we add, we want to subtract one group. For every group we subtract, it means they don’t get the vaccine,” for a few months, said Helen Keipp Talbot, an ACIP member at Vanderbilt University, Nashville, Tennessee. . . “It’s incredibly humiliating and heartbreaking.”
ACIP member Henry Bernstein, DO, who cast the only dissenting vote, said he agreed with most of the group’s recommendations. He said he fully supported the inclusion of adults aged 75 and over and essential front-line workers in the second wave, phase 1b. But he voted no, because the data on COVID-19 morbidity and mortality for adults aged 65 to 74 are similar enough to those in the older group to justify their inclusion in the first wave.
“So the inclusion of the 65- to 74-year-old group in Phase 1b made more sense to me,” said Bernstein, a professor of pediatrics at the Zucker School of Medicine in Hofstra / Northwell, New York.
As defined by CDC, the front-line essential workers included in Phase 1b will be what are commonly referred to as “first aid workers,” such as firefighters and police officers. Also part of this group are teachers, support staff, nursery school providers and food and agriculture workers. Others in this group would include U.S. postal service employees and workers in transit.
ACIP panelists noted the difficulties that will arise as government officials and leaders of health organizations move to apply their guidelines to real-world decisions on the distribution of a limited supply of COVID-19 vaccine. . There is potential to exacerbate existing disparities in access to health care, as people with higher incomes may find it easier to obtain evidence that they believe they have a high-risk condition, said José Romero, MD, president of ‘ACIP.
A lot of people “don’t have access to medical care and can’t get a medical note that says,‘ I have diabetes, ’” he said.
ACIP panelists also noted in their deliberations that people could technically qualify for a priority group, but that they have little risk, such as someone with a chronic illness working from home.
And the risk of COVID-19 remains serious even for those who will eventually fall into phase 2 vaccination. Young adults have suffered serious complications after COVID-19, such as a stroke, which can dramatically alter their lives, said Talbot, a member of the ACIP, who recalled this in his work.
“We have to be very careful when it comes to saying, ‘Young adults will be fine,'” he said. “I spent last week on a safety clinic call and I read these graphs and cried every day.”
The three ACIP members who had conflicts that prevented their vote were Robert L. Atmar, MD, who told Saturday’s meeting that he had participated in COVID-19 trials, including research on the Modern vaccine. ; Sharon E. Frey, MD, who told Saturday’s meeting that she had been involved in research on COVID-19 vaccines, including those from Moderna; and Paul Hunter, MD, who said he received a grant from Pfizer for pneumococcal vaccines. The other members of the panel have not reported any relevant financial reports.
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