As chairman of the advisory committee on immunization practices, Romero may be the most influential person to decide who will get the coronavirus vaccine and when in the coming months.
People know this, and have been pressuring Romero and other committee members, who guide U.S. Centers for Disease Control and Prevention, about vaccine allocation.
It was ACIP who decided that front-line health workers and the frail and vulnerable residents of long-term care centers should be the first to line up with the first vaccines.
On Sunday they meet to decide who comes next.
In the mix: essential workers, people over 65 and people with chronic conditions that put them at greater risk of serious illness if they become infected. There are tens of millions of people in each group and there will not be enough vaccine to cover everyone right away. They have to be chosen.
“We are dealing with these decisions knowing that there is not enough vaccine,” said Romero, a pediatric infectious disease specialist who is also Arkansas state secretary of health.
ACIP has been tasked with establishing a four-phase vaccine launch, but there are still so few vaccines available that phase 1 has been subdivided into phases 1a, 1b and 1c. Phase 2, Romero said, may not even be discussed until February.
Phase 1b is likely to include essential workers, but this is a group that includes 87 million people. U.S. Secretary of Health and Human Services Alex Azar estimates that the United States can vaccinate 50 million people by the end of January, including the roughly 20 million the United States expects to have vaccinated in December.
So who follows?
The CDC outlined a list that included the agri-food, transportation, energy, police, fire, manufacturing, information and communications technology, water and wastewater sectors.
But how about the councilors?
“Childcare staff in educational and recreational settings outside of school, such as camps and community centers, are critical to gaining continued support for the country’s health care, first aid, front-line and the essential workers, as well as to help our country’s continued economic recovery, ”the American Camp Association argued in its letter to Romero.
And the truckers?
“Our workforce represents a central and critical nexus in the nation’s supply chain and will play a key role in the upcoming COVID-19 vaccine distribution process. As the public transportation industry is asked to offer vaccines to nationwide, it is imperative that truck drivers have prioritized access to the vaccine to minimize the potential for supply chain delays and disruptions, “wrote Bill Sullivan, executive vice president of defense for U.S. truck associations. in a letter to ACIP.
Airlines, too.
“We do not ask aviation workers to be at the top of the list, but we need governments to ensure that transport workers are considered essential when developing vaccine deployment plans,” said Alexandre de Juniac, CEO of the International Air Transport Association.
Teachers don’t want to be left out.
“Our public schools are vital to the full recovery of this pandemic in California and we cannot safely and completely return to face-to-face instruction without placing our public school workers at the top of the priority list,” he said. say the California Teachers Association in a statement.
“Vaccine deployment should include vaccination sites at the school where school staff and parents, guardians and household members of students who are essential workers have the option to be vaccinated, providing a greater protection in our public school communities. “
But how can these people, many of them young and healthy adults, be put in front of older and sick people, who are at a much greater risk of serious illness if they become infected?
They will include people with obesity (more than 40% of the U.S. population), diabetes, heart disease, lung disease, kidney disease, cancer, sickle cell disease, and other conditions.
Should patients with rare diseases go first because both are vulnerable and few? Should smokers wait because their lifestyle is not technically a disease?
“We understand that our decisions will be examined,” Romero said. “I hope people criticize me for my decision.”
In deciding to include residents in the long-term care center in group 1a, the committee examined data showing that these patients accounted for 40% of Covid-19 deaths. Romero said ACIP will also look for data to decide who to recommend to groups 1b and 1c.
“I go to these meetings with an open mind. I just want to see the data,” he said.
A team of cancer experts claims to have this data, having reviewed 28 different studies showing that the risk of dying from Covid-19 is higher in cancer patients.
And there is also the issue of disparities.
“The idea is that we want to minimize the harm from the vaccine and maximize its benefits. We want to address care disparities. We want to make sure there is equity,” Romero said.
The committee has been specifically instructed to reflect on these factors when deciding.
“How do vaccine characteristics and logistical considerations affect fair access for all people?” the committee was asked in an initial document at the start of the November round of meetings.
“Does the allocation planning include contributions from groups disproportionately affected by Covid-19 or facing health inequalities stemming from social determinants of health, such as income and access to health care?”
For Romero, it is a good orientation.
“It’s a complex decision to make. Yes, it all counts. Don’t discount a factor.”
And states have the flexibility to adapt the guidelines. Legally, they should not follow it at all.
“States have the option of not using our recommendations,” Romero said. But expect them to do it.
“If we document that our decisions are based on the current epidemiological disease data we have, they will be sound and will allow governors to accept them.”