Editor’s Note: Find the latest COVID-19 news and advice at Medscape’s Coronavirus Resource Center.
UPDATED // The original text has been adapted to clarify the groups in phase 1c.
An influential federal advisory panel voted Sunday to recommend that the elderly and certain key workers be the next group of Americans to have access to limited doses of COVID-19 vaccine.
The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) voted 13-1 in favor of the recommendation. This builds on ACIP’s initial recommendation about which groups should be in the first wave of vaccination, described as phase 1a.
ACIP previously recommended that Phase 1a include US 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 be what it calls first-line essential workers, a group of about 30 million, and adults 75 and older, a group of about 21 million. When the overlap between the groups is taken into account, Phase 1b involves approximately 49 million people, according to the CDC.
Phase 1c then includes adults aged 65-74 (a group of approximately 32 million), adults aged 16-64 with high risk medical conditions (a group of approximately 110 million), and key workers who were not eligible for recording. in phase 1b (a group of approximately 57 million). With the overlap, Phase 1c would cover approximately 129 million.
The FDA this month issued emergency clearances for two COVID-19 vaccines, one developed by Pfizer-BioNTech and another from Moderna. Other companies, including Johnson & Johnson, have put their potential rival COVID-19 vaccines into late-stage testing. According to the CDC, approximately 2.83 million doses of Pfizer’s COVID-19 vaccine have been distributed to date and 556,208 doses have been administered.
But there will likely be another period of months when competition for limited doses of COVID-19 vaccine will lead to tough decisions. Current estimates say there will be enough supplies 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 Immunization and Immunization. Respiratory from the CDC. Diseases.
Government governments and health systems will consider ACIP’s recommendations in rolling out the first stocks of COVID-19 vaccines.
There is clearly a great deal of leeway in these decisions. For example, in the past week, many members of Congress tweeted photos of themselves receiving COVID-19 vaccines, despite not falling into the Phase 1 group’s description of ACIP.
Difficult choices
All ACIP members called Sunday’s vote a tough decision. It forced them to choose from segments of the US population that could benefit from early access to the limited supply of COVID-19 vaccines.
“For every group that we add, that means we subtract one group. For every group that we subtract, it means they won’t get the vaccine,” said ACIP member Helen Keipp Talbot, MD, of Vanderbilt University. Nashville, Tennessee. . “It’s incredibly humble and heartbreaking.”
ACIP member Henry Bernstein, DO, who cast the only vote against, said he agreed with most of the panel’s recommendations. He said he fully supported the inclusion of adults 75 years and older and key frontline workers in the second wave, phase 1b. But he voted no because the data on COVID-19 morbidity and mortality for adults aged 65-74 is sufficiently similar to that of the older group to warrant their inclusion in the first wave.
“Therefore, enrolling the 65-74 year-old group in Stage 1b made more sense to me,” said Bernstein, a professor of pediatrics at the Zucker School of Medicine at Hofstra / Northwell in New York.
As defined by the CDC, key primary care workers included in Phase 1b will be those commonly referred to as “first responders”, such as firefighters and police officers. Also in this group are teachers, support staff, daycare centers and those working in grocery and agriculture. Others in this group include employees of the US Postal Service and transit workers.
ACIP panelists pointed to the difficulties that will arise if government officials and health organization leaders start applying their guidelines to real-world decisions about the distribution of a limited supply of COVID-19 vaccine. There is a possibility of exacerbating existing inequalities in access to healthcare, as people with more income may find it easier to obtain evidence that they qualify as a high-risk condition, said José Romero, MD, ACIP’s chairman .
Many people “don’t have access to medical care and can’t come up with a doctor’s note that says, ‘I have diabetes,'” he said.
ACIP panelists also noted in their considerations that people may technically qualify for a priority group but are at low risk, such as someone with a chronic medical condition who works from home.
And the risk for COVID-19 remains serious, even for those who will eventually fall into phase 2 for vaccination. Young adults have had serious complications after COVID-19, such as a stroke, that can drastically change their lives, said ACIP member Talbot, adding that she is reminded of this in her work.
“We have to be very careful when we say, ‘Young adults will be fine,’” she said. “I made a clinical emergency call for the past week and read these charts and cried every day.”
The three ACIP members who had conflicts that prevented them from voting were Robert L. Atmar, MD, who said at the Saturday meeting that he had participated in COVID-19 studies, including research into the Moderna vaccine; Sharon E. Frey, MD, who said at the Saturday meeting that she had been involved in research into COVID-19 vaccines, including those from Moderna; and Paul Hunter, MD, who said he has received a grant from Pfizer for pneumococcal vaccines. The other panel members did not report any relevant financial relationships.
Follow Medscape on Facebook, Twitter, Instagram and YouTube.