As chair of the Immunization Practices Advisory Committee, Romero is arguably the most influential person in deciding who gets – and when – a coronavirus vaccine in the coming months.
The people know, and they lobby Romero and other members of the committee that heads the U.S. Centers for Disease Control and Prevention over vaccine allocation.
It was ACIP who decided that primary health care workers and the vulnerable, vulnerable residents of long-term care facilities should be at the forefront of the scarce initial vaccines.
On Sunday, they meet to decide who comes next.
In the mix: essential workers, over-65s and people with chronic conditions that put them at higher risk of serious illness if they become infected. Each group has tens of millions of people and there will not be enough vaccine to cover everyone right away. Choices have to be made.
“We are dealing with these decisions knowing that there is not enough vaccine,” said Romero, a pediatric infectious disease specialist and Secretary of Health for the state of Arkansas.
ACIP has been given the task of rolling out a vaccine in four phases, but so little vaccine is available that phase 1 is divided into phases 1a, 1b and 1c. Phase 2, Romero said, may not be discussed until February.
Phase 1b probably includes key workers, but that’s a group of 87 million people. US Secretary of Health and Human Services Alex Azar estimates that the United States could vaccinate 50 million people by the end of January – including the roughly 20 million the US hopes to have vaccinated by December.
So who will take the next step?
The CDC outlined a list of the food and agriculture sectors, transportation, energy, police, firefighters, manufacturing, information technology and communications, water, and wastewater.
But what about camp advisers?
“ Childcare workers in educational and recreational settings outside of school, such as camps and community centers, are critical to continued support for the national healthcare system, first responders, frontline workers and essential workers, as well as to aiding our country’s continued economic recovery, ” argued the American Camp Association in its letter to Romero.
And truckers?
“Our workforce is a central and critical link in the country’s supply chain and will play a vital role in the upcoming COVID-19 vaccine distribution process. As the transportation industry is called upon to deliver vaccines across the country, drivers have priority. access to the vaccine to minimize the potential for delays and supply chain disruptions, ”wrote Bill Sullivan, executive vice president of advocacy at American Trucking Associations, in a letter to ACIP.
Airlines too.
“We are not asking for aviation personnel to be at the top of the list, but we need governments to ensure that transportation workers are considered essential when vaccine rollout plans are developed,” 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 California’s full recovery from this pandemic and we cannot safely and completely return to face-to-face instruction without putting our public school employees at the top of the priority list,” said the California Teachers Association. in a statement.
“Vaccine rollout should include vaccination sites in schools where school staff and parents of students, guardians and household members who are key workers have the option of being vaccinated, thus better protecting our public school communities.”
But how can these people, many of them young and healthy adults, be placed in front of the elderly and the sick, who are at a much higher risk of serious illness if they do become infected?
This includes obese people – more than 40% of the US population – diabetes, heart disease, lung disease, kidney disease, cancer, sickle cell anemia, and other conditions.
Should rare disease patients go first because they are both vulnerable and few in number? Should smokers wait because their lifestyle choice isn’t technically a disease?
“We understand that our decisions will be scrutinized,” said Romero. “I expect people to criticize my decision.”
In deciding to include residents of long-term care facilities in Group 1a, the Committee looked at data showing that these patients accounted for 40% of Covid-19 deaths. Romero said ACIP will similarly search for data to decide who to recommend in 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 says they have that data, after looking at 28 different studies showing that the risk of dying from Covid-19 is higher in cancer patients.
And then there is the issue of inequalities.
“The idea is that we want to minimize the harm of the vaccine and maximize its benefits. We want to address the inequalities in health care. We want to make sure there is fairness,” said Romero.
The committee is specifically instructed to consider these factors when making decisions.
“How do vaccine characteristics and logistical considerations affect fair access for all individuals?” at the start of the November meeting, the committee was asked in a first document.
“Does allocation planning include input from groups disproportionately affected by Covid-19 or experiencing health inequalities as a result of social health determinants such as income and access to health care?”
It is a good accompaniment for Romero.
‘It’s a complex decision. Yes, everything counts. You don’t detract from one factor. ‘
And states have the flexibility to adjust the guidelines. Legally, they don’t have to follow it at all.
“The states have the option not to use our recommendations,” said Romero. But he hopes they will.
“If we document that our decisions are based on the current epidemiological disease data available to us, they will be valid and will enable the governors to accept them.”