NEW YORK (AP) – It wasn’t too difficult to decide that health workers and nursing home residents should be first in line for the first, limited supply of COVID-19 shots. Now US health officials must determine who should be next.
For example, how high should seniors, teachers, transit workers and supermarket employees be prioritized in the coming months as more vaccines become available?
A federal panel of vaccination experts will address that question at an emergency meeting this weekend. The guidelines are not binding, and whatever it decides, there will be differences from state to state.
The panelists tend to put “essential workers” first, as people such as bus drivers, shop assistants, and others who perform essential tasks that cannot be done from home are the most frequently infected. That’s also where concerns about racial inequalities during the crisis are most evident. Many essential workers are black and Hispanic.
But other experts say people 65 and older should be next, along with those with certain medical conditions. Those are the ones who die at the highest rates, they say.
The panel will vote on the proposal on Sunday.
‘I think we know this won’t be perfect. We don’t have a vaccine for everyone right away, so we will have to make tough decisions, ”said Claire Hannan, executive director of an organization representing managers of national vaccination programs.
If essential workers are indeed next, states already have different ideas about which of them should be the most up front in line.
In Nevada, for example, teachers and daycare workers will be ahead of public transportation workers, under the state’s current plan. Then come farmers and food workers, and then retail and utility workers.
In South Dakota, teachers could gain access for those who work in food and transportation. In Arkansas, the Essential Workers List includes educators, prison guards, police officers, meat packing plant workers and mayors.
The advice of the expert panel – the Advisory Committee on Immunization Practices – is almost always endorsed by the U.S. Centers for Disease Control and Prevention. That’s what happened earlier this month, when the group said top priority should be given to health workers and long-term care home residents for the first 20 million vaccinations this month.
But it is not clear that it will be the same in the next phase. CDC Director Dr. Robert Redfield has said he believes priority should be given to people 70 and older living with children or grandchildren.
The chairman of the advisory panel, Dr. Jose Romero, told The Associated Press that he was aware of Redfield’s comments but had not spoken to him directly.
Redfield declined to say whether he would prioritize seniors over essential workers, even if the panel recommended the opposite. “I look forward to hearing the advisory group’s discussion and receiving the recommendation for consideration,” he said in an email to the AP.
Most states followed the panel’s recommendation that health professionals and nursing home residents receive the very first doses. But there are a few exceptions.
Utah said Long-term care residents should queue behind health workers, rather than share the front with them. Massachusetts included prisoners and homeless people in the first tier. Nevada, New Hampshire, and Wyoming did the same for police officers.
The variations between states are likely to increase in the following priority groups, said Jennifer Kates of the Kaiser Family Foundation, who analyzed the state’s vaccination plans.
“I think we will see states fall apart in different ways,” with some putting older people above essential workers, Kates said.
It can get messy. For example, some experts said that if a state prioritizes certain essential workers and a neighboring state decides to give preference to seniors, people could try to cross state lines in the hope of getting vaccinated.
“That’s one of the problems with not having a full national vaccination plan,” said Romero, who is also the head of the Arkansas state health department.
The proposal submitted by the Advisory Committee is based on a broad definition of essential workers adopted by the US Department of Homeland Security in August. It has hundreds of various jobs as part of the critical infrastructure workforce, including first responders, teachers, communications technicians, weather forecasters, sewage treatment plant workers, and people working in animal shelters.
According to estimates submitted to the advisory committee, as many as 87 million people who do not work in health care could be considered essential employees.
The country has more than 53 million seniors. The CDC also counts more than 100 million Americans with underlying medical conditions that put them at higher risk for serious COVID-related illness, although there is overlap between the two groups.
Trade associations and workers’ groups have sent emails and other communications to the committee, arguing that they should be prioritized.
Julie Russell, who represented California’s Coronado Unified School District, insisted that teachers and other school staff should be prioritized. “We ask you to recognize the importance of the safety of our workforce and how many young lives we all come into contact with,” she said at a panel meeting last weekend.
Dr. Charles Lee of the American College of Correctional Physicians urged those who work in jails and prisons, plus inmates.
Romero said the committee will likely discuss ways to help states determine which key workers should go first. For example, people who are considered essential but can work from home may be placed lower on the list than those who cannot stay six feet away from others on the job.
What about the staff at the Atlanta-based CDC? In a memo to employees obtained by the AP, Redfield said the agency will not receive a direct vaccine allocation. However, under Georgia’s plan, certain public health and laboratory workers may belong to the state’s highest priority group. Some CDC employees also work in hospitals and clinics and may be given priority over staff in those places.
Of course, as more vaccines come out, “the matter of priority becomes less important,” said Dr. Eric Toner, a scientist from Johns Hopkins University who has written about possible vaccination priorities.
“The bottom line is we need to get as many people vaccinated as soon as possible,” he said.
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AP writers Candice Choi and Jason Dearen in New York City and Jonathan Poet in Philadelphia contributed to this report.
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The Associated Press’s Health and Science Department is supported by the Howard Hughes Medical Institute’s Science Education Department. The AP is solely responsible for all content.