NEW YORK (AP) – The US COVID-19 vaccination campaign has begun, and the few available doses usually go to the poor of health workers and nursing home residents.
But what about January, February, and March, when more photos are expected to become available? Who should get those doses?
A federal panel of vaccination experts will address that question at an emergency meeting this weekend. Whatever the committee decides, there will be differences from state to state.
Panellists tend to put “essential workers” first, as bus drivers, shop assistants and similar workers cannot work from home. They are the people who become infected most often, and where concerns about racial inequalities at risk are most evident.
But other experts say people 65 and older should be next, along with those with certain medical conditions. Those are the people who die at the highest rates, they say.
The group will vote on the proposal on Sunday, one day after discussing a vaccine made by Moderna.
‘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 the 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, according to the state’s current vaccination 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, 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. The director of the CDC, Dr. Robert Redfield, has said he believes that priority should be given to people aged 70 and over living with children or grandchildren.
The chair of the advisory panel, Dr. Jose Romero, told The Associated Press that he was aware of Redfield’s previous comments, but had not spoken to him directly.
Redfield declined to say whether he would prioritize seniors over key workers, even if the panel recommends the opposite. “I look forward to hearing the advisory group’s discussion and receiving the recommendation for consideration,” he said in an emailed statement to the AP.
States do not have to follow the guidelines.
After the CDC panel said health professionals and nursing home residents should receive the very first doses, most states followed those recommendations. But there are a few exceptions. Utah said Long-term care residents should stand behind the health workers, rather than share the front end with them. Massachusetts included inmates and homeless in the first tier, while 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, which analyzes the state’s vaccination plans.
“I think we’ll see states falling apart in different ways,” with some prioritizing seniors over key workers, Kates said.
It can get messy. For example, some experts said it is possible 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 different types of jobs as critical infrastructure personnel, 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 could be considered essential workers who do not work in healthcare.
The government expects to be able to vaccinate only 80 million new people in the first three months of 2021.
It is possible the committee could consider giving essential workers and seniors equal status, similar to how it said both health workers and nursing home residents should be at the front of the line together. But that would create a priority group far, far greater than the number that can be vaccinated before spring.
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.
Meanwhile, various professional associations and employee 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 meeting of the same CDC panel last weekend.
Dr. Charles Lee of the American College of Correctional Physicians advocated for those who work in jails and prisons, plus inmates. “There are many essential workers in prisons. Please don’t leave them out, ”he said at the same meeting.
Romero said the advisory 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 people who cannot stay six feet away from others at work.
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 Health and Science Department is supported by the Science Education Department of the Howard Hughes Medical Institute. The AP is solely responsible for all content.