PUBLISHED
SUN, DEC 20 20203:36 PM ESTUPDATED SUN, DEC 20 20204:51 PM EST
KEY POINTS
·
A Centers for Disease
Control and Prevention panel voted Sunday to put “frontline essential workers”
and people 75 years of age and older next in line to be eligible to receive a
vaccine against Covid-19.
·
That so-called phase
1b group is estimated to include about 49 million people, or nearly 15% of
Americans, according to the CDC’s Advisory Committee on Immunization Practices.
·
The committee’s
recommendations if accepted by the CDC director will set federal guidance on
how states should implement distribution of the scarce doses.
A
Centers for Disease Control and Prevention panel voted 13-1 Sunday
to put “frontline essential workers” and people 75 years of age and older next
in line to be eligible to receive a vaccine against Covid-19.
That
so-called phase 1b group is estimated to include about 49 million people, or
nearly 15% of Americans, according to the CDC’s Advisory Committee on
Immunization Practices. The committee included frontline essential workers such
as firefighters, police officers, teachers, corrections officers and others in
the phase 1b group, but relegated “other essential workers” to phase 1c.
The
full list of frontline essential workers covered by the recommendation also
includes all educational staff, including daycare workers, food and
agricultural workers, manufacturing workers, U.S. postal service employees,
public transit workers and grocery store workers, according to ACIP’s provided
list. These workers “are in sectors essential to the functioning of society and
are at substantially higher risk of exposure” to Covid, ACIP said.
“I
would like to note that the persons 75 years and older represent 8% of the
population, 25% of hospitalizations and have a very high death rate. Frontline
essential workers have high exposures. They include a disproportionate share of
racial and ethnic persons who also have a disproportionate share of
hospitalizations,” Dr. Katherine Poehling, a member of the committee, said
after the vote.
Dr.
Henry Bernstein of Northwell Cohen Children’s Medical Center, who voted against
Sunday’s recommendation, explained that he was in favor of including those 65
years of age and older.
Phase
1c should include persons between the ages of 65 and 74, people between the
ages of 16 and 64 who have high-risk underlying conditions and remaining
essential workers, ACIP also recommended Sunday. That’s 129 million Americans,
according to ACIP, or over one-third of the country.
Those
remaining essential workers include transportation and logistics workers, food
service workers, construction workers, finance workers, IT and communications
workers, energy workers, media personnel, legal workers, engineers and
wastewater workers, ACIP said. And underlying conditions for prioritization
purposes includes obesity, cancer, smoking and more, per ACIP.
The
committee’s recommendations will now go to CDC Director Dr. Robert Redfield,
who typically accepts the committee’s recommendations, setting federal guidance
on how states should implement distribution of the scarce doses. But state
officials are charged with the final say on distribution. The CDC earlier this
month recommended that states first prioritize health-care
workers and long-term care facility residents during the
initial rollout of the vaccines.
The
decision of what groups to prioritize over others is an excruciating one, many
voting members of the committee said Sunday, but it is necessary to ensure that
equity and the latest science guide states’ plans. The committee was asked to
thread the needle between competing values of the need to prioritize essential
workers, who keep society functioning, and the need to protect society’s most
vulnerable members, the elderly.
But
the CDC’s Dr. Kathleen Dooling noted that the order in which those groups are
vaccinated will ultimately have little impact on the dynamics of the outbreak,
based on the latest modelling.
“Differences
between strategies is minimal,” she said. “Vaccinating older adults first
averts slightly more deaths, while vaccinating younger adults first, essential
workers and younger adults with high-risk conditions, averts slightly more
infections.”
She
added that the most important factor is “actually the timing of the vaccine
introduction related to increases in Covid-19 cases.” She said that further
emphasizes the need to practice social distancing and mask wearing to reduce
spread while scarce doses of vaccines are distributed.
“We
are faced with the situation, at least in the short term, where we have a
limited supply of vaccine available to us,” Dr. Nancy Messonnier, director of
the CDC’s National Center for Immunization and Respiratory Diseases, said
Sunday to open the all-day meeting. “What that means is that there will be
difficult choices about who gets that vaccine first.”
The
U.S. currently projects it will have enough vaccine doses for 20 million people
in December, 30 million in January and 50 million in February, Messonnier said.
Phase 1a includes at least 24 million people, phase 1b will add another 49
million people and phase 1c will broaden eligibility to another 129 million.
Dr.
Amanda Cohn of the CDC noted that projections should not be assumed to be exact
and many factors could change vaccine availability.
While
older adults are more likely to die of Covid, they can also more easily isolate
and protect themselves from being infected than frontline essential workers
can, some committee members noted. Dr. Peter Szilagyi of the University of
California, Los Angeles said one reason to prioritize essential workers is that
minority communities are disproportionately represented among essential
workers. Communities of color in the U.S. have been hit disproportionately hard by Covid, dying at
much higher rates than white Americans.
However,
the committee noted that racial and ethnic minorities are less represented in
the frontline sub-group of essential workers than in the broader group. But the
broader group of essential workers includes another 57 million people and
including them in phase 1b would mean the demand for vaccine would far outstrip
supply, thereby passing along the hard decisions of prioritization to stressed
state and local officials.
Dr. Jeff
Duchin, public health officer of Seattle and King County, Washington,
emphasized the need to adequately fund local public health departments that are
actually turning vaccines into vaccinations.
“Resources
are needed for public health vaccination clinics to ensure equitable access to
vaccines across communities and populations,” he said. “There is a critical and
immediate need for adequate funding and resources for vaccine program
implementation.”
Several
committee members said they don’t expect all states to absolutely adhere to the
federal guidance and that, in fact, they should be adjusted to the state of the
local outbreak. For example, while corrections officers are prioritized in
phase 1b, the CDC’s Dr. Kathleen Dooling said it might make sense, depending on
local outbreaks, to simultaneously inoculate inmates, as well.
Dr.
Christine Hahn of the Council of State and Territorial Epidemiologists said
that local and state officials will undoubtedly stray from the federal
guidance. The most important thing, Hahn said, is that the CDC provide enough
guidance to avoid “paralysis by analysis” at the local level.
“There
is no way we’re going to be able to all stay lockstep, and we need to message
clearly that there’s going to be local decisions, because the worst thing that
can happen is we leave vaccines in the freezer because we are afraid to move
into that next group and keep going,” she said. “We have to have faith in our
local public health officials and state health officials to do the right thing”
“This
is not black and white,” Dr. Amanda Cohn of the CDC added. “They will
absolutely vary by local context.”
The
committee can always revisit their recommended prioritizations. Dr. Grace Lee
of Stanford University School of Medicine said the committee might need to be
flexible if, for example, vaccine manufacturers face interruptions and are
unable to supply as many doses as projected.
“I
am hoping that by the time phase 1c comes along that we will have enough doses,
but I did want to reflect that if, for some reason, we don’t have enough
doses,” Lee said, “I think we have to be prepared to adapt in the future
phases, because we don’t know where we’re going to be in another month as those
phases roll out.”
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