Coronavirus: an update on the COVID-19 vaccine

Putting essential workers second behind healthcare workers for a future COVID-19 vaccine would send a strong message that health equity is a key component of the country’s vaccine distribution plan, a group of experts confirmed on Monday. ‘medical and public health experts.

“If we are serious about assessing fairness, we have to have done it early in the immunization program,” said Dr. Beth Bell, chair of the COVID-19 vaccine working group for the Advisory Committee on Immunization Practices. immunization, the federal government group tasked with evaluating vaccines and making recommendations to the CDC.

“These essential workers are out there, putting themselves in danger to allow the rest of us to socialize.”

People from racial and ethnic minorities make up 40% of the U.S. population, but account for 50% of COVID-19 cases and 45% of COVID-19 deaths, Dr Sara Oliver presented on Monday at the meeting of the ACIP. Age-adjusted hospitalization rates are four times higher among minority groups than among non-Hispanic white Americans.

Members of racial and ethnic minorities are also disproportionately represented among the approximately 66 million Americans who are essential non-health workers: people working in restaurants, agriculture, education, transportation, corrections, public safety, water and wastewater, etc., – work which cannot be carried out remotely and often requires close proximity to others.

Although Monday’s 5-hour meeting did not end with a vote, the group expressed support for a presented framework in which healthcare workers and residents of long-term care facilities were first in line. for phase 1a. Essential workers are in phase 1b, while adults with high-risk medical conditions and adults 65 years and older were in phase 1c. The CDC also published an article on Monday explaining ACIP’s recommendations and processes.

The meeting came just hours after the University of Oxford and AstraZeneca announced that their vaccine showed an average efficacy of 70% – the latest vaccine candidate to produce promising data on the safety and efficacy of trials phase III.

Pfizer and BioNTech had previously announced more than 90% efficacy with their vaccine and asked the CDC for emergency use clearance on Friday, while Moderna also recently announced 94.5% efficacy with their vaccine and will approach. soon the FDA for an authorization.

Although no specific timeline exists, it is possible that the first doses will be available to healthcare workers by December. Doses are expected to be limited initially, with supply and access increasing in spring and summer 2021.

Complicated questions

The ACIP COVID-19 Vaccine Working Group, which has met nearly 25 times since its inception in April, has faced two big questions: First, “Should we recommend a COVID-19 vaccine?” then, “to whom should it be recommended?”

To help determine the first answer, the group looked at additional questions in 7 different areas: public health issue, resource use, equity, pros and cons, values, acceptability and feasibility – answers that will be updated as they come. a vaccine is authorized or approved. by the FDA.

For the first area, the advisory group agreed that COVID-19 is an urgent health problem, having infected more than 12 million people in the United States and causing more than 257,000 deaths.

John Cairns, University of Oxford

When it comes to resource use, if 20% of the U.S. population is infected with COVID-19, the direct medical costs could be $ 163 billion. The related costs, which include premature death, long-term health disorders and mental health disorders, have been estimated at $ 8.5 trillion, according to the ACIP presentation.

Thus, the answer to the question “Is the COVID-19 ‘X’ vaccine a reasonable and efficient allocation of resources?” was a resounding yes.

A question of fairness

Equity is a more complicated issue, and group members were asked to think about how vaccine distribution could reduce, not increase, inequalities in health.

This includes taking into account factors such as cost, access and opinions about vaccines.

Although the vaccine is promised free, will offices be allowed to charge a co-payment of $ 45 or $ 55 for an office visit? Because it can be too big a barrier for individuals, especially those without insurance, said Lynn Bahta, clinical immunization consultant with the Minnesota Department of Health and member of the ACIP committee.

What if people are not connected to traditional forms of public health messages?

Public health officials may need to identify opinion leaders and influencers in the community and proactively contact them, working together to help disseminate information or change people’s perceptions of the vaccine. said Dr. José Romero, chief medical officer for the Arkansas Department of Health. chairman of the committee.

What about reluctance to vaccinate?

“I think the interest in a vaccine is changeable,” said Dr. Peter Szilagyi, professor of pediatrics at UCLA and member of ACIP, who noted that when people can see themselves represented in trials of vaccines, they may feel more comfortable with the result. Moderna and Pfizer have released demographics for their vaccine trials.

Szilagyi also pointed out that the reluctance about a COVID-19 vaccine is closely related to the concept of trust, which can be built through transparent processes, “as we have here,” he said. .

Confidence will also build as people will be open and honest about their own vaccine reactions, which will not be a “walk in the park,” said Dr. Sandra Fryhofer, the ACIP liaison for the American Medical Association. “They’re going to know that they got a vaccine, and they probably won’t feel well, but they have to come back for that second dose.

Both Pfizer and Moderna vaccines are a two-dose regimen.

As with any vaccine, a feeling of discomfort should be taken as a sign that it is working and that the body is responding appropriately, said Dr Patricia Stinchfield, the ACIP Liaison Representative for the National Association of Pediatric Nurse Practitioners. .

She encouraged providers to consider using the words “immune response” instead of “adverse reactions,” which may seem “scary” to people, and to emphasize that arm pain, body aches, or even fever. are normal.

Now is the time to promote vaccines

These conversations about vaccines and getting them when the time comes must take place now between doctors and patients, said Dr Amanda Cohn, ACIP Executive Secretary, because “we need these seeds to be planted early.”

If the country is serious about seeing a nationwide vaccine distribution campaign that is not only feasible and equitable, but addresses reluctance, increases education, and provides access to all who want a vaccine, this will require a major investment.

Dr Bell reminded the group of the 2009 H1N1 influenza pandemic in which the focus was on the vaccine manufacturing process, but very little attention was paid to vaccine implementation.

While she’s thrilled with the $ 10 billion in federal funding spent to develop and produce vaccines, it can’t end there, she said.

“I am really concerned that the funds are not available to implement the immunization program as we want it to be implemented,” she said. “All of our recommendations here are really conditional on adequate funding to implement this program. I urge the relevant authorities to allocate these funds. “