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The CDC’s Advisory Committee on Immunization Practices met to discuss whether to recommend the use of a COVID-19 vaccine that the U.S. Food and Drug Administration may authorize.
Volunteers participating in vaccine trials said they frequently experience flu-like effects after being vaccinated, and ACIP members – as well as liaison representatives participating in the discussion – said this could affect the will of people. people to get vaccinated in the first place. , or to get the second dose of the two vaccine schedule.
“As a practicing physician, I must ensure that my patients come back for the second dose. We really need to make patients aware that it won’t be a walk in the park, ”Dr. Sandra Fryhofer of Emory University School of Medicine, representing the American Medical Association, told the meeting.
“They will know that they have received a vaccine. They will not feel wonderful.”
The purpose of vaccination is to elicit an immune response in the body which can sometimes cause flu-like symptoms such as body aches, even fever and headaches.
Patricia Stinchfield of Minnesota Children’s Hospitals and Clinics, representing the National Association of Pediatric Nurse Practitioners, said providers need to be prepared to explain this to people getting vaccinated.
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“These are immune responses, so if you feel anything after the vaccination you should expect to feel that. And when you do, it’s normal for you to have arm pain or fatigue or aches or even fever, “Stinchfield told the meeting. Some people may feel bad enough that they have to stay home from work for a day, she said.
Dr Paul Hunter, of the City of Milwaukee Health Department and a voting member of the committee, said it would be important for the first people to get vaccinated to describe these experiences to others.
Build confidence in a vaccine
“The people who really appreciate getting the vaccine quickly and quickly, early, are going to be really helpful to everyone. And I think we’re really going to have to honor them, because they’re going to let us know what it feels like,” he said. said. “And I think these people are probably healthcare workers who will probably be ready for these kinds of jobs.
Public willingness to get a coronavirus vaccine has steadily declined since the spring, but could improve as people start to learn more about the safety and effectiveness of the various vaccines in the pipeline, the said. Dr. Sara Oliver of the CDC to the committee during the five-hour meeting.
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Oliver said the CDC has looked at various attitude surveys and noted that between 40% and 80% of those polled said they would be willing to get the shot.
“Many adults have signaled their intention to receive the Covid vaccine. But concerns were raised about side effects, unknown efficacy and the speed of the (authorization) process,” Oliver said at the meeting.
Vaccine acceptance was highest among Asian Americans and lowest among African Americans, Oliver said. This is concerning as ACIP wants to ensure that any approved vaccine reaches the groups most affected by the pandemic, and black people are among the hardest hit by Covid-19.
Nurses were also a concern. A survey showed that if nurses agreed that vaccines were likely to be safe and effective, only 34% would be voluntarily vaccinated, Oliver said.
ACIP members said they believed these fears could be addressed through education campaigns and as people learned of data showing that, for example, Pfizer and Moderna vaccines were around 95% effective. to prevent symptomatic illnesses without any significant safety concerns.
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Vaccine allocation
Any plan for the distribution of the coronavirus vaccine should take into account fair and equitable access to all, especially to groups who are disproportionately affected by the pandemic.
Fair access tops the list, ACIP committee members said in a document released at the start of the meeting.
“How do the characteristics of the vaccine and logistical considerations affect equitable access for all people?” they asked in the document published in the CDC’s MMWR report.
“Does allocation planning include the contribution of groups who are disproportionately affected by Covid-19 or who face health inequalities resulting from social determinants of health, such as income and access to health? Health care?”
The CDC, the National Academies of Science, Engineering, and Medicine, and other advisers have proposed four groups who should get vaccinated first: healthcare workers, other essential workers, high-risk adults, and other adults aged 65 and over.
That’s a lot of people. The CDC estimates that there are 21 million healthcare workers, 87 million essential workers, 100 million adults with high-risk medical conditions, and 53 million more are 65 and over. The federal government has said 40 million doses of the coronavirus vaccine could be available by the end of December.
There is little disagreement that frontline health workers should be in the first group – referred to as 1a. The question is whether institutional residents of long term care should also be part of this group.
There is no doubt that this is a very vulnerable population. “Residents and staff of long-term care facilities accounted for 6% of cases and 39% of deaths in the United States, despite the fact that residents of long-term care facilities represent less than 1% of the US population CDC’s Dr. Kathleen Dooling told the meeting.
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In addition, this is a group that would be easier to reach if the staff caring for them are already vaccinated in the first phase of any vaccine that may obtain emergency clearance from the FDA.
But ACIP member Dr. Helen Keipp Talbot was concerned that this fragile group would hurt in general and undermine confidence in the vaccine.
“The death rate is so high in long-term care facilities,” Talbot said at the meeting. “There will be a number of patients who get vaccinated against Covid and die. And it will be whatever the vaccine and most likely whatever the vaccine,” Talbot said.
“But from the start, we build trust and we won’t be able to show data that says it’s not due to the vaccine because there hasn’t been a randomized controlled trial. And I think we’re going to have a very striking reaction from ‘my grandmother got the vaccine and she passed away’, and they’re probably not related, but that will be remembered and will break some of the trust in the vaccine. vaccine. “
But others didn’t think it would be helpful to bring those residents back online.
Hunter said it would be ineffective to vaccinate healthcare workers in facilities but skip residents. “Why not vaccinate people who, you know, you, you have everything prepared and ready to go? He asked. “It’s an efficiency to vaccinate a group of people who could benefit from it.”
ACIP will not make a decision on Monday. The group will meet after the FDA’s Vaccines and Related Biologics Advisory Committee (VRPBAC) meeting on December 10 to discuss an emergency use clearance application from vaccine maker Pfizer and its German partner BioNTech.
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