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A CDC panel of experts voted on Tuesday 13-1 to recommend that the first COVID-19 vaccines be sent to healthcare workers and nursing homes as soon as they are cleared by the FDA, a decision expected later this this month.
The CDC Advisory Committee on Immunization Practices (ACIP) vote prioritizes both populations equally for the first vaccines, coming amid a growing nationwide pandemic. The meeting finalized months of planning for vaccine distribution by committee experts and federal officials, who had to balance medical ethics, what science has learned about those most at risk, and the ease of vaccination. mass for these populations.
The debate over who should get the first vaccines has come to a head with recent reports from Trump administration officials pushing for people over the age of 65 to get vaccines before healthcare workers.
“My vote reflects maximizing benefits, minimizing harm, promoting justice and reducing inequalities in the distribution of these vaccines,” said group president José Romero, health secretary of the ministry of Arkansas Health.
If ACIP’s recommendations are approved by CDC Director Robert Redfield, they become agency guidelines as soon as they are released by the agency. The government will distribute the first vaccines to states based on their population, Alex Azar, head of the Department of Health and Human Services, said last week. The decision of who to distribute the vaccines to first will then be up to individual governors, he added.
“This is important because the COVID-19 pandemic is unprecedented,” Walter Orenstein of Emory University, former director of the United States immunization program, told BuzzFeed News. “It is important that planners at the national and local levels have a perspective, when the first doses of vaccine are deployed, to whom they should be targeted.”
There are some 21 million healthcare workers in the United States and 3 million nursing home residents. Operation Warp Speed, the $ 10 billion public-private partnership to accelerate the development of COVID-19 treatments and vaccines, hopes to have vaccines ready for about 20 million Americans by the end of the year. CDC officials told the meeting that they initially plan to distribute between 5 and 10 million doses of vaccine per week in 2021.
Two vaccine candidates, one made by Pfizer and the other by Moderna, have reported 95% and 94.1% effectiveness, respectively, in blocking cases of COVID-19 among clinical trial participants who received two injections of their vaccines spaced several weeks apart. Both have sought FDA clearance for their distribution.
On Dec. 10, an independent panel of FDA experts will meet to review the authorization for Pfizer’s vaccine, and a similar meeting will be held about a week later for Moderna’s, according to Azar.
Typically, the FDA first clears or clears a vaccine, and then the CDC director approves vaccine distribution priorities decided by its advisory committee. However, with more than 2,000 Americans dying each day from COVID-19 in the days leading up to Thanksgiving, the CDC panel vote came first, intended to facilitate the distribution of vaccines as the FDA allows. The CDC said there will be another meeting after the December 10 FDA meeting to specifically vote on the distribution of the Pfizer vaccine.
“We hope this vote will bring us all closer to the day when we can all feel safe again,” said Nancy Messonnier of the CDC, who spoke at Tuesday’s meeting.
Review by independent experts is the norm for any new vaccine, Orenstein said. “What’s rare is how quickly this is happening due to the ongoing pandemic,” he said.
Health workers
Panel members stressed the importance of vaccinating healthcare workers, doctors, nurses and staff first, who are most directly exposed to the novel coronavirus and are needed to treat patients with COVID-19 in hospitals across the country. The panel discussed the staggering mass vaccinations in hospitals to keep many ICU or emergency room staff from facing the side effects – usually fatigue and headaches – of injections at once.
One of the concerns was whether pregnant or breastfeeding healthcare workers should receive a vaccine. Women make up about three-quarters of the health workforce, and perhaps 300,000 of them could be pregnant or breastfeeding a baby. There is no data on the safety or effectiveness of COVID-19 vaccines in pregnant women. But infected breastfeeding women do not appear to transmit the virus this way, some panel members noted.
Most jurisdictions estimate that they will have given the first dose to all of their healthcare workers within three weeks, CDC’s Messonnier said.
Nursing homes
The plans for nursing home residents are based on a drugstore chain-run program that has enrolled 99% of these facilities nationwide in mass vaccination plans for staff and residents. More than 74,000 residents and employees of long-term care facilities across the country have died from COVID-19 during the pandemic, making it one of the groups most at risk. For the CDC panel, this risk outweighed concerns about the exposure of older people to new vaccines, especially in light of early data showing low rates of adverse reactions.
The decision to prioritize nursing home residents on an equal footing with health workers has been made in recent months as the number of deaths among this population has become more evident. Discussions at previous meetings had focused on the importance of preventing deaths while preserving the health system, which led to the decision to balance the two priorities.
“I have no reservations that healthcare workers receive these vaccinations,” said Helen Talbot, panel member, Vanderbilt University, the only expert to vote against prioritization. Talbot said she opposed the vote because she wanted to see more safety testing of elderly nursing home residents before they were given a vaccine.
The rest of the United States
Essential workers come next for vaccines, although this decision was not voted on by the panel, followed by people with high-risk health conditions, such as diabetes, cancer or heart disease, and people over 65.
Under the Affordable Care Act, or Obamacare, insurers must cover the costs of ACIP-approved vaccinations, with help from the federal government in the case of COVID-19 vaccines.
A first bulk shipment of the Pfizer vaccine arrived Friday at Chicago’s O’Hare International Airport. California Governor Gavin Newsom said Monday his state would receive 327,000 doses of the vaccine on its first shipments. With 12% of the US population in California, that suggests that the first nationwide shipment will be around 2.7 million doses.
The United States has recorded more than 13.5 million cases of COVID-19 and more than 270,000 deaths, with widespread deployment of vaccines to the public not expected until late spring.
Stephanie Baer contributed reporting for this story.
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