CDC panel says health workers, long-term care residents should get COVID-19 vaccine first

Health workers and residents of long-term care facilities should be at the front of the line to receive the first limited doses of a COVID-19 vaccine, a federal advisory panel formally recommended Tuesday.

The specific recommendations from the Centers for Disease Control and Prevention’s (CDC) independent Advisory Committee on Immunization Practices (ACIP) were expected, as the committee has been broadly supportive of giving this demographic access to the vaccine first during recent meetings. 

The recommendations passed by a vote of 13-1.

The recommendations for “phase 1a” will be sent to CDC Director Robert Redfield. If he approves, they will become official CDC guidance. 

States don’t necessarily have to follow the recommendations, but it gives them some guidance ahead of a Friday deadline to submit vaccination distribution plans to the federal government.

States also have significant leeway to come up with their own definitions, and even create separate sub-prioritization groups. 

Committee members said that in determining initial vaccine allocation, they wrestled with questions of justice and expediency, and what they believe is the overall goal of a vaccine. 

Once the recommendations are adopted, it will mean other high priority groups, like people older than 65, essential workers and those with underlying medical conditions, will have to wait for the second phase, which ACIP has classified as 1b, or later. ACIP is planning to discuss those groups later this month. 

According to ACIP, there are about 3 million people living in long-term care facilities; about 21 million health care workers; about 53 million senior citizens; about 87 million essential workers; and more than 100 million people with underlying medical conditions.

Residents and staff of long-term care facilities, especially nursing homes, accounted for 6 percent of all cases and 39 percent of all deaths in the U.S.

ACIP members said they want to prioritize health providers to keep the health care system running, and most jurisdictions said they expect to be able to vaccinate every health worker within three weeks of receiving initial doses. 

Health providers also have a high rate of vaccine acceptance, and many acute health care facilities have the equipment and expertise to carry out large scale vaccination with a vaccine that requires ultra-cold storage. 

No vaccine has been authorized for distribution yet, but a Food and Drug Administration advisory panel is set to meet on Dec. 10 to discuss the one manufactured by Pfizer. The agency could issue an emergency authorization within days of the meeting.

However, FDA Commissioner Stephen Hahn has tried to temper expectations even as COVID-19 cases spike nationwide. Nearly 2,000 people are dying every day, and the numbers are expected to increase in the coming weeks.

A vaccine authorization normally takes months after an application has been submitted, not weeks.

“One thing we can’t do is promise something that isn’t deliverable because of an issue that comes up regarding safety or effectiveness,” Hahn said. 

Operation Warp Speed, the Trump administration’s initiative to speed vaccine development and distribution, plans to send out the first 6.4 million doses of Pfizer’s vaccine to states within 24 hours of getting the green light from FDA.

Federal health officials said they expect to have enough doses of a shot from Pfizer and another from Moderna to vaccinate 20 million people by the end of the year, a fraction of the country’s 330 million people. 

Those doses will be available on a rolling basis, and the supply will be extremely limited. Each vaccine will require two doses administered about a month apart.

“We expect a constrained supply environment for some months,” CDC’s Sara Oliver told the panel, so states will need to make the best of the limited supply.

Oliver noted there will likely only be 5 to 10 million doses a week once a vaccine is authorized.