December 1, 2020 – An influential government committee has recommended that healthcare workers and people residing in long-term care facilities receive the first doses of COVID-19 vaccines as soon as they become available.
In a 13-to-1 vote, the Advisory Committee on Immunization Practices (ACIP) said healthcare workers and residents of nursing homes and other residential care facilities should be the first to get vaccinated against COVID-19.
Health care workers include any paid or volunteer staff who work in health care facilities. Residents of long-term care facilities include adults who live in facilities that provide medical or personal care to people who cannot live independently.
The vote follows months of deliberation by the committee to determine the most effective and fair way to distribute rare early doses. It follows similar recommendations made by the National Academies of Sciences in October.
ACIP is made up of 15 voting members, eight non-voting members from other government agencies, and 30 non-voting members from other organizations who have expertise and interest in immunization. The committee has met frequently this year to prepare for the deployment of the COVID-19 vaccine.
If the recommendation is approved by CDC director Robert Redfield, MD, it will be forwarded to states, which have previously worked with the agency to create their distribution plans.
This recommendation is not binding, although states generally follow ACIP guidelines.
ACIP prioritized health workers for immunization because of a “multiplier effect” – keeping them healthy ensures the health of others. The CDC says there are approximately 21 million healthcare workers in the United States. More than 3 million Americans are residents of skilled nursing facilities or assisted living or other group care homes.
In formulating its recommendation, the committee prioritized saving lives rather than using the vaccine to slow disease transmission.
“I think everyone, pretty much everywhere, agrees that with a limited number of doses, the best approach is to try to protect as many high-risk people as possible. This puts healthcare workers at the forefront, ”says Josh Michaud, PhD, associate director of global health policy for the Kaiser Family Foundation in Washington, DC
“If you wanted to cancel transmission, you would target your vaccination programs on those who transmit the most in the United States, who are sort of young adults,” he says.
Acceptance of vaccines is generally expected to be high among health workers, a group that will also be closely watched for any vaccine-related side effects. The CDC has developed a voluntary cellphone-based system called V-Safe that will monitor healthcare workers through text messages and regular phone calls.
But the survey results presented at a previous ACIP meeting revealed significant concerns about vaccines, even among this group. In a CDC survey of healthcare workers, 63% of them said they would receive the vaccine. A separate American Nurses Foundation survey found that only 34% of nurses said they would receive the vaccine if their employer did not require it, 36% said they would not get a COVID-19 vaccine and 31% said they were not sure.
CVS and Walgreens have signed agreements with the federal government to give vaccines to residents of long-term care facilities, agreeing to make three visits per facility to distribute vaccines.
Initial doses of a vaccine could be sent as early as mid-December, Vice President Mike Pence told governors on a call Monday.
Once a vaccine is approved, things will move quickly.
Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Disease, says most jurisdictions expect to be able to immunize all of their healthcare workers within 3 weeks of vaccine approval.
After the first vaccine shipments, 5 to 10 million additional doses could be administered each week on an ongoing basis.
The FDA is expected to make a decision on Pfizer’s emergency use authorization for its COVID vaccine after an advisory committee meets on December 10 to review the company’s request.
ACIP will meet and vote again on recommendations for specific products after their approval by the FDA. These recommendations trigger financial reimbursements by federal government health plans like Medicare and Medicaid.
Ultimately, the governors of each state will decide how the first doses of vaccine will be distributed.
“Ultimately, it will be the governors of our country, in implementing the distribution plans, to tell us… where to ship, and they will decide who the vaccine is administered to. We hope our recommendations will carry weight with them, but at the end of the day they will make that decision, ”Health and Human Services Secretary Alex Azar said during a press briefing by the Operation Warp Speed last week.
He said the vaccine would be distributed to states on a formula basis based on each state’s adult population.
General Gus Perna, COO of Operation Warp Speed, said in a press briefing on Nov. 23 that he was planning at least 6.4 million doses of vaccine to go to states on the first shot.
Operation Warp Speed has yet to release the list of doses that will be assigned to each state.
For a short time, vaccine supplies will not cover everyone, even in the groups designated as first priority. States will therefore have to decide which workers and residents need the vaccine most.
On Tuesday, the CDC further recommended that healthcare workers who have direct contact with patients and cannot telecommute be the first to come first. They also suggested that residents of nursing homes should be given priority over residents of other types of residential facilities because they tend to be older and more physically fragile.
A major issue to be addressed is what to do for healthcare workers who are pregnant or breastfeeding. The CDC says 75% of healthcare workers are women, and up to 330,000 people can be pregnant when a vaccine becomes available. While COVID poses a higher risk to pregnant women, the CDC says it does not have data on mRNA vaccines, like the type made by Pfizer and Moderna, during pregnancy. The agency says it is awaiting clinical trial information for review.
California Governor Gavin Newsom Monday ad that his state expected to receive 327,000 doses of the Pfizer vaccine by mid-December. The state has more than 2 million health workers, which means that the first doses will fall far short of the total demand, even for people who have the first priority.
According to a chart released by Operation Warp Speed, Pfizer will distribute its own vaccines, which require ultra-cold storage. The Moderna vaccine will be distributed by McKesson, which has a long-standing contract with the CDC and distributed vaccines during the H1N1 flu epidemic. McKesson also distributes seasonal flu shots to states.
Pfizer and Moderna vaccines require two doses per person. Pfizer’s vaccine requires a booster 3 weeks after the first dose. The second dose of Moderna is given 4 weeks later.
In the November 23 press briefing, Azar, the HHS secretary, said he expected to have enough vaccine to vaccinate the most vulnerable by the end of December.