(Bloomberg) --
The elderly and front-line essential workers, including firefighters, teachers and grocery store workers, should be next in line for coronavirus vaccines, an advisory committee to the Centers for Disease Control and Prevention voted on Sunday.
The first round of vaccinations, which started last week, is going mostly to to health-care workers and residents of long-term care facilities.
After the so-called Phase 1B group, the third tranche, or Phase 1C, would include those ages 65 to 74, younger people with high-risk medical conditions, and other essential workers, including those who work in the construction, food service and legal fields, the CDC’s Advisory Committee on Immunization Practices recommended.
“While we want to provide vaccine to all Americans who want it, we are asked to provide recommendations during a time of limited vaccine availability to ensure safety and effectiveness, minimize transmission, morbidity and mortality, minimize social disruption, and ensure equity in allocation distribution,” Katherine Poehling, a member of the committee and a pediatrician at the Wake Forest School of Medicine, said after the vote.
A further breakdown among the third group may be provided at a later date, since multiple committee members expressed concern about how large it is -- about 129 million people -- and the need to further prioritize within it.
Members of the committee voted 13-1 on the recommendations. The one dissenting member, Henry Bernstein, a doctor at Northwell Health in New York, said he voted no because he thought it made more sense to vaccinate adults 65 and up sooner.
Two Approvals
The panel’s recommendations offer a road map of whom to vaccinate when there are not enough shots for all Americans.
While identifying members of those first two groups is relatively clear, thornier issues are sure to arise once vaccines are offered to broader groups that aren’t so easily defined.
Two Covid-19 vaccines, one from Pfizer Inc. and BioNTech SE and another from Moderna Inc., have been authorized for emergency use by the U.S. Food and Drug Administration this month. Initial doses are being distributed across the country.
More than half a million doses of the Pfizer/BioNTech vaccine were administered in the U.S. last week, the CDC said, adding that the figure could be an undercount given reporting lags. The federal government distributed 2.84 million doses of the vaccine last week, the first of the inoculation campaign, according to the CDC.
About 24 million health-care workers and long-term care residents fall into the first group eligible for Covid-19 vaccines. The next group, elderly people ages 75 and up, and front-line essential workers, includes an estimated 49 million people.
Not Binding
Officials for the federal government’s Operation Warp Speed, the initiative spearheading development and distribution of Covid-19 vaccines, have said there could be enough shots to vaccinate about 100 million people by the end of February.
CDC advisers offered suggestions for how to divvy up shots among front-line essential workers if there aren’t enough shots to cover the entire group. They include identifying workers in places where outbreaks have occurred, and workers who are at a higher risk of developing severe illness.
States aren’t required to follow ACIP’s recommendations, possibly creating a situation where certain people in similar risk groups can get vaccinated in one state before another. Some of the thorniest issues may arise among companies with national reach.
Governors should feel confident ACIP’s recommendations are rooted in scientific evidence, ACIP Chair Jose Romero said in an interview Friday. The committee has held more than 25 meetings outside of the public sessions to review epidemiological data used to craft its guidelines.
‘Greatest Impact’
“I think we can prove to the governors that the recommendations are sound and this is the best way to deliver the limited vaccine we have to the groups where it will have the greatest impact,” said Romero, who is also secretary of Arkansas Department of Health.
Trade groups including the Household & Commercial Products Association and corporate giants such as Amazon.com Inc. have been jockeying to get their workers prioritized. Their battles could become more local as states set their priorities, which could vary in how closely they mirror ACIP’s guidelines.
Kansas, for example, has already announced that grocery store employees and meatpacking plant workers will be near the top of the list.
State and local governments will decide when to expand Covid-19 vaccinations. They should not necessarily wait for everyone in the priority groups to be vaccinated before moving to the next, especially if they have more shots available than people wanting them, the CDC advisers said.
Robert Atmar, an advisory committee member and an infectious disease doctor at the Baylor College of Medicine, raised the possibility of one community moving quickly through the priority groups and starting to vaccinate the general public, while another community continues working its way through the initial phase.
And Molly Howell, North Dakota’s immunization program manager, stressed the need for clear communication to help the public understand why their neighbors can be vaccinated while they must wait.
Screening Hurdles
Implementing the recommendations could also be challenging.
Screening people for medical conditions that put them at higher risk for severe disease, such as obesity or chronic obstructive pulmonary disease, could pose one hurdle. Vaccinating these people could make more sense in doctors’ offices and pharmacies, where providers can verify their medical conditions, the CDC advisers said.
Another obstacle could be reaching essential workers. Helen Keipp Talbot, a committee member and an infectious disease doctor at Vanderbilt University, urged federal lawmakers to fund state health departments so they can vaccinate workers who cannot afford to take time off work.
“We’re going to have to do a lot of public-private partnerships to make this happen,” Talbot said.
Jeffrey Duchin, health officer for public health in Seattle and King County, said local health departments are on “life support” and are desperate for money to host vaccination clinics, help providers in the community, and educate their residents.
“Operation Warp Speed has delivered two Cadillac vaccines to us,” says Duchin, “But they’ve come with empty gas tanks and we have a long and difficult road ahead of us.”
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