Medical Workers, Long-Term Care Get Nod for First Covid Shot

Health-care workers and residents at long-term care centers should be first in line for Covid-19 vaccines, key U.S. government advisers urged Tuesday, citing the high risk for infection within these groups and the positive effects on hospitals.

The Advisory Committee on Immunization Practices, or ACIP, includes medical and public health experts that advise the Centers for Disease Control and Prevention on vaccine use. Their recommendation, approved by a 13-to-1 vote, comes as regulators are set to rule within weeks on emergency use of a Pfizer Inc.-BioNTech SE vaccine, followed quickly by a decision on a Moderna Inc. shot.

“My vote reflects maximizing benefit, minimizing harm, promoting justice and mitigating health inequities that exist with regard to distribution of this vaccine,” ACIP Chairman Jose Romero said after the vote.

Kathleen Dooling, a CDC epidemiologist, cited a “multiplier effect” in vaccinating health-care workers first, noting they provide care in high-risk settings and keep hospitals open and working. Finally, she said, this group includes low-wage earners as well as racial and ethnic minority groups hit hard by the virus.

Most jurisdictions “believe that they can vaccinate all of their health-care workers within 3 weeks,” said Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases.

Final Hurdles

The recommendation approved on Tuesday is one of the last remaining hurdles before vaccinations begin. If the Food and Drug Administration authorizes the shots this month as expected, at least some portion of the country’s 21 million health-care workers and 3 million nursing home residents could get their first immunization doses within weeks.

Still, the advisers don’t have the final say: The agency’s director, Robert Redfield, will determine whether to accept their advice. And eventually, individual states will get a set number of doses from the federal government to distribute as they choose.

Tuesday’s meeting opened with Beth Bell, the head of the working group, saying that the nation is now averaging one death from Covid-19 every minute. “In the time we’re having this meeting,” she said, “180 people will have died.”

In the U.S., more than 13 million Covid-19 cases have been confirmed and almost 270,000 people have died, according to Johns Hopkins University’s Coronavirus Resource Center.

Priortizing Groups

About 5 million to 10 million vaccine doses are expected to be made available per week after a shot is authorized, said the CDC’s Sara Oliver. That makes it likely that hospitals and others will have to prioritize certain subgroups among those allowed earliest access to the shots.

At the hospital level, the first shots should be targeted at those with direct patient contact, along with workers who provide services to patients or their family members and employees who handle infectious materials, Oliver said.

Moving a step deeper, the advisory group also suggested that hospitals stagger vaccinations from similar units or positions, and plan for workers to have time away from clinical care if they experience side effects from the shots.

Growing Push

Previously, ACIP’s working group on Covid-19 vaccines was only considering health-care workers for the first phase of allocation, according to a September presentation from Dooling. Since then, there has been a growing push for early use in long-term care facilities, which have accounted for 6% of Covid-19 cases and 39% of deaths in the U.S. as of early November.

Long-term care facilities offer medical care for a variety of medical conditions and include nursing homes and assisted-living centers.

In a statement Monday, the American Health Care Association said that the lack of prioritization “for long-term care and seniors housing at the outset of the pandemic led to devastating losses, and we cannot let that happen again.”

Providing first-in-line vaccine availability to long-term care centers may reduce hospital utilization and it’s well supported by a partnership with pharmacies to vaccinate at such facilities, the CDC’s Dooling said on Tuesday. The CDC has tapped pharmacy giants Walgreens Boots Alliance Inc. and CVS Health Corp. to vaccinate residents and employees of nursing homes and assisted-living facilities.

There have been concerns that there isn’t detailed clinical trial data that has been made public on the use of the vaccines in older adults, something Helen Talbot, an associate professor at Vanderbilt University, cited in her lone vote against the ACIP recommendation.

Interim Recommendations

The recommendations from the advisers are being made on an interim basis, aimed at helping state health departments finalize their plans and place their orders, which are due on Friday, ACIP Secretary Amanda Cohn said. The group will meet again once the FDA decides to authorize emergency use of a vaccine.

States, which will get doses based on their adult populations, are largely expected to set priorities based on the advisory panel’s recommendations. But they have the authority to make their own decisions about whom to vaccinate first and some states are already moving forward with their own plans.

Texas last week unveiled priorities which call for vaccinating health-care workers likely to provide direct care for Covid-19 patients and other vulnerable residents first.

Ultimate Decision

Ultimately, those actually administering the vaccines will make the final decisions. Hospitals, for instance, are anticipating they won’t initially get enough doses for all of their employees. They’re now racing to decide which to vaccinate first.

The ACIP Covid-19 vaccines working group has also been exploring other groups with vulnerable populations for early vaccine use after those first in line, including essential workers and those 65 and older.

Racial and ethnic minorities, a group that has been disproportionately affected by Covid-19, are more widely represented among essential workers and are under represented among people 65 and older, Dooling said. At a meeting last week, ACIP members were leaning toward prioritizing essential workers over older adults.

©2020 Bloomberg L.P.

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