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First Covid vaccines to be offered to health workers, nursing homes, CDC panel says

The CDC's advisory panel convened virtually to determine who would receive the first doses of the vaccine.
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Health care personnel and residents of long-term care facilities will be the first groups to be offered the Covid-19 vaccine, according to a new proposal from an independent advisory committee within the Centers for Disease Control and Prevention.

The Advisory Committee on Immunization Practices met virtually on Tuesday to discuss who would receive the first doses of the vaccine and to vote on the proposed language for the recommendation. The proposal passed 13 to 1.

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The panel of outside scientific experts makes recommendations to the CDC, which almost always accepts them.

“We have spent eight months discussing and evaluating the data,” Dr. José Romero, ACIP chair, said following the vote. “We are using the principles of maximizing benefits and minimizing harms, promoting justice and mitigating health inequities.”

The first phase of the vaccine rollout will be known as Phase 1a and is set to begin as soon as a vaccine receives authorization from the Food and Drug Administration, which is currently reviewing data on two vaccines, made by Pfizer and Moderna. The FDA’s advisory committee will meet on Dec. 10 to consider an emergency use authorization for the Pfizer vaccine.

Current estimates project that no more than 20 million doses of each vaccine will be available by the end of the year. And each product requires two doses.

As a result, the shots will be rationed in the early stages. Experts say the vaccine will probably not become widely available in the U.S. until the spring.

The two groups in Phase 1a together represent around 24 million Americans — 21 million health care workers and 3 million residents of long-term care facilities. Staff working at long-term care facilities are considered among the health care workers.

As the meeting got underway, panel member Dr. Beth Bell of the University of Washington noted that on average, one person is dying of COVID-19 per minute in the U.S. right now, “so I guess we are acting none too soon.”

During the discussion period, panel members asked about how the vaccine doses would be prioritized within the groups in Phase 1a. For example, health care workers with direct patient contact would be among the first to be offered the vaccine, as well as individuals working in long-term care facilities.

Other questions addressed vaccine safety and adverse events monitoring after people received the vaccine.

“We're going to hold ourselves to an exceedingly high standard for safety monitoring after a vaccine is authorized and when it's rolled out more broadly,” said Dr. Nancy Messioner, the head of the National Center for Immunization and Respiratory Diseases at the CDC.

Safety monitoring will include several components, including the long-running Vaccine Adverse Event Reporting System, managed by both the CDC and FDA, and a new approach called V-SAFE, which monitors early recipients of the Covid-19 vaccine with text messages and online surveys.

The one “no” vote came from Dr. Helen Talbot, an associate professor of medicine at Vanderbilt University. After the vote, Talbot said that she supported giving the vaccine to health care workers, but had concerns about frail, older residents of long-term care facilities receiving the shot and whether the vaccines would work as well for them.

“I do not feel like our safety network for long-term care facilities is strong enough yet,” Talbot said. “I think there's some work that needs to be done.”

Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, Tennessee, who is not on the panel, said the recommendation was an excellent decision.

“Long journeys begin with first steps,” he said. “And this was a firm, clear first step that health care workers and residents of long-term care facilities should be the first in the line to get the vaccine.”

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Schaffner acknowledged the concern about giving the vaccine to nursing home residents. “Will the vaccine be as effective in that group? We’ll just have to find out.”

“There’s no right decision here, there’s no wrong decision here,” he added.

The advisory panel will meet again in several weeks to decide who should be next in line.

Among the possibilities: teachers, police officers, firefighters and workers in other essential fields such as food production and transportation; the elderly; and people with underlying medical conditions.

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