A new report that aims to prioritize groups to receive Covid-19 vaccine focuses on who is at risk, rather than using job categories or ethnic groups to determine who should be at the front of the line.

It was widely expected that health care workers would be the first priority grouping, and some — though not all — are. There were also many voices arguing for people of color to be given priority access, because the pandemic has exacted a disproportionately heavy toll on Black and Latinx people, both in terms of overall numbers of infections and deaths.

But in the end the panel of experts that wrote the priority setting framework for the National Academies of Sciences, Engineering, and Medicine chose instead to focus on the factors that create the risk for some people of color — systemic racism that leads to higher levels of poor health and socioeconomic factors such as working in jobs that cannot be done from home or living in crowded settings. The report, a draft, was issued Tuesday.

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“This virus has no sense of skin color. But it can exploit vulnerabilities,” said Bill Foege, a former director of the Centers for Disease Control, who is co-chair of the committee. The committee was set up by the National Academies at the request of Francis Collins, director of the National Institutes of Health, and Robert Redfield, director of the Centers for Disease Control and Prevention.

Foege said he expects pushback. A virtual public meeting on the recommendations will be held Wednesday afternoon, and written comments can be submitted until Friday. The committee’s final report will be submitted later in September.

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When Covid-19 vaccines are approved for use, initial supplies will be tight — potentially in the tens of millions of doses. Most of the vaccines under development will require two doses per person: a priming dose followed by a booster either three or four weeks later.

Phase graphic
A phased approach outlined in the draft National Academy report. The National Academies of Sciences, Engineering and Medicine

The resulting recommendations put health workers in high risk settings and first responders to the very front of the vaccination line, in what the committee called the “jumpstart phase.” Closely behind are adults of any age who have medical conditions that put them at significantly higher risk of having severe disease, primarily heart or kidney failure or a body mass index of 40 and over. Also in this group are older adults living in long-term care homes or other crowded settings.

The report suggests that a second phase of vaccinations should involve critical risk workers — people in industries essential to the functioning of society — as well as teachers and school staff; people of all ages with an underlying health problem that moderately increases the risk of severe Covid-19; all older adults not vaccinated in the first phase; people in homeless shelters and group homes, and prisons; and staff working in these facilities.

Young adults, children, and workers in essential industries not vaccinated previously would make up the third priority group. Remaining Americans who were not vaccinated in the first three groups would be offered vaccine during a fourth and final phase.

The report is meant to serve as a guide for more detailed prioritization plans on the order in which Americans will be offered vaccine. That more granular work is already being conducted by the Advisory Committee on Immunization Practices, an expert panel that crafts vaccination guidance for the CDC, and by state, local, and tribal health authorities, who must identify the actual people in their regions who fall into the priority groups.

The ACIP’s recommendations will go to the CDC. It remains unclear, however, whether the CDC, Operation Warp Speed — the task force set up to fast-track development of Covid-19 vaccines, drugs, and diagnostics — or the White House will make the final determinations on who will be vaccinated first.

The draft report, produced in just a little over a month, earned some early praise.

“I think they did a really good job,” said Eric Toner of the Johns Hopkins Center for Global Security, calling the report credible and based on sound reasoning.

Toner and colleagues published their own report on the issue recently, recommending two tiers. Health workers and others essential to the Covid-19 response in the first tier and other health workers in the second.

In that report, people at greatest risk and their caregivers, and workers most essential to maintaining core societal functions would also be designated to be in the first tier.

The task of determining who should be at the front of the vaccines line is not an easy one, and must be made without crucial pieces of information. It’s not yet known how many vaccines will prove to be successful, when they will be approved for use, and in what quantities. Critically, some vaccines may prove to be more effective in key groups — the elderly, for instance — than others. Knowing that in advance could influence the recommendations, but people working on the priority groups cannot wait for that information to become available.

Initial discussions suggest, depending on how some of the target groups are defined, large numbers of Americans would qualify as members of priority groups, a reality that will likely require additional tough decisions to be made.

The CDC estimates that there are between 17 million and 20 million health care workers in the country, and roughly 100 million people with medical conditions that put them at increased risk of severe illness if they contract Covid-19. There are roughly 53 million Americans aged 65 and older, and 100 million people in jobs designated as essential services. There is some overlap among these groups — health workers, for instance, are also essential workers.

  • The US governmental handling of COVID has been a complete disaster. Why should we trust it to be able to distribute a two-shot vaccine properly?

    Why should we trust a vaccine at all, particularly when it just happens to show up just before a crucial election?

  • I am not going to be getting the vaccine. It’s unnerving that the vaccine company has no liability for any of the side effects their vaccine might do. It needs much more testing. Yes the virus is serious, I take the same precautions as I do with the flu. I will continue to take the added supplements.

    • If the pharmaceutical companies and the government won’t assume any risk for adverse reactions the vaccine may cause, why would anyone want to get it? I’m a nurse who has been caring for a few COVID-19 “suspect” patients since March and have yet to come down with the virus. I’ll pass on the poisonous concoction that may harm people. It will have to be a few years before I trust getting this vaccine.

    • Sherry- you take some risk getting any vaccine, but to answer your question – the reason “anybody” would want to get the vaccine:
      1. Depending on age and risk factors, a 3% chance of dying and maybe another 3% chance of permanent harm to their health, eg – lung damage, heart damage, kidney damage – etc, etc, etc.
      2. If enough people get a working vaccine, the economy can reopen – that might happen anyway as people get desperate enough but knowing it is safe is very helpful.

      I understand there is risk but we have to end this before too much longer.

  • However well intentioned these recommendations are, they dead on arrival. I don’t think anyone would disagree with doctors, nurses, hospital aides, first responders, medical high risk, and anyone over 60 getting the vaccine first. After that, it should shift to a lottery. Any attempt at prioritizing beyond these simple understandable categories will open the process to corruption and favoritism. You can’t re-open schools if the teachers are vaccinated but not the students. Until I am vaccinated my kids aren’t going to school, period. Is a CEO of a hospital more important or the cleaning crew. Why should someone who is 25, single, and obese take priority over a 35 year old single mother? Is a supermarket manager more important than a lineman? Complicated criteria will create an uproar, feed rumor machines (Facebook), and will be exploited by people who will play the system. Politically this would be a disaster. You can’t roll out a complicated criteria across a nation of 328 million.

    • If vaccinating groups of people in certain occupations lowers case numbers for a region, it benefits everyone. Who deserves to be vaccinated isn’t the point, as much as who is unavoidably at risk at work, and will therefore create asymptomatic spread.

    • Lindsay – Your point brings up something I totally missed in my own thinking- without recognizing it, I was assuming no medical personnel were at risk of infecting anyone- like, when you go to the Doctor, you may be worried about the people in the waiting room but not the doctor and staff -of course that is not logical – but I was making that assumption without being aware of it. But I hope medical people will be careful and get tested very often.

  • I want to save the most lives, so I want case numbers to go down. High priorities should be people dealing with likely high-transmission-risk populations, regardless of citizenship, economic worth, legal status, such as health care workers, educational workers, residential and work facilities for the immobile, like eldercare, prisons, meat packing plants. Anyplace that tends to be a reservoir of positive-testing people, with or without symptoms, employees, workers, and residents need to be vaccinated, right away!

  • We had a vaccine back in April – No, it did not have ANY human testing- and very little animal testing-but if you look at the old papers you see small animal testing of spike protein in a few papers, and apparent immunity on challenge testing.
    My point is, it is distressing to see the country really go to hell in a handbasket, when challenge testing on humans might have resulted in a vaccine they would be giving out now, and some of the rioting and such might not be going on.
    I blame the medical establishment – challenge testing was warranted in the extreme conditions we found ourselves in – still are in – massive shutdowns doing huge economic and psychological damage to our country, and the world, and a death toll probably going to 300K before a vaccine is available on a large scale in February 2021.
    It is a little hard to accept the argument “What about the polio vaccine fiasco of 1955? And “What about the Swine Flu vaccine of 1975?” as reason not to take some risks – for one thing, – was nothing learned in virology and immunology in the past 65 years? 45 years?
    No, no one wanted to be in the hot seat if it did go wrong, even though the risk of that was low – our power elites failed us IMO – well, not totally failed us – but could not deviate from an excessively rigid viewpoint enough to save us, either.

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