A committee that advises the Centers for Disease Prevention and Control voted overwhelmingly on Tuesday to recommend that health care providers and residents and staff of long-term care facilities be at the front of the line for Covid-19 vaccine.
The recommendation must still be accepted by CDC Director Robert Redfield. The agency will then issue its guidance on who should get priority access, though final decisions will rest with the states.
State governments must put in their first orders of Covid vaccines to Operation Warp Speed, the U.S. government’s vaccine development fast-tracking program, by Friday. Tuesday’s vote was aimed at giving them concrete advice on who they should prioritize for vaccination with first deliveries, which are expected to be limited.
Members of the Advisory Committee on Immunization Practices voted 13 to 1 to put health care providers and long-term care residents — two groups that represent about 24 million Americans — at the top of the vaccine priority list. Health care providers is a very broad group encompassing people who work in hospitals and outpatient clinics, the staff of long-term care facilities, people who deliver home health care or who work in public health, emergency medical services and pharmacies.
The one dissent was cast by Helen “Keipp” Talbot, a vaccines researcher at Vanderbilt University, who argued there aren’t yet data to support the use of Covid vaccines in long-term care residents.
“I have spent my career studying vaccines in older adults. We have traditionally tried a vaccine in a young, healthy population and then hoped it worked in our frail, older adults. And so we enter this realm of ‘We hope it works and we hope it’s safe.’ And that concerns me on many levels,” said Talbot.
While Covid-19 vaccines have not yet been tested in long-term care residents, they have been tested in some older adults in clinical trials. Talbot noted that these volunteers reported fewer side effects after vaccination, raising questions about how strong an immune response the vaccines are inducing.
Another member of the committee, Peter Szilagyi, a pediatrician at UCLA’s Mattel Children’s Hospital, called the decision “a Solomon’s choice” but noted that for Americans not in the two first priority groups, more vaccine will be coming “very soon.”
In fact, the committee was told the government expects to begin to take possession of between 5 million and 10 million doses a week this month and anticipates having enough vaccine to vaccinate 20 million people by the end of December.
The two vaccines expected to be soon distributed in this country were developed by the partnership of Pfizer and BioNTech as well as by Moderna. Neither has been approved, but both are expected to receive emergency use authorizations from the Food and Drug Administration in the next two to three weeks. The Pfizer vaccine will likely receive an EUA within days of a Dec. 10 advisory committee meeting that will study the vaccine and make recommendations to the FDA. The same group will meet Dec. 17 to study the Moderna vaccine.
Both vaccines have shown impressive results in Phase 3 clinical trials, reducing the risk of developing symptomatic Covid-19 infection by about 95%.
The ACIP, as the CDC’s advisory committee is called, has been meeting at least monthly on matters related to Covid vaccines since the spring, using mathematical models and ethical frameworks to try to determine how to best use scarce supplies of vaccine when the national vaccination effort begins.
From the beginning, health care workers have been at the very top of the list. Long-term care residents, who have suffered a terrible toll in the pandemic, are a more recent addition to Phase 1a, as the first group is called. As of Nov. 26, there have been 730,000 Covid-19 cases in this population, and 100,240 deaths.
A work group that advises the committee noted states need further guidance on how to sub-prioritize vaccination during Phase 1a, because there will not be sufficient supplies initially to vaccinate all health providers at once. And vaccinating all health care providers at once might not be advisable, the group said, noting that these vaccines are “reactogenic” — they often induce fatigue, sore arms, sometimes even fever.
The committee said hospitals might want to vaccinate departments or clinics in a couple of waves, so that all staff aren’t dealing with these side effects at once.