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A federal vaccine committee is leaning toward giving health care workers priority for receiving a COVID-19 vaccine once one becomes available.
The Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) has not made any final decisions and could vote on these priorities in September. ACIP’s recommendations must be approved by the CDC director. Once approved, they are published as official recommendations in the Morbidity and Mortality Weekly Report.
On Wednesday, the group discussed how to prioritize four groups — health care personnel, essential workers, people with high-risk medical conditions and people ages 65 and older.
The health care personnel group is broad, including about 17 million to 20 million people who work paid or unpaid in facilities like hospitals, long-term care facilities, outpatient centers, home health care, pharmacies, emergency medical services and public health. This group includes workers with direct or indirect exposure to patients or infectious materials.
“I agree starting with health care personnel will prevent a large number of infections and deaths, much more than any other priority groups so that makes sense starting with them,” said ACIP member Paul Hunter, M.D., medical director of the Wisconsin Research and Education Network.
Several of the vaccines in development will require specialized storage and management. Therefore, they could be handled more easily by larger, centralized health systems than community clinics or local pharmacies, making health care workers easier to vaccinate. Vaccinating this group also may reassure others.
“My sense is that uptake among health care personnel would be much higher and that could start a nice process toward increasing confidence in the vaccine if we get it ourselves,” said ACIP member Peter Szilagyi, M.D., M.P.H., FAAP, a pediatric health services and clinical researcher at UCLA Health.
Which group to prioritize next sparked more debate with members struggling to choose between essential workers and people with underlying conditions.
The essential worker group includes people in industries like food, agriculture, transportation, education, energy, water/wastewater and law enforcement. The group with high-risk medical conditions includes people with conditions like obesity, diabetes, chronic obstructive pulmonary disease, heart conditions and chronic kidney disease.
“I think it’s absolutely critical that we continue to think about the essential workers … because many are of lower socioeconomic status, many have high-risk conditions and they are unable to work from home,” said ACIP member Helen “Keipp” Talbot, M.D., M.P.H., associate professor of medicine in the Vanderbilt University Medical Center Department of Medicine, Division of Infectious Diseases.
But several members noted the group with underlying conditions is at higher risk for more severe disease and death.
While several vaccine candidates are in Phase 3 trials, the committee is dealing with several major unknowns — how effective a vaccine will be for different age groups, how many doses will be available, how many doses will be needed per person and the timing of availability.
Other factors being considered during Phase 3 trials include diversity among enrolled participants, safety signals after the second dose, maternal and fetal outcomes for those who get pregnant during trials, and vaccine impact on shedding and transmission for symptomatic and asymptomatic populations
Wednesday’s meeting was one of several special sessions in recent months to discuss these vaccines. The ACIP’s COVID-19 vaccine work group has said its goals are to ensure the safety and effectiveness of vaccines, reduce the impact of COVID-19 on health and society, and ensure equity in vaccine allocation. ACIP will meet again on Sept. 22.