US panel offers advice on who should get vaccinated first

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NEW YORK – Healthcare workers and nursing home residents should be on the front lines when the first coronavirus vaccines become available, an influential government advisory group said on Tuesday.
The panel voted 13-1 to recommend that these groups get priority in the early days of any upcoming vaccination schedule, when doses are expected to be very limited. The two groups are made up of about 24 million people out of a US population of about 330 million.

Later this month, the Food and Drug Administration will consider authorizing emergency use of two vaccines manufactured by Pfizer and Moderna. Current estimates predict that no more than 20 million doses of each vaccine will be available by the end of 2020. And each product requires two doses. As a result, shots will be rationed in the early stages.

The Advisory Committee on Immunization Practices will meet again at some point to decide who should be next on the list. Among the possibilities: teachers, police, firefighters and workers in other essential areas such as food production and transport; old people; and people with underlying medical conditions.

Tuesday’s action simply designated who should get vaccinated first if a safe and effective vaccine becomes available. The panel did not approve any particular vaccine. Panel members are waiting to hear the FDA’s assessment and see more safety and efficacy data before approving a particular product.

Experts say the vaccine is unlikely to be widely available in the United States until spring.

The group of outside scientific experts, created in 1964, makes recommendations to the director of the Centers for Disease Control and Prevention, who almost always approves them. It normally has 15 voting members, but one seat is vacant.

The recommendations are not binding, but for decades they have been widely followed by physicians, and they have determined the scope and funding of U.S. immunization programs.

Whether or not to follow the guidelines will be up to the state authorities. They will also be responsible for making other more detailed decisions if necessary – for example, whether to put emergency doctors and nurses ahead of other health workers if vaccine stocks are low.

The epidemic in the United States has killed nearly 270,000 people and caused more than 13.5 million confirmed infections, with deaths, hospitalizations and cases exploding in recent weeks.

As the virtual meeting began, panel member Dr. Beth Bell of the University of Washington noted that on average one person dies from COVID-19 per minute in the United States at this time, “so I guess that we don’t act too early. ”

About 3 million people live in nursing homes, chronic long-term care hospitals, and other long-term care facilities in the United States. These patients and the staff who care for them accounted for 6% of coronavirus cases in the country and 39% of deaths, according to CDC officials.

Despite the heavy toll, some board members at Tuesday’s meeting said they were reluctant to include these patients in the first group receiving vaccines.

Dr Helen Keipp Talbot, an infectious disease researcher at Vanderbilt University who was the only committee member to vote against the proposal, cited influenza research which found that vaccinating staff at these facilities has a major impact on preventing its spread in this country.

Dr Richard Zimmerman, a flu vaccine researcher at the University of Pittsburgh who watched the meeting online, echoed Talbot’s concerns.

“I think it was premature” to include nursing home residents as a priority group, said Zimmerman, a former ACIP member. “Their vote seems to assume that these people will respond well to the vaccine. … I don’t think we know that. ”

Committee members unanimously expressed support for vaccinating healthcare workers – about 21 million people, according to CDC officials.

This broad category includes medical personnel who care for – or come into contact with – patients in hospitals, nursing homes, clinics and doctor’s offices. It also includes home health workers and paramedics. Depending on how state officials implement the group’s recommendations, it could also encompass janitorial staff, food service workers, and medical records clerks.

The government estimates that people working in healthcare account for 12% of COVID-19 cases in the United States, but only about 0.5% of deaths. Experts say keeping healthcare workers upright is imperative so they can administer vaccines and deal with the growing number of infected Americans.

For months, members of the vaccination panel had said they would not vote until the FDA approved a vaccine, as usual. But at the end of last week, the group scheduled an emergency meeting.

Group chairman Dr Jose Romero said the decision stemmed from a realization that states face a deadline on Friday to place initial orders for the Pfizer vaccine and determine where they should be delivered. The committee has decided to meet now to give advice to national and local authorities, he said.

But some panelists and other experts had also worried about comments from Trump administration officials who suggested different vaccine priorities.

Dr Deborah Birx of the White House Coronavirus Task Force said in a meeting with CDC officials last month that people 65 and older should head the line, a federal official says who was not authorized to discuss the matter and to whom The Associated Press on condition of anonymity.

Then last week, US Secretary of Health and Human Services Alex Azar pointed out that ultimately governors will decide who in their states will receive the vaccines. Vice President Mike Pence echoed this point of view.

When asked if Azar’s comment played a role in the reunion’s scheduling, Romero said; “We don’t live in a bubble. We know what he said. But that’s not the main reason it’s done. ”

Jason Schwartz, professor of health policy at the Yale School of Public Health, said it made sense for the group to take the unusual step of making their recommendation known first.

“Without that formal recommendation, it creates a vacuum from which states could go in all kinds of different directions,” said Schwartz, who is not on the panel.

HHS officials have said they will distribute initial doses to states based on population, and some states may not receive enough to cover all of their healthcare workers and nursing home residents.

CDC officials said they were optimistic such shortages would only last for a few weeks.

Still, governors and local officials may have to decide which health workers or regions will be vaccinated first, Schwartz said.

“It’s up to states to determine the most granular details,” he said.

The Associated Press’s Department of Health and Science receives support from the Department of Science Education at the Howard Hughes Medical Institute. The AP is solely responsible for all content.

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