An important federal advisory group Tuesday recommended that the first doses of COVID-19 vaccine be offered to medical workers and the residents of nursing homes and assisted living facilities.
Health-care workers — from frontline doctors and nurses to aides and housekeeping staff — are considered a high priority because of their heightened exposure to the virus and because they need to stay healthy to care for others as cases surge in much of the United States.
Nursing home and assisted living residents, who make up just 1% of the population, have accounted for 6% of cases and 40% of deaths. Cases have been rising again in nursing homes since September, according to the American Health Care Association, which represents senior residential care providers. It, along with LeadingAge and other senior housing organizations, Monday endorsed vaccination for residents and staff.
Health settings also have the practical advantage of offering relatively efficient access to large numbers of people as well as the cold storage the first vaccines will require. Plus, experts on public health communication believe medical personnel may influence a populace that is leery of vaccines developed at record speed.
The Advisory Committee on Immunization Practices (ACIP) makes recommendations to the U.S. Centers for Disease Control and Prevention, which usually accepts them. ACIP’s 13-1 vote Tuesday was only about how to allocate the first doses of vaccine. It was not putting its stamp of approval on a particular vaccine. Once the Food and Drug Administration has authorized a vaccine for emergency use, ACIP will meet again to discuss it. More information on safety and effectiveness should be available then.
The group decided who should be in the first tier, which it called 1a, this week because states are facing a Friday deadline for reporting their vaccine distribution plans to the federal government. States will have some leeway in deciding priority groups.
The first doses of vaccine could be available later this month. Pfizer and its partner, BioNTech, as well as Moderna have applied for emergency authorization of their vaccines, which they say were 94% to 95% effective in clinical trials. A group that advises the FDA is expected to hold hearings on these products later this month. If the FDA approves the vaccines, the companies have said that a limited number of doses — possibly enough to vaccinate 20 million people — could be ready to distribute quickly. Both vaccines require two doses, and both must be stored at low temperatures. Pfizer’s requires ultra-cold freezers capable of reaching negative 94 degrees Fahrenheit, which are not widely available.
The CDC estimates that there are 21 million health-care workers and three million nursing home residents.
ACIP’s chair, Jose Romero, a pediatric infectious diseases doctor at the University of Arkansas for Medical Sciences, said he kept in mind the group’s broad goals — maximizing benefit and minimizing harm, promoting justice, and mitigating inequity — when deciding to support vaccination of medical workers and those in care homes.
While others expressed concern that the Pfizer and Moderna vaccines have been tested in only a small number of seniors who live in the community, only Helen Keipp Talbot, an associate professor of medicine at Vanderbilt University, decided to vote against the proposal. She worried the vaccines may not be as effective in frail, older people. She also wanted stronger systems for reporting vaccine safety problems in nursing home residents.
She added that it will be “incredibly important” to vaccinate care home employees and later said she had “no reservations for health care workers taking this vaccine.”
If there is not enough vaccine at first, the committee discussed starting with medical workers who have direct contact with patients or infectious waste and are unable to work remotely. Nursing home residents would go before those in assisted living, who tend to be healthier and have their own apartments.
Next in line likely will be essential workers, including food, education, and energy workers, as well as police and firefighters. At its last meeting on Nov. 23, the committee said this group should get high priority because these workers often don’t have the luxury of working from home and tend to be racially and demographically diverse. Making sure that racial groups that have faced higher risk of serious illness and death get early access to vaccines is one of the committee’s goals.
After that would come other high-risk groups: those with chronic health problems like obesity and diabetes and people aged 65 and older.
A CDC staffer described a multilayered surveillance system for safety problems after people get the vaccines that will include a text-messaging system that will allow recipients to report symptoms frequently. The CDC is preparing written materials that will help people understand the vaccines. In nursing homes, residents, family members or other official decision-makers will be consulted before residents receive vaccines.
After the vote, Nancy Messonier, director of the CDC’s Center for Immunization and Respiratory Diseases, said she knows many people are anxiously awaiting a vaccine. She said she hopes the U.S. is now closer to the day “when we can all feel safe again.”