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The people saving our lives should get vaccinated first, experts say

Vulnerable long-term care residents will also be at the front of the line

CDC headquarters by James Gathany

An independent committee at the Centers for Disease Control and Prevention officially recommended Tuesday that the limited first batch of COVID-19 vaccines in the United States go to health care workers and residents in long-term care facilities.

We expect a constrained supply environment for some months and need to make the best use of available vaccine,” said Sara Oliver, an epidemic intelligence service officer at the CDC, during Tuesday’s meeting.

Officials in the Trump administration have pushed for an early wave of vaccinations to go to older adults over the age of 65, who are at high risk of having a severe case of and dying from COVID-19, Stat News reported. But the committee, called the Advisory Committee on Immunization Practices (ACIP), stuck to the expected plan of placing health care workers and residents in long-term care facilities first in line. The recommendations will now go to CDC Director Robert Redfield for final approval.

Beth Bell, the chair of the committee’s COVID-19 vaccine work group, stressed the urgency of the efforts to distribute vaccines. “We’re averaging one COVID-19 death per minute in the United States right now,” she said during the meeting Tuesday. “In the time it takes us to have this ACIP meeting, 180 people will have died from COVID-19.”

Health care workers are at high risk of exposure to the coronavirus through their interactions with patients, and hundreds of thousands have contracted the disease. Protecting this group also helps prevent staffing issues at hospitals and health care facilities — surges in COVID-19 cases, and illness among health care workers, has led to shortages of doctors, nurses, and other health care workers.

Long-term care facilities have been devastated by outbreaks of COVID-19. Even though residents of these facilities make up less than 1 percent of the US population, they’ve accounted for 40 percent of COVID-19 deaths.

The Food and Drug Administration (FDA) hasn’t yet authorized any of the leading COVID-19 vaccine candidates, and it’s set to review submissions from Pfizer and Moderna this month. But states have to let the federal government know by Friday where to send shipments of the shots once the FDA signs off — and having guidelines as to which groups will get them first will guide those decisions. States don’t have to follow the recommendations, but most likely will.

ACIP usually works to recommend how and when routine vaccinations should be given to children and adults. But when quantities of vaccines are limited, like the COVID-19 vaccine will be in the next few months, it’s also responsible for determining where the limited supply goes. ACIP laid out four ethical principles it used to determine COVID-19 vaccine priority in a report published last week: maximizing benefits and minimizing harms; promoting justice; mitigating health inequities; and promoting transparency.

Moderna and Pfizer said that they’d likely have enough vaccines available to vaccinate 10 million and 12.5 million people in the US, respectively, by the end of 2020. That’s more than enough to vaccinate the approximately 3 million residents of long-term care facilities in the US. But there are about 21 million health care workers in the US. If states or individual health care facilities don’t have enough vaccines to cover all health care workers in the first round of vaccinations, Oliver said there may need to be additional subgroups — workers with direct patient contact may take priority over people who could work remotely, for example.

Capacity is expected to ramp up through the start of 2021, and vaccines will become available to broader swaths of the population. At later meetings, ACIP will vote on the groups that should get COVID-19 vaccines after health care workers and long-term care residents — next in line is expected to be essential workers, people over 65, and adults with underlying health conditions.