Look for discussion of two questions: Where should people in long-term care facilities be in the vaccine line and the power of states and governors to shift priorities for who gets immunized first.
The Advisory Committee on Immunization Practices is an independent group convened by the Centers for Disease Control and Prevention to offer advice on who should get specific vaccines and when.
It typically deals with less time-sensitive questions such as what age people should get the shingles vaccine (50 and over) or whether adults need a whooping cough booster (under discussion.) When a pediatrician says, “It’s time for the second polio immunization,” it’s based on ACIP recommendations.
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Now this under-the-radar committee is front and center as the nation waits for COVID-19 vaccines.
The general outlines of COVID-19 vaccine allocation were worked out this summer by the ACIP’s COVID-19 working group and a panel convened by the National Academies of Sciences, Engineering and Medicine.
The U.S. population has been put into several groups, 1a, 1b, 2, 3 and 4, each of which will get access to the vaccine in phases.
The lineup features front-line health care workers, followed by people with underlying diseases that put them at high risk of illness or death, people 65 and over, essential workers, then healthy adults and finally children.
Now the committee is fine-tuning the first part of that list, the group known as 1a.
ACIP won’t actually vote on who gets a specific vaccine until a vaccine is actually authorized by the Food and Drug Administration, expected to happen with the Pfizer vaccine by mid-December. On Tuesday, it will vote on who it is assigning to the phase 1a group.
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Front-line health care workers are clearly first but then there’s the question of who else should be in the initial group. Suggestions include first responders such as police, firefighters and EMTs but also people in long-term care facilities.
That’s a suggestion that’s been pushed by members of Operation Warp Speed, the COVID-19 vaccine and treatment initiative by the Trump administration. Health and Human Services Secretary Alex Azar has said on multiple occasions that the most vulnerable Americans should be vaccinated early.
Long-term care facility residents make sense both because they’re a relatively small group – about 3 million by CDC estimates – and because they’re at such high risk for severe illness or death if they get COVID-19, said L.J. Tan, chief strategy officer for the Immunization Action Coalition, a non-profit that promotes immunization.
“The science supports it because the burden to the overall healthcare system is so large when these huge outbreaks happen in long-term care facilities,” he said.
People who live in assisted living facilities are at especial risk for dying from COVID-19. In the general population, only 3% of people with COVID-19 die, while 21% of people living in nursing homes die of the disease, according to a CDC publication.
It also makes sense to immunize residents at the same time healthcare workers in those facilities are immunized, to avoid having to return to the same locations for a second set of shots.
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Though “front of the line” is slightly misleading because few of these people will get shots the first day the vaccine becomes available, Tan noted. According to General Gustave Perna, the initial shipment of vaccine will be 6.4 million doses, divided across the entire United States based on population.
The CDC estimates there are about 20 million health care personnel in the United States. So it will take several weeks of vaccine deliveries for the entire group of 23 million people to be vaccinated.
The other issue is who ultimately decides what groups will get the vaccine first. Azar has said several times that governors will have final say on COVID-19 vaccine priorities.
It is true that ACIP guidelines are recommendations, not regulations, said Tan.
“That’s always been the case. All vaccine guidelines are recommendations except for school entry requirements and those are at the state level,” he said.
Because no state will immediately get sufficient vaccine to immunize all its front-line health care workers, states will have to make decisions about who to prioritize.
Tan doesn’t expect the decision will be made by governors.
“The state health officials, along with their vaccine program managers, will huddle and make those decisions. And then presumably the governors will sign off on them,” he said.”