A CDC expert panel voted 13–1 on Tuesday to recommend that the first COVID-19 vaccines should go to healthcare workers and nursing homes as soon as they are authorized by the FDA, a decision expected later this month.
The CDC Advisory Committee on Immunization Practices (ACIP) vote prioritizes both populations equally for the first vaccines, coming amid a surging nationwide pandemic. The meeting finalized months of vaccine distribution planning by the committee’s experts and federal officials, who had to balance medical ethics, what science has learned about people with the highest risk, and ease of mass vaccination for these populations.
The debate over who should get the first vaccines reached a fever pitch with recent reports of Trump administration officials pressing for seniors over age 65 to receive vaccines ahead of healthcare workers.
“My vote reflects maximizing benefits, minimizing harms, promoting justice, and minimizing inequities in distributing these vaccines,” said panel chair José Romero, secretary of health at the Arkansas Department of Health.
If the ACIP recommendations are approved by CDC Director Robert Redfield, they become agency guidelines as soon as they are published by the agency. The government will distribute the first vaccines to states based on their populations, Alex Azar, head of the Department of Health and Human Services, said last week. The decision of who to distribute the vaccines to first will then ultimately be up to individual governors, he added.
“This is important because the COVID-19 pandemic is unprecedented,” Emory University’s Walter Orenstein, former director of the United States Immunization Program, told BuzzFeed News. ”It is important for planners at the state and local level to have a perspective, when the first doses of vaccine are rolled out, to whom they should be targeted.”
There are some 21 million healthcare personnel in the US and 3 million residents of nursing homes. Operation Warp Speed, the $10 billion public–private partnership aimed at fast-tracking the development of COVID-19 treatments and vaccines, hopes to have shots ready for about 20 million Americans before the end of the year. CDC officials said at the meeting they initially expect to distribute 5 million to 10 million doses of the vaccine a week in 2021.
Two vaccine candidates, one made by Pfizer and one made by Moderna, have reported 95% and 94.1% efficacy, respectively, in blocking COVID-19 cases among participants in clinical trials who have received two shots of their vaccines spaced weeks apart. Both have requested FDA authorization for their distribution.
On Dec. 10, an FDA independent expert panel will meet to consider the Pfizer vaccine’s authorization, and a similar meeting will be held about a week later for the Moderna one, according to Azar.
Typically, the FDA first licenses or authorizes a vaccine and then the CDC director approves vaccine distribution priorities decided by its advisory panel. However, with more than 2,000 Americans a day dying from COVID-19 in the days ahead of Thanksgiving, the CDC panel vote came first, intended to ease distribution of vaccines as the FDA authorizes them. CDC said there will be another meeting after the Dec. 10 FDA meeting to vote specifically on distributing Pfizer’s vaccine.
"We hope this vote will get us all one step closer to the day when we can all feel safe again," said the CDC’s Nancy Messonnier, who spoke at Tuesday's meeting.
Consideration by independent experts is standard for any new vaccine, Orenstein said. “What is uncommon is the speed with which this is occurring because of the ongoing pandemic,” he said.
Healthcare workers
Panel members stressed the importance of first vaccinating healthcare workers, doctors, nurses, and staff, who have the most direct exposure to the novel coronavirus and are needed to treat COVID-19 patients at the nation’s hospitals. The panel discussed staggering mass vaccinations at hospitals to avoid many ICU or ER staffers dealing with side effects — typically fatigue and headaches — from the shots at once.
One area of concern was whether pregnant or nursing healthcare workers should be given a vaccine. Women make up roughly three-quarters of the healthcare workforce, and perhaps 300,000 of them might be pregnant or nursing an infant. There is no data on the safety or effectiveness of COVID-19 vaccines in pregnant women. But nursing women with an infection do not appear to transmit the virus that way, noted some panel members.
Most jurisdictions believe they will have given the first dose to all of their healthcare workers within three weeks, said the CDC’s Messonnier.
Nursing homes
Plans for nursing home residents rely on a pharmacy chain-led program that has enrolled 99% of these facilities nationwide in mass vaccination plans for both staff and residents. More than 74,000 long-term care facility residents and staff nationwide have died of COVID-19 in the pandemic, making them one of the highest-risk groups. For the CDC panel, that risk outweighed concerns about exposing elderly people to new vaccines, particularly in light of early data showing low rates of adverse reactions.
The decision to prioritize nursing home residents equally with healthcare personnel was made in recent months, as the number of deaths among that population became more apparent. Discussions in past meetings had centered on the importance of preventing deaths while also preserving the healthcare system, leading to the decision to balance both priorities.
"I have no reservations about healthcare workers getting these vaccinations," said panel member Helen Talbot of Vanderbilt University, the only expert to vote against the prioritization. Talbot said she opposed the vote because she wants to see more safety testing in elderly nursing home residents before they received a vaccine.
The rest of the US
Essential workers appear next in line for shots, although that decision was not voted on by the panel, followed by people with high-risk medical conditions, such as diabetes, cancer, or heart disease, and people over age 65.
Under the Affordable Care Act, or Obamacare, insurers must cover the costs of ACIP-approved vaccinations, with help from the federal government in the case of COVID-19 ones.
A first mass shipment of the Pfizer vaccine arrived at Chicago’s O’Hare International Airport on Friday. California Gov. Gavin Newsom said on Monday that his state will receive 327,000 doses of vaccines in its first shipments. With 12% of the US population in California, that suggests the first nationwide shipment will be around 2.7 million doses.
The US has recorded more than 13.5 million COVID-19 cases and more than 270,000 deaths, with the widespread rollout of vaccines for the public not expected until late spring.
Stephanie Baer contributed reporting to this story.
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