Healthcare workers and residents of long-term care facilities should be in the lead when the first doses of COVID-19 vaccines are available in the United States. 1.
The news comes when two vaccine candidates, from Pfizer (SN: 11/18/20) and Moderna (SN: 11/16/20), will be considered for emergency use authorization by the U.S. Food and Drug Administration on December 10th. and 17, respectively. If one or both vaccines are approved by the FDA and the CDC Advisory Committee on Immunization Practices, people with top priority could start getting vaccinated before the end of the year.
“This is an especially difficult time in the United States,” said Beth Bell, a member of ACIP, the University of Washington in Seattle, who noted during the meeting that the country averages one COVID-19 death per minute. "So we don't act too soon."
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As of Dec. 1, more than 13.6 million people in the United States have become infected with SARS-CoV-2, the virus that causes COVID-19, and nearly 270,000 people have died, according to Johns University's COVID-19 tracker. Hopkins.
This is the first guide that ACIP has issued on the allocation of initial and limited supplies of COVID-19 vaccines. There will still need to be guidance for people who are still in line, such as other essential workers, older adults, and people with pre-existing conditions. It will be up to the state health departments to implement the guidance.
ACIP met throughout the year to prepare for the availability of COVID-19 vaccines, with the understanding that there would not be enough vaccines for everyone right away. Pfizer and Moderna vaccines require two separate doses several weeks. By the end of the year there will be about 40 million doses available, which means that around 20 million people will be able to be vaccinated.
The United States has about 21 million health care workers and about 3 million adults living in long-term care centers. The initial supply is lower than needed for the first group, so the committee is expected to offer more guidance for this level.
In addition, there are 87 million other essential workers, including educators and police officers, 53 million people aged 65 and over and more than 100 million people with high-risk medical conditions, according to ACIP.
Everyone will ultimately benefit from the vaccine, but in the beginning, when shots are scarce, it’s about “who will benefit the most,” says bioethicist Nancy Kass of the Johns Hopkins Berman Institute for Bioethics and Bloomberg School of Public Health. And those who benefit most can be divided between those most at risk of becoming infected, such as health workers and meat-feeding and packaging employees, and those most at risk of becoming seriously ill if they become infected, including older adults and people with pre-existing conditions.
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Another consideration is equity. That means being transparent about what the criteria are “so that when people see others going in front of them, they know why,” says Kass, who did not participate in the deliberations. Ensuring that the vaccine reaches all groups in a priority group is also crucial to ensuring equity. “If COVID vaccine allocations are done properly, there will be people from so many different demographic backgrounds who should be at the first level which would be equal opportunity with respect to income and race,” he says.
ACIP established the ethical principles that influence its deliberations on how to allocate the initial supply of a COVID-19 vaccine on November 27 in the Weekly Morbidity and Mortality Report: maximizing benefits and minimizing harm, promoting justice, mitigating inequalities in health and promote transparency.
Healthcare providers were considered a top priority throughout the ACIP discussions and in the guidance provided by other groups, including the National Academies of Science, Engineering, and Medicine. According to the CDC, there were at least 243,000 confirmed cases of COVID-19 among U.S. health care workers and 858 deaths on Nov. 30.
The committee noted that women make up 75 percent of the health workforce, and among them, 330,000 could be pregnant or recently postpartum when the vaccine is available. ACIP will review data from Phase III vaccine trials, as well as the FDA’s assessment of vaccines and the conditions of any emergency use authorization before providing guidance to these women.
Long-term care facilities, which provide care for frail and older adults who cannot live independently, have been especially affected during the pandemic. Approximately 730,000 residents and long-term care center staff had COVID-19 and more than 100,000 died as of Nov. 26, according to the COVID Follow-up Project.
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