Health care workers and long-term care facility residents should be the first to get access to a coronavirus vaccine, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices said Tuesday.
The influential panel voted 13 to 1 to recommend that those two groups receive the vaccine ahead of others once one is approved by the Food and Drug Administration.
Two U.S. drug companies, Pfizer and Moderna, have filed for emergency-use authorization with the FDA, meaning distribution may start for either of their vaccine candidates in just a few weeks. An FDA advisory panel is meeting Dec. 10 to discuss Pfizer’s request – made with its German partner BioNTech – and will meet again on Dec. 17 to discuss Moderna’s request. Both Pfizer and Moderna have said they’ve developed a vaccine candidate that is more than 90% effective based on phase 3 trials.
World Braces For Another Wave of Coronavirus
Tuesday’s recommendation was largely supported by committee members, although a few expressed concerns about long-term care residents receiving the vaccine early.
Dr. Helen Keipp Talbot, the lone member of the committee to vote against the recommendation, said agreeing to the long-term care portion was hard for her because of a lack of data on the safety of vaccine candidates within that population. There was no clinical trial data collected on the vaccines in long-term care facilities.
“We enter this realm of, ‘We hope it works and we hope it’s safe.’ That concerns me on many levels,” she said. She said she hopes the interim recommendation highlights the need to develop and test vaccines to prolong quality of life for long-term care residents.
Talbot added she had no reservations about recommending that health care personnel be prioritized.
CDC official Dr. Sara Oliver told the committee that vaccination programs would need to consider side effects or reactions that were reported during clinical trials. These reactions included severe fatigue reported by 10% of older adults in Moderna’s clinical trial, she said.
However, Oliver also noted that systemic symptoms such as fever were “generally lower among the older adult populations” included in both trials.
Other committee members who agreed to the recommendation pointed out that long-term care facilities have been hotspots for coronavirus outbreaks and deaths. According to data collected by the Kaiser Family Foundation, more than 100,000 long-term care residents and employees had died from COVID-19 as of Nov. 24, with that number likely an undercount.
And while the interim recommendation broadly identifies the two groups for priority access, Oliver said subprioritization of the vaccine doses may still be needed.
“We expect a constrained supply environment for some months and need to make the best use of available vaccines,” she said.
Officials estimate that by the end of December, 40 million vaccine doses from Pfizer and Moderna could be available. That would be enough to vaccinate 20 million people, since each vaccine requires two doses.
To further delineate who should get the vaccine among health care providers, Oliver proposed that personnel with direct patient contact and those who are unable to telework should be prioritized. She also proposed health care personnel who work in long-term care facilities and haven’t had a coronavirus infection in the past 90 days be prioritized.
Oliver noted, however, that 75% of health care workers are women and 330,000 workers could either be pregnant or postpartum. But data is not yet available on the effectiveness and safety of the vaccine candidates on pregnant or breastfeeding women, as those groups were excluded from the companies’ clinical trials.
For the subprioritization of long-term care residents, Oliver proposed prioritizing nursing home residents before those in assisted-living facilities, due to data showing higher rates of death and infection in nursing homes.
Tuesday’s recommendation comes at a dire time: COVID-19 cases have topped 13 million in the U.S., which has also seen more than 270,000 deaths tied to the pandemic. ACIP member Dr. Beth Bell told participants in the meeting that the U.S. is seeing approximately one coronavirus death per minute.