Coronavirus: Medical workers, long-term care centres get nod for first shots

About 5 million to 10 million vaccine doses are expected to be made available per week after a shot is authorised in the US. PHOTO: REUTERS

WASHINGTON (BLOOMBERG) - Healthcare workers and residents at long-term care centres should be first in line for Covid-19 vaccines, key government advisers urged Tuesday (Dec 1), citing the high risk for infection within the two groups and the positive effects on hospital care.

The Advisory Committee on Immunisation Practices, or Acip, includes medical and public health experts that advise the Centres for Disease Control and Prevention (CDC) on vaccine use.

Their recommendation, approved by a 13-to-1 vote, comes as regulators are set to rule within weeks on emergency use of a Pfizer Inc-BioNTech SE vaccine, followed quickly by a decision on a Moderna Inc shot.

Dr Kathleen Dooling, a CDC epidemiologist, cited a "multiplier effect" in vaccinating healthcare workers first, noting they provide care in high-risk settings and keep hospitals open and working. Finally, she said, this group includes low-wage earners as well as racial and ethnic minority groups hit hard by the virus.

Most jurisdictions "believe that they can vaccinate all of their healthcare workers within 3 weeks," said Dr Nancy Messonnier, Director of the CDC's National Centre for Immunisation and Respiratory Diseases.

The recommendation approved on Tuesday is one of the last remaining hurdles before vaccinations begin. If the Food and Drug Administration (FDA) authorises the shots this month as expected, at least some portion of the country's 21 million healthcare workers and 3 million nursing home residents could get their first immunisation doses within weeks.

Still, the advisers don't have the final say: The agency's director, Dr Robert Redfield, will determine whether to accept their advice. And eventually, individual states will get a set number of doses from the federal government to distribute as they choose.

Tuesday's meeting opened with Dr Beth Bell, the head of the working group, saying that the nation is now averaging one death from Covid-19 every minute. "In the time we're having this meeting," she said, "180 people will have died."

In the US, more than 13 million Covid-19 cases have been confirmed and almost 270,000 people have died, according to Johns Hopkins University's Coronavirus Resource Centre.

Priortising groups

About 5 million to 10 million vaccine doses are expected to be made available per week after a shot is authorised, said the CDC's Dr Sara Oliver. That makes it likely that hospitals and others will have to prioritise certain subgroups among those allowed earliest access to the shots.

At the hospital level, the first shots should be targeted at those with direct patient contact, along with workers who provide services to patients or their family members and employees who handle infectious materials, Dr Oliver said.

Moving a step deeper, the advisory group also suggested that hospitals stagger vaccinations from similar units or positions, and plan for workers to have time away from clinical care if they experience side effects from the shots.

Previously, Acip's working group on Covid-19 vaccines was only considering healthcare workers for the first phase of allocation, according to a September presentation from Dr Dooling. Since then, there has been a growing push for early use in long-term care facilities, which have accounted for 6 per cent of Covid-19 cases and 39 per cent of deaths in the US as of early November.

In a statement Monday, the American Health Care Association said that the lack of prioritisation "for long-term care and seniors housing at the outset of the pandemic led to devastating losses, and we cannot let that happen again."

Providing first-in-line vaccine availability to long-term care centres may reduce hospital utilisation and it's well supported by a partnership with pharmacies to vaccinate at such facilities, the CDC's Dr Dooling said on Tuesday.

The CDC has tapped pharmacy giants Walgreens Boots Alliance Inc and CVS Health Corp to vaccinate residents and employees of nursing homes and assisted-living facilities.

Interim recommendations

The recommendations from the advisers are being made on an interim basis, aimed at helping state health departments finalise their plans and place their orders, which are due on Friday, Acip Secretary Amanda Cohn said. The group will meet again once the FDA decides to authorise emergency use of a vaccine.

States, which will get doses based on their adult populations, are largely expected to set priorities based on the advisory panel's recommendations. But they have the authority to make their own decisions about whom to vaccinate first and some states are already moving forward with their own plans.

Texas last week unveiled priorities which call for vaccinating healthcare workers likely to provide direct care for Covid-19 patients and other vulnerable residents first.

Ultimately, those actually administering the vaccines will make the final decisions. Hospitals, for instance, are anticipating they won't initially get enough doses for all of their employees. They're now racing to decide which to vaccinate first.

The Acip Covid-19 vaccines working group has also been exploring other groups with vulnerable populations for early vaccine use after those first in line, including essential workers and those 65 and older.

Racial and ethnic minorities, a group that has been disproportionately effected by Covid-19, are more widely represented among essential workers and are under represented among people 65 and older, Dr Dooling said. At a meeting last week, Acip members were leaning toward prioritising essential workers over older adults.

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