Health-care workers, nursing home residents should get vaccine first, U.S. government panel advises

Later this month, the Food and Drug Administration will consider authorizing emergency use of two vaccines made by Pfizer and Moderna. Current estimates project that no more than 20 million doses of each vaccine will be available by the end of 2020. Also, each product requires two doses. As a result, the shots will be rationed in the early stages.

Tuesday’s action merely designated who should get shots first if a safe and effective vaccine becomes available. The panel did not endorse any particular vaccine. Panel members are waiting to hear the FDA’s evaluation and to see more safety and efficacy data before endorsing any particular product.

Experts say the vaccine will probably not become widely available in the U.S. until the spring.

The panel of outside scientific experts, created in 1964, makes recommendations to the director of the Centers for Disease Control and Prevention, who almost always approves them. It normally has 15 voting members, but one seat is currently vacant.

The recommendations are not binding, but for decades they have been widely heeded by doctors, and they have determined the scope and funding of U.S. vaccination programs.

In Canada, the National Advisory Committee on Immunization, or NACI, has released preliminary recommendations that prioritize the elderly and others at severe risk of illness, including health-care workers, front-line staff and those with lower access to health care, such as Indigenous populations. 

In the U.S., it will be up to state authorities whether to follow the guidance. It will also be left to them to make further, more detailed decisions if necessary — for example, whether to put emergency room doctors and nurses ahead of other health-care workers if vaccine supplies are low.

Devastating toll in homes

The outbreak in the U.S. has killed nearly 270,000 people and caused more than 13.5 million confirmed infections, with deaths, hospitalizations and cases rocketing in recent weeks.

As the virtual meeting got underway, panel member Dr. Beth Bell of the University of Washington noted that on average, one person is dying of COVID-19 per minute in the U.S. right now, “so I guess we are acting none too soon.”

About three million people in the U.S. live in nursing homes, long-term chronic care hospitals and other long-term care facilities. Those patients and the staff members who care for them have accounted for six per cent of the nation’s coronavirus cases and a staggering 39 per cent of deaths, CDC officials say.

Despite the heavy toll, some board members at Tuesday’s meeting said they hesitated to include such patients in the first group getting shots.

Dr. Richard Zimmerman, a University of Pittsburgh flu vaccine researcher who watched the hearing online, said he thought it was “premature” to include nursing home residents as a priority group. “[The panel’s] vote seems to assume that these people will respond well to the vaccine. … I don’t think we know that,” said Zimmerman, a former ACIP member.

Committee members were unanimous in voicing support for vaccinating health-care workers, according to CDC officials.

That broad category of an estimated 21 million in the U.S. includes medical staff who care for — or come in contact with — patients in hospitals, nursing homes, clinics and doctor’s offices. It also includes home health-care workers and paramedics. Depending on how state officials apply the panel’s recommendations, it could also encompass janitorial staff, food service employees and medical records clerks.

Trump cabinet members say governors should make the call

The government estimates people working in health care account for 12 per cent of U.S. COVID-19 cases but only about 0.5 per cent of deaths. Experts say it’s imperative to keep health-care workers on their feet so they can administer the shots and tend to the booming number of infected Americans.

For months, members of the immunization panel had said they wouldn’t take a vote until the FDA approved a vaccine, as is customary. But late last week, the group scheduled an emergency meeting.

WATCH l Canadian vaccine committee member speaks to challenges:

As Canada prepares to distribute millions of doses of COVID-19 vaccines in January, Chair of the National Advisory Committee on Immunization Dr. Caroline Quach-Thanh and David Levine, who managed the H1N1 vaccine rollout for Montreal, say this vaccination campaign won’t be without challenges. 3:56

The panel’s chairman, Dr. Jose Romero, said the decision stemmed from a realization that the states are facing a Friday deadline to place initial orders for the Pfizer vaccine and determine where they should be delivered. The committee decided to meet now to give state and local officials guidance, he said.

But some panel members and other experts had also grown concerned by comments from Trump administration officials that suggested differing vaccine priorities.

Dr. Deborah Birx of the White House coronavirus task force said in a meeting with CDC officials last month that people 65 and older should go to the head of the line, according to a federal official who was not authorized to discuss the matter and spoke to The Associated Press on condition of anonymity.

Then last week, U.S. Health and Human Services Secretary Alex Azar stressed that ultimately governors will decide who in their states gets the shots. Vice-President Mike Pence echoed that view.

Asked whether Azar’s comment played a role in the scheduling of the meeting, Romero said, “We don’t live in a bubble. We know what he said. But that wasn’t the primary reason this is being done.”

Jason Schwartz, a professor of health policy at the Yale School of Public Health, said it makes sense for the panel to take the unusual step of getting its recommendation out first.

“Without that formal recommendation, it does create a void from which states could go off in all sorts of different directions,” said Schwartz, who is not on the panel.

The panel will meet again at some point to decide who should be next in line. Among the possibilities: teachers, police, firefighters and workers in other essential fields, such as food production and transportation; the elderly; and people with underlying medical conditions.