Health care workers would be among the first to receive vaccines against COVID-19 in a timeline presented to the Centers for Disease Control and Prevention’s (CDC’s) vaccines advisory committee. The proposed scheme would have essential workers next in line for vaccination, ahead of those with serious medical comorbidities and most of the elderly.

In a 23 November meeting, CDC’s Advisory Committee on Immunization Practices (ACIP) heard presentations and advice from a working subgroup about how vaccines should be allocated. If, as many anticipate, the vaccines sponsored by Pfizer/BioNTech and Moderna receive emergency use authorizations before the end of 2020, about 40 million vaccine doses could be delivered in 2020. At two doses per individual, vaccines would be given to most of the health care workers in the US, a group that ACIP members agreed should have first access to COVID-19 vaccines.

Along with health care workers – a group that includes non-medical staff such as housekeepers and receptionists – ACIP also heard from the working group that residents of long-term care facilities should be placed in the first tier of vaccination recipients, because of their frailty and the proven ability of the novel coronavirus to rip through nursing homes and assisted living facilities, leaving death in its wake.

The next group to receive vaccination in the working group’s proposed schema would be essential workers. This term, defined for the US by the Cybersecurity and Infrastructure Security Agency (CISA), includes those working in grocery stores, the agriculture and transportation sectors, those in the protective services, and others.

The definitions of essential jobs are set by CISA, but local jurisdictions can adjust which workers are included in this group according to local needs, said ACIP chair Jose Romero, MD, chief medical officer for the Arkansas Department of Health, who also participated in the working group.

The rationale for placing essential workers next in the lineup was driven at least in part by equity considerations. The CDC’s Sarah Oliver, MD, put forward ACIP’s framework to address equity issues, concluding that “Successful implementation of the COVID-19 vaccination program and confidence in COVID-19 vaccines are pivotal to reducing health inequities.”

Many workers in these essential jobs are people of color, or experience socioeconomic hardship; by vaccinating workers in these groups, the possibility of serious economic and supply chain disruption is minimized, and those workers may be protecting their communities as well, agreed the committee. The working group acknowledged that some overlap exists among the proposed priority groups.

The final doses of vaccines to distribute to special populations should go to those aged 65 years and older, and to those with chronic medical conditions known to be associated with poorer outcomes from COVID-19. At a vaccine production rate of about 20 million doses per month in the US, this latter group would mostly be vaccinated sometime early in the second quarter of 2021.

However, the current cold-chain and storage requirements for the two vaccines most likely to receive authorization may hamper accessibility for certain vulnerable groups, including those living in rural areas. Committee member Paul Hunter, MD, of the University of Wisconsin-Madison, said that although “The working group has given us a really good process” for decision-making, “that local emphasis is really important” when it comes to making decisions and allocating resources for optimal and equitable distribution of COVID-19 vaccines.

The liaison for the Infectious Diseases Society of America (IDSA) was Jeffrey Duchin, MD, medical officer for King County, Washington’s public health department. “I must reemphasize how inexorably intertwined equity and implementation is,” he said. Regarding the rollout of resources to the states for vaccine delivery, Duchin said, “It’s not been Operation Warp Speed; it’s more like Operation Status Quo… We need to make sure we have resources available at the state and local level” to be able to deliver vaccines when they are available, he said.

Though no votes were taken at the meeting, the working group presentations were followed by discussion that largely led to consensus among those committee members who spoke. The CDC anticipates calling another emergency meeting if ACIP to address specific vaccines when they are authorized.

ACIP