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September 01, 2020

Health care workers and high-risk adults should receive COVID-19 vaccine first

The National Academies of Sciences, Engineering, and Medicine offers recommendations for vaccine prioritization

Ever since the first COVID-19 vaccine trials started under Operation Warp Speed, one of the biggest questions has been: Who will get the vaccine first?

With an expected initial supply of tens of millions of doses, and most vaccine candidates requiring two doses to be effective, not every American will be able to receive the vaccine in the first distribution. So who should be the priority?

The National Academies of Sciences, Engineering, and Medicine offers a possible answer to that question in a draft guidance released on Tuesday.

According to their recommendations – which were requested by Francis Collins, director of the National Institutes of Health, and Robert Redford, director of the Centers for Disease Control and Prevention – health care workers and first care responders, as well as vulnerable adults with underlying conditions, should be the first in line. High priority also should be given to older adults living in long-term care facilities and other crowded settings.

A virtual public meeting will be held on Wednesday afternoon to discuss the draft with a final report expected in later in September.

To ensure prior prioritization of the vaccine, the National Academies of Sciences, Engineering and Medicine developed a four-phase approach that considers a person's risk of infection, risk of severe illness or death, and risk of their easily transmitting the coronavirus to others.

After health care workers, first responders, those with underlying conditions and old adults in long-term car, the second phase of distribution would include critical-risk workers — basically essential workers in high-risk settings, teachers and school staff, and people living in congregate settings, like jails and group homes.

Any older adults who didn't receive the vaccine in the first phase would be eligible for the vaccine in this phase, as well as people of all ages considered at moderate risk of severe COVID-19.

The third phase focus on administering the vaccine to young adults and children and any essential works who still haven't received the vaccine. The final phase is a catch-up phase for everyone else in the country who still hasn't be vaccinated.

The report is meant just as a guide for official vaccine prioritization plans, which are being developed by the Advisory Committee on Immunization Practices for the CDC and state, local health authorities.

Mounting research shows that people of color are disproportionately affected by the COVID-19 pandemic. The recommendations don't give priority to Black, Hispanic, Latinx people or American Indians or Alaskan natives.

According to the committee, the reasons for high infection rates and deaths in these communities has to do with systemic racism which leads to higher levels of poor health and socioeconomic factors, like working in essential jobs and or living in crowded settings. That's why officials focused on underlying causes instead of racial and ethnic categories.

There are still many unknowns when it comes to the development of a COVID-19 vaccine and that could impact how it is distributed. While there are several promising candidates now in Phase 3 clinical trials, it isn't clear yet which will be the most effective, and if certain ones will work better for particular at-risk groups than others.

Another major concern is having enough supply for even those considered high priority. According to the CDC, there are almost 20 million health care workers in the U.S. and 100 million people with underlying medical conditions who are at greater risk for severe illness with COVID-19. These groups may need to be broken down even further in any prioritization plan.

Philadelphia is also playing a pivotal role in how distribution plans are being created at the national level. Philadelphia along with the state governments of California, Florida, Minnesota and North Dakota are consulting both with the CDC and the Department of Defense on how to best distribute a COVID-19 vaccine.

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