Next phase of vaccinations should include patients over 75, essential workers, ACIP says
The next phase of COVID-19 vaccinations in the United States should include patients aged 75 years or older and frontline essential workers, including first responders, a CDC panel said Sunday.
In a 13-1 vote, the Advisory Committee on Immunization Practices (ACIP) voted to recommend who should be included in the next two phases of vaccination after health care workers and residents of long-term care facilities, who began receiving the first dose of the Pfizer and BioNTech vaccine under an emergency use authorization (EUA) last week.
The FDA on Friday issued a second EUA for a COVID-19 vaccine after an advisory committee endorsed its use last week. Doses of that vaccine, which was developed by Moderna Inc. and the NIH, will be available this week, government officials said.
In addition to patients aged 75 years or older and first responders, the ACIP said phase 1b also should include postal workers, public transit workers, grocery store workers and patients who work in food and agriculture and manufacturing.
These workers “are in sectors essential to the functioning of society and are at substantially higher risk of exposure to SARS-CoV-2,” the working group said.
The ACIP recommended that the next phase of vaccinations, phase 1c, should include patients aged between 65 and 74 years, patients aged between 16 and 64 years with high-risk medical conditions, and other essential workers, including patients in transportation and logistics, food service, construction, finance, information technology and communication, energy, media, legal, public safety and water and wastewater.
Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, said the ACIP vote “[reflects] a good approach to putting this public health emergency behind us.”
“It has been clear since the start of the pandemic that age is a major factor driving hospitalizations and deaths, so vaccinating those 75 years and older is a data-driven practice that will be impactful,” Adalja said.
“There also are many people in the community whose occupation places them at unique risk because they involve activities that cannot be done remotely. These individuals are key to the day-to-day function of society,” he said. “When a resource that is in limited supply, as are the Pfizer and Moderna vaccines, it is important to deploy the vaccine in a manner that will have the most impact and I think that the ACIP priority groups do just that.”
Reference:
CDC. ACIP COVID-19 vaccines work group: Phase allocation of COVID-19 vaccines: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/slides-12-20/02-COVID-Dooling.pdf. Accessed December 21, 2020.
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The ACIP’s newest recommendations for the subsequent prioritization of groups for COVID-19 vaccination tries to balance the need to get society functioning again and protecting the most vulnerable. To that end, the four tiers in order of those who will be vaccinated are below and the aim is to get all Americans who qualify vaccinated in the next 6 months.
- Phase 1a is health care workers and residents/staff of long-term care facilities.
- Phase 1b is those aged 75 years or older and front-line essential workers, defined as firefighters/police; teachers and education staff; food and agriculture; manufacturing; public transit, grocery store, postal service, and correction workers.
- Phase 1c is those aged 65 to 74 years; those aged 16 to 64 years with high-risk conditions (eg, cancer, chronic kidney disease, COPD, heart conditions, organ transplant, obesity, sickle cell disease, smoking, pregnancy, type 2 diabetes); and essential workers not represented in 1b (specifically transportation, food service, construction, finance, information technology and communications, energy, media, legal, public safety, water/wastewater.
- Phase 2 is everyone else aged 16 years or older.
I am generally in favor of these recommendations and think they are trying hard to strike a balance in protecting those who must serve essential functions in our society to get it “moving again” and protecting the vulnerable. I particularly agree with putting teachers in the category of essential frontline workers, given the impact on children of not having consistent in-person learning. Not everyone will be happy with these recommendations and the biggest concern will be not including those aged 65 to 74 years in phase 1b, but I think the balance the ACIP had to strike between helping society to function and protecting the vulnerable was a difficult one and it did a great job.
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