ACIP: Health care workers, long-term care facilities should get COVID-19 vaccine first
In a 13-1 vote, the CDC’s Advisory Committee on Immunization Practices recommended Tuesday that health care personnel and residents in long-term care facilities be prioritized to receive a COVID-19 vaccine when one is available.
The first wave of vaccinations in the United States could occur shortly after an FDA advisory committee meets on Dec. 10 to discuss Pfizer and BioNTech’s request for an emergency use authorization (EUA) for their messenger RNA (mRNA)-based vaccine candidate. The companies said doses of the vaccine will be ready “within hours” of an FDA authorization.
The FDA’s Vaccines and Related Biological Products Advisory Committee also will meet on Dec. 17 to discuss an EUA request for the mRNA-based COVID-19 vaccine candidate developed by Moderna Inc. and the NIH.
Both vaccines have demonstrated high efficacy and no serious safety concerns in phase 3 trials.
“This is a particularly difficult time in the United States as we are averaging one COVID-19 death per minute right now. In the time it takes to have this meeting 180 will have died of COVID-19,” Beth P. Bell, MD, MPH, director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said during the Advisory Committee on Immunization Practices (ACIP) meeting. “So, we are acting none too soon.”
The committee voted that health care personnel and long-term care facility (LTCF) residents should receive pre-exposure vaccination with a vaccine as part of phase 1a of a COVID-19 vaccination program. It defined health care personnel as “paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials” and residents of LTCFs as “adults who reside in facilities that provide a variety of services, including medical and personal care, to persons who are unable to live independently.”
“We’ve seen a growing number of health care workers that have become infected ... we see that individuals living in long term care facilities are at an exceptional risk for mortality and morbidity of this virus,” ACIP chairman Jose R. Romero, MD, FAAP, chief medical officer for the Arkansas Department of Health, said after voting “yes.”
“I believe that my vote reflects maximum benefits and minimizing harm, promoting justice and mitigating health inequalities that exists with regards to distribution of this vaccine. It is because of that that I voted in favor of this motion,” Romero said.
Kathleen Dooling, MD, MPH, a medical officer in the CDC’s Division of Viral Diseases, said there have been 243,000 cases of COVID-19 and 858 reported deaths from the disease among health care personnel as of Nov. 30. The roughly 3 million residents of LTCFs are “disproportionately affected by COVID-19” and account for 6% of all cases and 40% of COVID-19 deaths as of Nov. 26, Dooling said.
Sara E. Oliver, MD, MSPH, an Epidemic Intelligence Service officer in the CDC's Division of Viral Diseases, said additional clinical considerations should be assessed to sub-prioritize these groups considering about 40 million vaccine doses are expected to be available initially — enough to vaccinate 20 million people.
“Initial doses of any COVID-19 vaccine will be limited,” Oliver said. “We expect a constrained supply environment for some months and need to make the best use of available vaccine.”
Among health care personnel, Oliver suggested that individuals with direct patient contact who are unable to telework, personnel working in residential care or LTCFs and personnel without a documented SARS-CoV-2 infection 90 days prior to vaccination receive further prioritization.
According to Oliver, 75% of health care workers are women and approximately 330,000 of these workers could be pregnant or recently postpartum at the time of vaccination implementation. Because of this, pregnant and breastfeeding health care personnel should also receive prioritization.
Oliver said residents in skilled nursing facilities which care for the most medically vulnerable residents should receive first sub-prioritization among recipients in LTCFs. She said the CDC will publish more detailed guidance on sub-prioritization on its website.
Helen “Keipp” Talbot, MD, an associate professor of medicine at Vanderbilt University Medical Center, was the only ACIP member to vote “no.” Talbot expressed concerns about the ability of LTCFs to report adverse vaccine reactions and a lack of vaccine data in older adults.
“This was not an easy vote,” Talbot said. “Our skilled nursing facilities are a population that need lots of vaccines, not just COVID, and we really need to start finding ways of developing and testing these vaccines to prolong quality of life for our long-term care facility residents. I also want to say out loud that I have no reservations for health care workers taking this vaccine. We are going through some amazing data for a respiratory vaccine that we’ve never seen before and it’s incredibly exciting.”
The ACIP recommendations are for adults. Pfizer has received FDA approval to enroll children as young as age 12 years in the trial for its vaccine. The ACIP said it would consider children in its recommendations for prioritization if the FDA authorizes a vaccine for use in children.
Phases 1b and 1c of vaccination could include nonmedical essential workers, older adults and patients with high-risk medical conditions.