Health care workers and long-term care facility residents should get Covid-19 vaccine first, CDC vaccine advisers say

Vaccine advisers to the US Centers for Disease Control and Prevention voted 13-1 on Tuesday to recommend that both health care workers and residents of long-term care facilities be first in line for any coronavirus vaccines that get emergency authorization from the US Food and Drug Administration.

The Advisory Committee for Immunization Practices voted to include both groups in what they’re calling Phase 1a of the CDC’s coronavirus vaccine distribution plan.

They are at “exceptionally high risk,” Dr. Jose Romero, who chairs ACIP, said.

“Long term care facility residents are defined 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,” the CDC said.

These very frail people account for 40% of coronavirus deaths in the US and the ACIP committee members felt strongly they need to be protected. So far, the CDC’s Sara Oliver told the meeting, 100,000 long term care facility residents have died from Covid-19.

ACIP members also agreed it would be efficient to vaccinate the staff working in nursing homes and similar long term care facilities and the residents at the same time.

And no one had doubts about the need to protect health care workers. More than 240,000 health care workers have been infected with coronavirus and 858 have died, the CDC says.

“Anybody that works within a health care institution that could have contact with an individual who has Covid should receive vaccination,” Romero told CNN before the meeting started. “That includes individuals such as the persons delivering food, those persons in housekeeping who rapidly turn over rooms in the emergency room or who perform cleaning in the patient’s rooms. Those individuals will be included.”

Just before the vote, the American Health Care Association and National Center for Assisted Living released a report showing nursing homes have recorded their highest weekly count of coronavirus cases since the spring.

“Given the asymptomatic and pre-symptomatic spread of this virus combined with the explosion of community spread across the U.S., we are extremely hopeful this vaccine will literally be a lifesaver for thousands of residents and expedite the reopening of our facilities to family members and loved ones,” Mark Parkinson, president and CEO of AHCA/NCAL, said in a statement after the vote.

The single vote against the recommendation came from Dr. Helen Keipp Talbot of Vanderbilt University, who said she was worried that the vaccine had not been studied in residents of long-term care facilities.

“We hope it works and we hope it’s safe. That concerns me on many levels,” Talbot told the meeting.

Later, she added: “I have no reservations for health care workers taking this vaccine.”

Early data on the Pfizer and Moderna vaccines suggest both are safe and highly effective, with each preventing 95% of symptomatic infections in the people who have volunteered to test them according to the companies.

“Our discussions have been transparent and our motives have been clear,” Romero said after the vote.

“We see the growing number of health care providers that have become infected, some of which have, unfortunately, passed away,” added Romero, who is secretary for health for the Arkansas Department of Health.

“I believe my vote reflects maximum benefit, minimum harm, promoting justice and mitigating that health inequalities that exist with regard to distribution of this vaccine.”

Dr. Robert Atmar of the Baylor College of Medicine said he initially had qualms about putting long-term care facility residents in the first group.

“Ultimately, I was persuaded by the tremendous burden in terms of mortality and hospitalizations that the residents of these facilities bear, the remarkable efficacy that has initially been reported and that ultimately we will have a chance to review … and the plans for monitoring of safety in this population and the extra mile that will be pursued to make sure that the residents and their families will be fully informed about the amount of evidence that is available before the residents receive the vaccine.”

The next meeting will come after the FDA’s advisers, known as the Vaccines and Related Biological Products Advisory Committee or VRBPAC, meet on December 10 to decide on Pfizer’s application for an EUA, said ACIP’s executive secretary, Dr. Amanda Cohn.

“We anticipate that the next ACIP meeting will occur sometime after the VRPBAC meeting,” Cohn said. ACIP will vote to recommend whether any vaccine the FDA authorizes should actually be given to anyone in the United States.

The CDC and ACIP are considering a four-phase plan for allocating vaccines eventually. Phases 1b and 1c will likely include essential workers such as food production workers who are at high risk of infection, as well as emergency personnel and perhaps people at highest risk of coronavirus complications and death.

The federal government anticipates that 40 million doses of vaccine could be available in the United States by the end of December if both the Pfizer and Moderna vaccines are approved.

But all 40 million doses would not be available right away, Oliver told Tuesday’s meeting.

“We expect a constrained supply environment,” Oliver said.

Oliver said the CDC expects between 5 million and 10 million doses will become available each week for the first few months as vaccine makers ramp up manufacturing.