The recommendation was a compromise aimed at getting the coronavirus vaccine to the most vulnerable of two high-risk groups.

Striking a compromise between two high-risk population groups, a panel advising the Centers for Disease Control and Prevention voted Sunday to recommend that people age 75 and older be next in line to receive the coronavirus vaccine in the United States, along with about 30 million “frontline essential workers,” such as emergency responders, teachers and grocery store employees.

The debate about who should receive the vaccine in these early months has grown increasingly urgent as the daily tally of cases has swelled to numbers unimaginable to the general public even weeks ago. The country has already begun vaccinating health care workers, and on Monday, CVS and Walgreens are to begin a mass inoculation campaign at the nation’s nursing homes and long-term care facilities. This week roughly six million doses of the newly authorized Moderna vaccine are to start arriving at more than 3,700 locations around the country, including many smaller and rural hospitals, widening the rollout that began with Pfizer’s vaccine last week.

The panel of doctors and public health experts had previously indicated it would recommend a much broader group of Americans defined as essential workers — about 90 million people with jobs designated by a division of the Department of Homeland Security as critical to keeping society functioning — as the next priority population, and that older people who live independently should come later.

But in hours of discussion on Sunday, conducted remotely, the committee members concluded that given the limited initial supply of vaccine and the higher Covid-19 death rate among older Americans, it made more sense to allow the oldest among them to go next, along with workers whose jobs put them “at substantially higher risk of exposure” to the virus.

“I feel very strongly we do need to have that balance of saving lives and keeping our infrastructure in place,” said Dr. Helen Talbot, a member of the panel and an infectious-disease specialist at Vanderbilt University.

Other types of essential workers, such as construction and restaurant workers, would qualify for a third wave of prioritization under the panel’s recommendations. The committee members acknowledged that they couldn’t determine a timeline for that next group, because they did not know how much demand there would be for the vaccine among the earlier priority groups.

“What we are providing governors and health officials with is a framework which is supported by evidence and will address this limited supply of vaccine that we have at this time,” said Dr. Jose R. Romero, the committee’s chairman and a pediatric infectious disease specialist in Arkansas.

Together, the two groups the committee recommended be vaccinated next number about 51 million people. Federal health officials have estimated that there could be enough vaccine supply to inoculate 100 million people before the end of February, including the nation’s 21 million health care workers and three million residents of long-term care facilities. The C.D.C. reported on Sunday that more than 556,000 people had received an initial shot over the last week; both the Pfizer and Moderna vaccines require a second dose several weeks later.

The director of the C.D.C., Dr. Robert Redfield, will now review the panel’s latest recommendation and decide, likely by Monday, whether to embrace it as the agency’s official guidance to states. After the committee suggested last month that it would recommend that essential workers get vaccinated ahead of older people, Dr. Redfield urged its members in a statement to “demonstrate that we as a nation also prioritize the elderly.”

A working group of the committee suggested that in addition to teachers, firefighters and police, “frontline essential workers” should include school support staff, day care employees, corrections personnel, public transit, grocery store and postal workers, and those in working in food production and manufacturing.

But the group’s formal recommendation is not that specific. The panel, the Advisory Committee on Immunization Practices, emphasized that its recommendations were nonbinding and that every state should fine-tune them to serve the unique needs of its population.

The 13-to-1 vote came as frustrations flared nationally about the pace of vaccine distribution. This weekend, Gen. Gustave F. Perna, who heads the Trump administration’s distribution effort, apologized for states learning at the last minute that they would receive fewer doses of the Pfizer vaccine next week than they had expected. Tensions were also roiling in some states over local decisions regarding which health care workers should get their shots immediately, and which — including hospital administrators who do not see patients, some of whom were vaccinated last week — should wait.

When the committee signaled last month that essential workers should precede adults 65 and older, many members supported that view, expressing alarm that these workers, who are often low-wage people of color, were being hit disproportionately hard by the virus and were additionally disadvantaged because of their limited access to good health care.

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But when word of that proposal emerged, the public reaction was frequently harsh because many people felt that the elderly deserved protection first, as they, too, are dying at disproportionately high rates and overwhelming health care facilities.

In addition, the committee faced a flood of often vicious accusations that it was prioritizing other racial groups over white people.

In a strongly worded statement before the panel’s vote on Sunday, its chairman, Dr. Romero, pushed back. “Our attempt has been always to achieve equitable ethical and fair distribution of that resource. We have never targeted a specific ethnic nor racial group for receipt of the vaccine,” he said.

The position the committee ultimately endorsed was intended to mediate between competing and compelling concerns. The latest recommendation now trims back essential workers to a smaller category and narrows the eligible older population by a decade.

The full committee also voted to recommend a third priority group to get the vaccine after people who are older than 75 and those who are “frontline” essential workers: people ages 65 to 74 (roughly 32 million); people ages 16 to 64 with high-risk medical conditions (more than 110 million); and all other essential workers, including those with jobs in restaurants, construction, law, transportation other than public transit and water treatment.

Dr. Grace M. Lee, a committee member who is a professor of pediatrics at the Stanford University School of Medicine, noted that while the C.D.C. currently lists 11 “high-risk” conditions that make people more vulnerable to a life-threatening case of Covid-19, such as severe obesity, sickle cell disease or Type 2 diabetes, the list needs to be constantly updated as clinicians learn about more conditions that can leave patients exposed.

Later this week, the C.D.C. is expected to issue further explanations of the panel’s rationales and more guidance for doctors with high-risk patients.

Some on the committee called for refining priorities further within each large group, if only to help states and local governments make difficult decisions in the coming weeks. For example, one asked, shouldn’t older frontline essential workers go before younger ones?

The committee members said that the overarching consideration should be for those who could not do their jobs without social distancing or who did not have ready access to personal protective equipment. Those who can work remotely and otherwise don’t fall into a higher priority group, they said, should wait.

But the group also suggested that the categories would be fluid, and that states could move from one phase to the next if supply increased, if data suggested that most people in a group had gotten vaccinated, or if appointments for the shots in any given jurisdiction began to be less than 80 percent filled.

“Vaccination within the phases may and likely will overlap,” said Dr. Beth Bell, a panel member and a global health expert at the University of Washington.

One debate centered on how congregate housing, such as prisons and jails, should receive vaccination priority. The recommendation lists correctional staff as frontline essential workers but is silent about prisoners themselves, who have been at very high risk of contagion.

Ultimately, the panel suggested local health departments determine whether to vaccinate prisoners simultaneously with corrections officers based in part on whether an outbreak was flaring in their institution.

Repeatedly, members of the committee underscored the fluidity of the factors they were considering in determining their allocation priorities. There is still more to be learned about the virus and the vaccines themselves, they said, that could affect decisions further down the road.

Committee members also pointed out that their recommendations could change based on what happens with supply of and demand for the vaccine. They issued an urgent call for more federal funding to state and local health departments for distribution efforts, which they said were in grave danger of being thwarted by insufficient staffing and resources on the ground.

“Today, state and local health departments are on life support,” said Dr. Jeffrey Duchin, a panel member who is in charge of public health in Seattle and King County, Wash., which saw the nation’s first Covid-19 outbreaks in March. “We’re hamstrung and stymied by the lack of necessary federal funding to allow us to take advantage of these newly available vaccines.”

Source: https://www.nytimes.com/2020/12/20/health/covid-vaccine-first-elderly-workers.html

News – Frontline Workers and People Over 74 Should Get Shots Next, C.D.C. Panel Says