A federal advisory committee voted on Tuesday to recommend distribution of precious COVID-19 vaccines first to health care workers and long-term care residents, a move that marks the beginning of the end of a pandemic that is claiming one American life every minute.
The historic agreement, which likely will be followed by California and other state public health departments, is a triage plan: With too many needy people and too few doses, these two groups were deemed most deserving of protection.
“To all the people out there anxiously waiting for vaccine, we hope that this vote gets us one step closer to the day when we can all feel safe again, and when this pandemic is over,” said Dr. Nancy Messonnier, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases.
Until more doses are available, access within these two groups also will be restricted, according to the panel called the Advisory Committee on Immunization Practices, comprised of physicians and public health experts.
For instance, health care workers with direct patient contact will be first in line. Most facilities say they can vaccinate all of their health care workers within three weeks, according to Messonnier.
Care facilities that provide services to the most frail and oldest adults will also be prioritized, along with the health care workers who staff these nursing facilities. Assisted living facilities would be next in line, if supplies allow.
Only 40 million doses will be available nationwide by the end of December. Because two doses are required, this will protect 20 million people.
But after the vaccines receive federal authorization, an additional 5 to 10 million doses will be available every week.
California initially will get 327,000 doses, according to Gov. Gavin Newsom, far short of what is needed.
California alone has up to 2 million people at risk of exposure through their work in health care or long-term care settings. The state also has nearly half a million residents in skilled nursing facilities, assisted living facilities and similar settings.
The state’s “Phase 1 allocation” plans for high-risk groups, which likely will mirror the federal group’s decision Tuesday, will be finalized this week. States have a Friday deadline to submit initial vaccine distribution plans.
The state is also determining allocations for counties in a prioritization framework that is still under development, according to the California Department of Public Health. Local public health departments will both administer vaccines and allocate doses to other providers. Large health care systems are expected to continue their role in immunizing many Californians.
Two state “working groups” are designing these plans. A Drafting Guidelines Workgroup is developing California-specific guidance for the prioritization and allocation of vaccine. The Community Vaccine Advisory Committee is providing input to ensure equitable access.
Health care workers across the country have been hit hard by the pandemic, with at least 243,000 infections and 858 deaths, according to data presented at the advisory committee meeting. It’s important that this workforce stays strong to sustain health services during the pandemic.
Residents and staff at care homes also have been disproportionately affected, with nearly 500,000 infections and 70,000 deaths.
“It’s something I’ve been dreaming about for months now,” said infectious disease expert Dr. Peter Chin-Hong, who works on the front lines of COVID-19 care, treating some of UC San Francisco’s most infectious patients. “It’s not only because we’re being protected individually, but because we come into contact with so many potentially infected patients every day, others will be protected. I’m thinking about my family, people at home. It goes beyond me.”
He knows his risk of infection is low because he wears gloves, gowns and goggles, “but it is still always a lingering doubt in my mind. It’s a powerful psychological burden,” he said. “I don’t pull my kids as close as I would normally do.”
California’s hospitals already are planning distribution, experts say. It’s not based on seniority or status but rather those at highest risk.
“Direct caregivers like respiratory therapists, janitors who clean the rooms, housekeepers, transporters who are moving patients, respiratory therapists, phlebotomists that are testing patients — they’re all at risk,” said Sal Rosselli, president of the National Union of Healthcare Workers, which represents more than 15,000 health care workers in California and Hawaii.
Residents of long-term care facilities need protection not only because of their age and disabilities but because they live together. And many have have other illnesses, such as diabetes and heart disease, that put them at elevated risk, said Los Altos geriatric specialist Dr. Mehrdad Ayati, who cares for patients at Mountain View’s Grant Cuesta Sub-Acute and Rehabilitation Center.
Preventing infections in those facilities will reduce the burden on hospitals, he said, because “they are the ones sending patients to the hospital,” he said. Early in the pandemic, many of the most devastating outbreaks were caused by infections introduced by health care workers in those facilities, he said.
The pharmacies that provide care to these facilities, such as CVS and Walgreens, already have reached out to describe their plans, said Ayati.
Federal and state authorities have not yet decided which groups would be next in line. Based on recommendations by the National Academy of Medicine, the “Phase 2” group would likely include people with significant illnesses, “essential workers” who cannot telework, teachers and school staff, older adults, people in homeless shelters and incarcerated people and staff. Young adults, children and workers who can telecommute would be last.
Phase 1 and Phase 2 of the plan would cover the estimated 45% to 50% of the U.S. population at greatest risk.
Two vaccines — one from Pfizer and its partner BioNTech, the second from Moderna — have filed for an emergency use authorization from the U.S. Food and Drug Administration. Both enlist a new and hitherto unproven idea of using messenger RNA to trick our own cells into making a viral protein, triggering an antibody response. Their requests are under review by the FDA’s Vaccines and Related Biological Products Advisory Committee.
If the FDA gives the go-ahead, Pfizer said it could start delivering vaccines no later than Dec. 14. Moderna says its vaccine would be ready a week later.
The approach causes unease for Liz Thurstone, a registered nurse at San Jose’s Regional Medical Center. “I want to protect myself and those around me,” she said. But the vaccine strategy “is difficult for me to wrap my head around. At this moment, I am reserving my final decision but am leaning towards accepting the vaccine.”
So far, 13.6 million people in the country have been infected, and nearly 270,000 have died.
