An advisory committee to the U.S. Centers for Disease Control and Prevention (CDC) voted Tuesday to designate health care workers and long-term care (LTC) facility residents and staff as the first groups to receive COVID-19 vaccines.
The motion passed with a 13 -1 vote, setting the stage for vaccines to be distributed immediately this month, once one is authorized. The U.S. Food and Drug Administration (FDA) has two meetings set, the first of which is December 10, to review vaccine emergency use filing.
The meeting to vote on the group deemed “Phase 1a,” according to the CDC’s anticipated priority designations, has been highly anticipated for weeks, and two emergency use authorization filings in the past week have cranked up the pressure on ensuring equitable allotment of vaccines as they become available.
The committee defined health care workers as “paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials.” The committee also defined long-term care residents to include anyone in medical long term recovery in a correctional facility.
The CDC’s Dr. Kathleen Dooling said the agency estimates that 21 million health workers are eligible for the vaccine, including support staff serving food and nurses’ aides with access to patients. The CDC identified roughly 3 million eligible recipients among long-term care facility residents.
High patient turnover is one one obstacle to ensuring full vaccination of long-term care center residents. While some residents live in nursing homes, others are patients for shorter periods. If those individuals leave the facility before the second of two vaccine doses is administered, they could be left to wait until vaccines are more widely available, experts said.
‘We need to ask, especially in the initial phase, for everyone to be rowing together’
Dr. Nancy Messonnier, the CDC’s top vaccine expert, said during the meeting that health facilities are operationally preparing to vaccinate all staff in 3 weeks or less.
Messonnier said that the CDC is going to hold itself “to an exceedingly high standard of monitoring” adverse events after the vaccines are authorized and require that reporting systems rely on a variety of individuals, even if it requires extra time, to ensure the necessary data is captured.
With little known about potential issues with the vaccine in the real world, the CDC will also be monitoring various adverse event platforms for long-term care facilities and Department of Veterans Affairs facilities.
“We need to ask, especially in the initial phase, for everyone to be rowing together,” she said.
How distribution will work at the local level and whether there will be enough doses to vaccinate health care workers and the elderly, however, remains to be seen.
Dr. Joshua Lesko, an emergency physician at Naval Medical Center Portsmouth, wrote Monday, “The anticipated (40 million) doses ... are not enough to adequately cover even these two groups.”
Both companies used messenger RNA technology, which has never before been approved or authorized on the market, and both require colder storage than usual. Moderna was able to keep its vaccine stable at temperatures near that of a home freezer, while Pfizer’s requires extra-cold temperatures, spurring concerns about the ability of rural areas to receive the vaccine.
Looking ahead at general public access
Meanwhile, the U.S. Health and Human Services Department (HHS) is working, via Operation Warp Speed, to provide broad retail access at pharmacies to alleviate pressure on health facilities. It is also working to ensure vaccine distribution in tribal communities.
On Tuesday, HHS announced that all tribal health programs and Urban Indian Organizations have made their decisions on how to receive a vaccine, a result of communicating with tribal leaders in September. The Indian Health Services released a guide and plan for vaccinations in November.
“By offering Indian health providers a choice in how COVID-19 vaccines are delivered, the Trump administration will ensure that vaccines are effectively delivered throughout Indian Country in ways that make sense for tribal communities,” said HHS Sec. Alex Azar. “Tribal nations have been a key part of our planning for the vaccine rollout so that American Indians and Alaska Natives will have equitable access to safe and effective COVID-19 vaccines as soon as they become available.”
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