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Many states prioritized COVID-19 vaccines for people over 75, then moved to those over 65, but they shouldn't keep stepping down by age, an advisory committee to the Centers for Disease Control and Prevention said Monday.
The approach is inherently unfair to minorities, committee members said, because they have a lower life-expectancy and because people of color are dying of COVID-19 at younger ages than white Americans – even in their 30s, 40s and 50s.
"I'm not in favor of any part of an age eligibility bracket under 65," said Dr. José Romero, a pediatric infectious disease specialist at the University of Arkansas for Medical Sciences in Little Rock and chairman of the Advisory Committee on Immunization Practices.
The committee disagreed with plans in some states to require people to show proof that they have two medical conditions on a pre-specified list before being allowed to be vaccinated.
People with two medical conditions that are well-controlled might be at lower risk of serious COVID-19 than those with one out-of-control condition or with a less common disease that wasn't frequent enough make the list.
For example, although Type 2 diabetes is considered a highest-risk condition, Type 1 isn't always, even though people with this less common, autoimmune version are at the same risk, noted Dr. Katherine Poehling, a professor of pediatrics at Wake Forest School of Medicine in Winston-Salem, North Carolina.
Yes, there will be some people who lie about their medical conditions, admitted Dr. Helen Talbot, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tennessee. "There's always someone who finds a way to cheat."
But it's better to let in a few cheaters than to deny vaccine to people who really need it, she said.
The other category of people who should be prioritized, committee members said, are those who care for others who may not be able to be vaccinated.
Dr. Grace Lee, a professor of pediatric infectious diseases at the Lucile Packard Children’s Hospital and Stanford University School of Medicine in Stanford, California, cited the parents of children who received stem cell transplants.
"Being able to protect those individuals in the absence of any high-risk medical condition, I think in and of itself, is important, in part because we can't vaccinate young kids at this time," she said.
Every state makes its own vaccination allotment plan, so there's a lot of mixed messages about who should be prioritized in the next few months as vaccine supply remains tight, committee members said.
For that reason, committee members said the Johnson & Johnson vaccine, authorized over the weekend, should be added to the general pool of available vaccines, rather than targeted to any particular group or population.
They reemphasized their commitment to equitable distribution of vaccines, even as they are distributed to as many people as possible.
"I feel very challenged by ensuring that we continue to keep equity as a focus for implementation of the COVID-19 vaccination program," Lee said.
Many vaccine distribution facilities are so worried about getting precisely the right people vaccinated that they're turning too many away, she continued.
"Since our intent is to vaccinate everyone anyway, other than the most egregious of situations, whether or not I get high-risk condition A versus B correct, I think, is less important than just making sure that we are providing access," she said.
About 50 million Americans have received at least one dose of a COVID-19 vaccine. By the end of this month, Pfizer-BioNTech will have provided a total of 120 million doses of its vaccine, enough to vaccinate 60 million people; Moderna will have provided 100 million doses to vaccinate 50 million people; and J&J will provide 20 million doses of its single-shot vaccine. That's enough to cover more than half of the 210 million adults in the USA.
In its second four-hour meeting in two days, the committee considered whether to extend the recommended period between the two doses of the Pfizer-BioNTech or Moderna vaccines.
Some suggested a delay would allow more vaccine to be distributed, but committee members said they did not feel there was enough data to justify delaying the second dose of either vaccine.
There were more mixed opinions on whether people who had symptomatic COVID-19 would need both doses of the two-dose vaccines.
Basic immunology suggests that the illness would act as a primary dose and the first shot as a booster, Talbot said. "I don't need any more data. We've all taken immunology," she said.
Others raised questions about whether the risks of vaccination for people who have had COVID-19 would outweigh the benefits, particularly of a second shot. CDC officials said there is not enough information to answer that question.
Implementing such a policy would be challenging, because it's not clear how long protection lasts and how sick someone has to be to develop adequate natural protection.
Contact Karen Weintraub at kweintraub@usatoday.
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This article originally appeared on USA TODAY: Should states prioritize vaccine by age? Some experts say no