With two Covid-19 vaccine candidates expected to be approved for the US market in the coming weeks, a group of experts met Tuesday to advise on which Americans should be immunized first. In a 13-1 vote, they put health care personnel and staff and residents of long-term care facilities at the front of the line. <\/p>\n
The Advisory Committee on Immunization Practices (ACIP), a panel of independent medical and public health experts, has been meeting for months to think through the question of whom to prioritize during a pandemic while vaccine supplies are still limited. <\/p>\n
ACIP is highly influential in the US. It makes recommendations on vaccination policy to the Centers for Disease Control and Prevention, which overwhelmingly accepts the committee\u2019s guidance. States aren\u2019t obliged to follow it, however. It\u2019s up to governors \u2014 and individual hospitals and vaccine sites \u2014 to make their own vaccine prioritization plans. <\/p>\n
But with coronavirus hospitalizations and deaths rising exponentially, the meeting was another stark reminder that vaccine rationing will be a painful reality for months while supplies remain short. <\/p>\n
\u201cThere is an average of one Covid death per minute right now,\u201d said Dr. Beth Bell of the University of Washington, who chairs ACIP\u2019s Work Groups, at the meeting\u2019s opening. \u201cIn the time it takes us to have this ACIP meeting, 180 people will have died of Covid-19.\u201d <\/p>\n
And that\u2019s one reason why, vaccine and public health experts told Vox, ACIP should have weighed in sooner. Major health groups like the World Health Organization (WHO) and the National Academies of Sciences, Engineering, and Medicine (NASEM) have published advice on how countries and other decision-making bodies can set their prioritization plans for Covid-19 vaccines. <\/p>\n
\u201cIt would have been helpful to have this a week ago,\u201d said Ruth Faden, the founder of the Johns Hopkins Berman Institute of Bioethics, since states, which have been waiting on the guidance, must place their first orders of Covid-19 vaccines with the government and share their initial distribution plans by Friday. \u201cStates were not caught completely unaware here,\u201d Faden added \u2014 since ACIP had signaled in previous meetings the direction they were likely to go \u2014 but Tuesday\u2019s guidance could have been more specific, particularly when it comes to how to immunize America\u2019s health workforce.<\/p>\n
The advice is not specific enough<\/p>\n
ACIP\u2019s primary task on Tuesday was to vote for phase 1a of the rollout for two priority groups: health care personnel and long-term care facility staff and residents, comprising about 24 million people. <\/p>\n
According to CDC officials, there will only be 5 million to 10 million doses of the vaccines available per week for these groups once vaccines are approved, which should happen before the end of the year. The two manufacturers that are expected to have vaccines approved first, Moderna and Pfizer\/BioNTech, will have enough doses to vaccinate only around 20 million people by the end of December. <\/p>\n
Long-term care facility residents and staff are a top priority because they have accounted for 40 percent of US Covid-19 deaths, according to the committee. And it makes sense to prioritize health care workers \u2014 they\u2019ve also been among the groups hardest hit by the virus, and we need them healthy and working to keep the health system functioning. <\/p>\n
But the gap between the priority groups and the expected supply is a problem ACIP should have addressed, experts say. <\/p>\n
It\u2019s not clear from the guidance who among the health workers should go first, said Jason Schwartz, assistant professor of public health at Yale School of Public Health. \u201cThis matters because states might have 20,000 or 100,000 doses and figuring out where to use them in a priority group is going to be a hard question.\u201d <\/p>\n