By Peter Loftus, Jared S. Hopkins and Betsy McKay
A federal vaccine advisory panel recommended that health-care
workers and residents of long-term care facilities be the first to
receive any Covid-19 vaccine doses from the limited supply that
will be available initially.
The panel, which advises the Centers for Disease Control and
Prevention, voted 13-1 on Tuesday in favor of giving the first
vaccines to about 21 million health-care workers and three million
residents of long-term care facilities.
Health experts have long expected that the panel would recommend
health-care workers get first dibs, but some federal health
officials have been advocating including those most medically
vulnerable to Covid-19.
Federal officials have said they expect there will be about 40
million doses available in December. The initial vaccines available
are given in two doses three or four weeks apart, so there may be
enough for 20 million people to be vaccinated in the early weeks.
Supplies are expected to increase during 2021.
U.S. health regulators are expected to decide in the coming
weeks whether to authorize the emergency use of two Covid-19
vaccines, one from Pfizer Inc. and BioNTech SE and another from
Moderna Inc. The companies have been manufacturing doses, but it
could take several months to make enough to vaccinate the broader
The CDC usually follows the recommendation of its advisory
panel, and if they are accepted by the agency's director and
Secretary of Health and Human Services Alex Azar, they will become
official CDC policy. A CDC spokeswoman said CDC Director Robert
Redfield will likely make the decision on Wednesday.
Mr. Azar, who has supported early vaccination of nursing-home
residents, has said state governors may make final decisions about
whom to vaccinate first with the doses that the federal government
allocates to them based on their adult populations.
States wouldn't have to follow the CDC recommendations, but
state and local authorities are expected to rely on them as
guideposts for deciding who gets the vaccine first. States have
until Friday to indicate to the federal government where they want
their initial doses sent.
The CDC panel, an outside group of medical experts known as the
Advisory Committee on Immunization Practices, held an emergency
meeting Tuesday to consider how to prioritize which groups are most
in need of receiving the initial doses.
"We see a growing number of health-care providers that have
become infected and some of which, unfortunately, have passed
away," said committee chairman José Romero. "We see individuals
living in long-term care facilities are at exceptional risk for
mortality and morbidity due to the virus and disease."
Other high-risk populations, including essential workers such as
teachers and police, adults with underlying health conditions and
people ages 65 and over who aren't in communal settings, are
expected to be next in line, although the panel didn't set
recommendations for them yet.
Votes on the order of priority for them would probably come
later, after U.S. regulators authorize each vaccine and more
clinical trial data becomes available.
A special National Academy of Medicine committee recommended
health-care workers be in the very first phase of vaccination,
followed by older adults in crowded settings such as nursing homes.
Adding residents of long-term care facilities represents a
compromise with some federal health officials advocating for those
most vulnerable to Covid-19, according to people familiar with the
Still, the expected limited supply means there may not be enough
even for all health-care workers and long-term care residents in
the early days of vaccination. So facilities will need to further
prioritize who among their staff and residents should get shots in
the early days.
CDC staffers who briefed the advisory panel Tuesday said skilled
nursing sites should be given priority among long-term care
facilities because they house the most medically vulnerable
residents. Among health-care workers, those in direct contact with
sick patients and infectious materials should get priority over
others, said Dr. Sara Oliver, a CDC officer who is working with the
Hospitals and other health facilities also must consider the
vaccines' side effects when scheduling immunizations. In studies,
people receiving Pfizer's and Moderna's vaccines experienced
symptoms like fever and headache, which were more intense after the
second doses. CDC officials said health facilities should avoid
vaccinating all of their workers at once, and instead stagger them
in case workers have to miss work for a day or two if they
experience side effects.
Both the Pfizer and Moderna vaccines were shown to be more than
94% effective and generally safe in late-stage testing and could be
authorized within weeks. Pfizer's will be discussed next week
during a public meeting by an outside panel of experts advising the
Food and Drug Administration, with Moderna's discussed at a second
meeting the week after.
The committee typically votes on recommendations for the use of
vaccines only after they have been cleared by regulators. It was
originally going to vote on Covid-19 vaccine prioritization in
September, but the committee delayed action until it could learn
more about the particular shots.
Supplies are expected to be limited initially. Pfizer and
BioNTech have said they could provide the U.S. with about 25
million doses, potentially enough for 12.5 million people, and
Moderna has said it could make 20 million doses by the end of
December. Weekly shipments of five million to 10 million doses are
expected upon authorization, federal officials said Tuesday.
Government officials have expressed differing views on which of
the two populations in the top group -- health-care workers and
people in long-term care facilities -- should be given priority for
the limited supplies likely to be available in December.
Older people are at greatest risk of death. Long-term care
facilities are linked to 6% of all Covid-19 cases, but 40% of
deaths, according to the Kaiser Family Foundation. Covid-19 had
claimed the lives of more than 100,000 nursing-home residents and
staff as of the last week of November, the foundation said.
Health-care workers have fared better, but public-health experts
argue they should be first in line because exposure to Covid-19 and
illness reduce the number of staff who can care for the sick during
a surge like the current one. Health-care workers can be exposed
both at the hospital or in the community, and some hospitals have
recently reported staffing shortages.
While most ACIP members supported the inclusion of long-term
care residents in the first wave of vaccinations, one member, Dr.
Helen Keipp Talbot, dissented. Explaining her vote against the
recommendations, the Vanderbilt University Medical Center
infectious-disease specialist said she was concerned about whether
the vaccine is safe and effective among frail, elderly people. She
also said there are limitations to systems that monitor safety of
vaccines among long-term care residents.
Dr. Richard Zimmerman, a professor of family medicine and
clinical epidemiology at the University of Pittsburgh, called the
decision to include nursing-home residents premature because it
isn't known yet how well the most vulnerable respond to the
vaccine. Those data have yet to be made public, said Dr. Zimmerman,
a former ACIP member.
"We need to look at medical benefit," he said. "Because we think
it works well with seniors, we hope that it works great in
long-term care facilities. It's a hope but it's not a known
The U.K., which is soon expected to approve the Pfizer and
BioNTech vaccine, plans to provide vaccines to residents and staff
in nursing homes first, followed by health workers and people over
A U.S. government modeling study found that vaccinating
nursing-home health-care workers would reduce infections and deaths
more than vaccinating nursing-home residents.
As of Nov. 30, 243,826 cases of Covid-19 were reported among
just over two million health-care workers, or about 12% of the
measured population, according to CDC data. The agency has
mortality data on 180,989 of the health-care workers with Covid-19.
Of them, 858 died.
Write to Peter Loftus at email@example.com, Jared S. Hopkins
at firstname.lastname@example.org and Betsy McKay at email@example.com
(END) Dow Jones Newswires
December 01, 2020 20:23 ET (01:23 GMT)
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