The Centers for Disease Control and Prevention panel responsible for guiding the rollout of COVID-19 vaccines voted Tuesday 13 to 1 to include both healthcare workers and residents of long-term care facilities in the first group that will receive inoculations.
“We see that the individuals living in long term care facilities … are at an exceptional risk for mortality morbidity due to this virus and disease,” said Dr. Jose Romero, chairman of the committee. “I believe that my vote reflects maximum benefit, minimum harm.”
The body, the Advisory Committee on Immunization Practices, prioritized healthcare workers because they are essential to the COVID-19 response. Long-term care facility residents were prioritized because they are one of the most vulnerable populations. Residents and staff of skilled nursing facilities and assisted living facilities amount to less than 1% of the U.S. population but account for 6% of infections and 40% of deaths due to the coronavirus.
While the committee can make recommendations for allocating the first doses of the vaccine, the decisions for distributing the shots will ultimately fall to state governments.
Critics of the position, such as Dr. Robert Atmar, an infectious disease professor at the Baylor College of Medicine, stated that since clinical trials had not targeted nursing home residents, there was not enough data to show that the vaccine was generally safe and effective for that population. Atmar also noted that flu vaccines are often less effective in long-term care residents than in other people.
But Dr. Grace Lee, a professor of pediatrics at the Stanford University School of Medicine, argued that it might take too long to wait for more data, especially for such a vulnerable population.
Debate over the inclusion of nursing home residents was subdued at the Tuesday meeting. However, it stoked a considerable debate among ACIP members at the previous meeting on Nov. 23.
ACIP also discussed how to prioritize vaccine allocation within the two groups after the Food and Drug Administration authorizes the coronavirus vaccine. An estimated 5-10 million doses will be available each week. Initially, that will not be enough to inoculate the estimated 21 million healthcare workers and 2 million nursing home residents.
ACIP suggested that, among healthcare workers, personnel who had direct contact with patients and personnel working in long-term care facilities be given priority. The committee also suggested that personnel who did not have a known COVID-19 infection in the prior 90 days be given priority, as reinfection after the first 90 days of a COVID-19 infection appears to be rare.
There was also discussion over whether women healthcare workers who were pregnant or recently postpartum should be given priority, as COVID-19 does increase the risk of severe maternal illness and premature birth. There is not yet any data on the effect that the vaccine might have on pregnant or breastfeeding women.
