Yesterday, the CDC Advisory Committee on Immunization Practices (ACIP) met and voted on recommendations for phased allocations of vaccines to subsets of the U.S. population. The first of several planned recommendations is to prioritize the first phase of the vaccine allocation to health care workers and residents and employees of nursing homes.
CDC director Dr. Robert R. Redfield, is expected to make a final decision and formal announcement today.
The allocation of the vaccine has been broken into multiple phases, only phase 1 has been fleshed out in detail. See chart below of which groups of people are categorized into subphases 1a, 1b and 1c.
Within phase 1, phase 1a is the critical one, for whose members the recommendations apply. Phase 1a will cover approximately 24 million people, as shown below.
The graphic below shows previous proposals on the allocations, which are slightly different than the ones recommended above. It also shows other groups of the population that will be covered in future recommendations.
From www.nytimes.com/… about the one negative vote among 12 -
The only member of the committee to vote against the recommendation was Dr. Helen Talbot, an infectious-disease specialist at Vanderbilt University, who expressed discomfort with putting long-term-care residents in the first priority group because the vaccines’ safety had not been studied in that particular population. “We enter this realm of ‘we hope it works and we hope it’s safe,’ and that concerns me on many levels,” she said before the vote.
But most panel members who offered opinions said they thought the high death rate among that group made it imperative to include it.
See the article at the NYTimes for more coverage -
More Insights
Bob Wachter, Chair, UCSF Dept of Medicine, has a comprehensive thread on the subject. Here is his crack at the vaccination timeline, based on estimates of vaccine availability and distribution. The 144M high-priority folks will probably get vaccinated by May 2021. It will be around September when we reach herd immunity at 230M vaccinations.
He has some other concerns as well, which will have to be tackled by the Biden administration with co-operation from the U.S. population. Here are selected quotes from his thread -
- We know that a fair # of folks will have symptoms – arm pain, fever, the blahs – that’ll last for 1-2 days. Seems a small price to pay for immunity to a terrible infection. But will this day of discomfort dissuade people… from getting their shots? Probably some, particularly in lower-risk groups – & we’ll need many to take shots to get to herd immunity. Analogous to the challenge of getting low-risk folks to wear masks & buy health insurance – many are too selfish to accept pain for others.
- There will also be post-vaccination issues: when somebody has a post-vaccine fever, do we assume it’s the vaccine? Test for Covid if it lasts for >2 days? Should healthcare or essential workers come to work if they feel sick after their shot? We’ll need super-clear guidance.
- If we vaccinate 10M Americans, how many will develop a serious illness in 2 months after they got their shots. Answer: many thousands (& I’ve only included 4 illnesses, plus death). And the vaccines will have zero to do with any of them.
- Misinformation: Whether it’s anti-vaxxers or Russian bots, if somebody wants to turn every post-vaccine illness into a “See, I warned you” canard, there’ll be ample fodder. We’ll need a strong campaign to combat it.
- I do worry about keeping track of who got which vaccine. Who will remind a pt to come in for a 2nd dose, and be sure that the 2nd dose is the same brand as the first? If we had a national medical record (like the VA or the NHS), this would be easy. But in the U.S., it’s not.
- I worry a bit about how long immunity lasts, but also not too much. We’re now pretty confident that immunity lasts for >1 yr. If it turns out that we need a booster in 2-3 years, that'll be a small price to pay to save tens of thousands of lives and a return to normal life.
- So, yes, I do have worries. But let’s not lose sight of the fact that, on November 1st, we didn’t know for sure that we would have ANY effective vaccines. Today we have at least 2-3 highly effective ones, an impressive safety track record, and millions of doses ready to go
Distribution
Earlier, Operation Warp Speed announced that they have allocated 6.4 million doses of COVID-19 vaccines to states based on their populations. It will be up to states to follow the CDC guidelines for prioritization.
Epilogue
The vaccines are coming. There is light at the end of the tunnel. The UK already approved emergency use of the Pfizer/BioNTech vaccine today. Moderna and Oxford/Astrazeneca in UK and US should follow soon. There are more vaccines in the pipeline- J&J, Novavax, the Russian Sputnik vaccine and the Chinese vaccines (Sinopharm, Sinovac and CanSino) are all in advanced stages of testing.
We have confidence that the Biden administration will handle this with competence and professionalism, but we have to hope that the outgoing trump administration will not sabotage efforts by the CDC and health experts to get these vaccines approved, distributed according to plan and to help educate the American public about the need for everyone to get vaccinated in due time.