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Covid-19 vaccines may not be recommended for children initially and there could be limited supply at first: CDC

Once a vaccine is authorized or approved, 5% of the US population will be covered initially and this includes frontline health workers and first responders
(Getty Images)
(Getty Images)

There is a possibility of one or more Covid-19 vaccines becoming available before the end of the year, according to the US Centers for Disease Control and Prevention (CDC). But once they become available, they may not be initially recommended for children, suggests the agency. "At first, Covid-19 vaccines may not be recommended for children. In early clinical trials for various Covid-19 vaccines, only non-pregnant adults participated. However, clinical trials continue to expand those recruited to participate. The groups recommended to receive the vaccines could change in the future," says the agency.

The CDC also informed that there may be a limited supply of coronavirus vaccines before the end of 2020, but that supply will continually increase in the months that follow. If there is a limited supply, some groups may be recommended to get a Covid-19 vaccine first, it says. Currently, no vaccine has been authorized or approved against Covid-19.

"The goal is for everyone to be able to easily get a Covid-19 vaccine as soon as large quantities are available. The plan is to have several thousand vaccination providers available so no one will have to travel far to be vaccinated, whether it’s at your doctor’s office, retail pharmacy, hospital, or federally qualified health center," explains the CDC. It adds, "Experts are working on how to distribute these limited vaccines in a fair, ethical, and transparent way. The National Academies of Sciences, Engineering, and Medicine (NASEM) gave input to the Advisory Committee on Immunization Practices, which will make recommendations to the CDC director once a vaccine(s) is authorized or approved for use."

Rollout in phases, suggest national academies

The NASEM, meanwhile, has recommended that coronavirus vaccines should be rolled out in four phases, with initial supply going to frontline health workers and first responders. Accordingly, “phase 1a” will cover approximately 5% of the population and includes frontline health workers (in hospitals, nursing homes, or providing home care), workers who provide healthcare facility services such as transportation and environmental services who also risk exposure to bodily fluids or aerosols, and first responders. "This group has a critical role in maintaining healthcare system functionality, high risk of exposure to patients exhibiting symptoms of Covid-19, and a higher risk of then transmitting the virus to others, including family members,” explains the final report.

The committee was formed in July in response to a request to the National Academy of Medicine from the National Institutes of Health and the CDC. Within each of the phases, the authors call for prioritizing people of color — specifically Black, Hispanic or Latinx, American Indian and Alaska Native, and Native Hawaiian and Pacific Islanders — who have been disproportionately affected by coronavirus.

Frontline health workers, workers who provide healthcare facility services, and first responders have a critical role in maintaining health care system functionality, high risk of exposure to patients exhibiting symptoms of Covid-19, and a higher risk of then transmitting the virus to others (Getty images)

“Despite the committee’s intense effort, this framework should still be regarded as an evolving document — meant to be adapted and refined in the face of continuing improvement in our understanding of the dynamics of the pandemic," explains committee co-chair William H Foege, emeritus distinguished professor of international health at Emory University and former CDC director. 

Phase 1b covers about 10% of the population and includes people of all ages with comorbid and underlying conditions — such as cancer, serious heart conditions, and sickle cell disease — that put them at significantly higher risk of severe coronavirus disease or death. Based on data from the Covid-19 Associated Hospitalization Surveillance Network, adults with two or more comorbid conditions make up the large majority of those hospitalized for Covid-19 in the US. Older adults (age 65 and over) living in congregate or overcrowded settings, including nursing homes, long-term care facilities, homeless shelters, group homes, prisons or jails are also included in this phase. According to the experts, this group faces the joint risk factors of severe disease and reduced resilience associated with advanced age and of acquisition and transmission due to their living settings, in which they have limited opportunity to follow public health measures such as maintaining physical distance.

The report indicates that phase 2 covers approximately 30-35% of the population and includes K-12 teachers and school staff — including administrators, environmental services and maintenance workers, and bus drivers — and child care workers, who play a vital role in children’s education and development. Also included are critical workers in high-risk settings who cannot avoid a high risk of exposure to Covid-19, such as workers in the food supply system and public transit. 

According to the NASEM report, phase 2 can cover approximately 30-35% of the population and includes K-12 teachers and school staff, and child care workers, who play a vital role in children’s education and development (Getty Images)

The second phase also covers people of all ages with comorbid and underlying conditions that put them at moderately higher risk, defined as having one of the conditions listed by the CDC as being associated with increased risk of severe coronavirus, and potentially some rare diseases as well. Others included are people in homeless shelters or group homes for people with disabilities and those in recovery, as well as the staff who work in those settings, as many of the individuals in this group have chronic healthcare needs and challenging living settings that increase potential exposure, suggest scientists. “In addition to people in prisons, jails, and detention centers and staff working in those settings, all older adults not included in phase 1 should be included in phase 2, as adults age 65 and older account for approximately 80% of reported deaths related to Covid-19,” says the analysis.

Phase 3 has approximately 40-45% of the population and includes young adults, children and workers in industries such as colleges and universities, hotels, banks, exercise facilities and factories that are both important to the functioning of society and pose a moderately high risk of exposure because there are likely to be some protective measures implemented in these work settings.

“Young adults between the ages of 18 and 30 typically have broader social networks than older adults, increasing their risks of infection and transmission, but they are less likely to become severely ill or die due to Covid-19, making them, along with children, targets for transmission prevention. Broad immunization of children will depend on whether Covid-19 vaccines have been adequately tested for safety and efficacy in these age groups,” writes the team.

In phase 4, everyone residing in the US who did not have access to the vaccine in prior phases will be covered. “There are many uncertainties affecting Covid-19 vaccine allocation, such as number and timing of available vaccine doses, number of available vaccine types, vaccine efficacy and safety, vaccine uptake, and vaccine distribution and administration. This report offers a framework for equitable allocation of Covid-19 vaccine. While vaccine distribution is an essential part of the pandemic response, other efforts such as social distancing, testing, diagnostic testing, contact tracing, and wearing masks will continue to be vital, especially during the early phases of vaccination,” recommend the national academies.