Who will be first in line to get Covid-19 vaccine in the US once it's ready? The answer is not clear yet

CDC’s preliminary plan says 12 million of the most critical health, national security, and other essential workers should be vaccinated first


                            Who will be first in line to get Covid-19 vaccine in the US once it's ready? The answer is not clear yet
(Getty Images)

Scientists in the US and across the world are racing to find a vaccine for Covid-19 which has affected millions of people. A parallel effort has started in the US to figure out who should first get the vaccine, if and when it is ready. This is because there will not be enough vaccines for the first several months and this implies that there will be rationing. The decision is complex and challenging and several experts are now debating the same to make hard choices about who goes to the front of the line.

A preliminary plan by the US Centers for Disease Control and Prevention (CDC) gives priority to the most critical healthcare workers and other essential workers, then to people with underlying medical conditions and older people. The CDC is yet to decide whether the next in line should be Blacks and Latinos, groups that have been disproportionately affected by the coronavirus pandemic. Traditionally, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommends who should get vaccines. The agency’s initial plan is said to have been borrowed from ACIP’s guidelines on allocating and targeting pandemic flu vaccine during an influenza pandemic.

“The CDC’s opening suggestion: First vaccinate 12 million of the most critical health, national security, and other essential workers. Next would be 110 million people at high risk from the coronavirus — those over 65 who live in long-term care facilities, or those of any age who are in poor health — or who also are deemed essential workers. The general population (of over 200 million) would come later,” reports The Associated Press (AP). It is unclear at the moment who the most critical or essential workers are.

In response to a request from the National Institutes of Health (NIH) and the CDC, the National Academies of Sciences, Engineering, and Medicine and the National Academy of Medicine (NAM) have formed a committee that will develop a framework to assist policymakers in the US and global health communities in planning for an equitable allocation of vaccines against Covid-19. “While there has been a worldwide effort to accelerate the development of safe and effective SARS-CoV-2 vaccines, there will inevitably be limited doses available for the first several months. We are pleased to be able to mobilize expertise quickly to respond to the government’s request for an independent study of priority-setting for the equitable allocation of potential vaccines for SARS-CoV-2,” said NAM President Victor J Dzau. 

As part of the study, the committee is considering what criteria should be used to set priorities for equitable distribution among groups of potential vaccine recipients, taking into account factors such as population health disparities, individuals at higher risk because of health status, occupation, or living conditions; and geographic distribution of active virus spread. Besides, the committee will also consider how communities of color can be assured access to Covid-19 vaccines in the US and recommend strategies to mitigate vaccine hesitancy among the American public. “Setting priorities will require creative, moral common sense,” Bill Foege, who devised the vaccination strategy that led to global eradication of smallpox, told AP. Foege, who is co-chairing the committee, called it both an opportunity and a burden.

A committee in the US is considering what criteria should be used to set priorities for equitable distribution among groups of potential vaccine recipients (Getty Images)

To incorporate feedback from the public and stakeholder groups, the committee will produce a discussion draft of its report for public comment and hold a public workshop to discuss its recommendations later this summer. The final version of the report is expected to be released early this fall. CDC Director Robert Redfield said that it was important for Americans to see vaccine allocation as “equitable, fair, and transparent.” 

“Not everybody’s going to like the answer. There will be many people who feel that they should have been at the top of the list,” Dr Francis Collins, director of the National Institutes of Health, recently told one of the advisory groups the government has asked to help decide.

There is also Operation Warp Speed, created by the Trump Administration, which aims to deliver 300 million doses of a safe, effective vaccine for Covid-19 by January 2021. This is said to be part of a broader strategy to accelerate the development, manufacturing, and distribution of coronavirus vaccines, therapeutics, and diagnostics, collectively known as countermeasures.

Public health experts are expressing concern and confusion with so many players in the mix. “It seems to me like we’ve just assigned four different air traffic control towers to land the same plane. Between ACIP, and this new committee, the group working within Operation Warp Speed and just in terms of input from the general community, it’s not clear to me who will make the final decision and how that process will unfold,” Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy told Stat.

The World Health Organization (WHO), meanwhile, has also proposed a “global allocation framework” for fair and equitable allocation mechanisms. The priority population includes healthcare system workers constituting 1% of the global population (about 50 million global population, 115 million doses needed to vaccinate), adults who are older than 65 years and account for 8% of the population (about 650 million, approximately 1,500 million doses needed to vaccinate), and other high-risk adults (with comorbidities) constituting 15% of the population. The last group comprises 1,150 million people globally and 2,650 million doses will be needed to vaccinate them, according to the WHO estimates.

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