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By Gary Evans, Medical Writer
Healthcare workers have been designated as the highest priority group to receive the first safe and effective SARS-CoV-2 (COVID-19) vaccine that is cleared for use in the United States, according to recent discussions and materials reviewed in a non-voting meeting of top immunization advisors to the Centers for Disease Control and Prevention (CDC).
Facing a dearth of data that await clarification in a host of clinical trials, the CDC’s Advisory Committee on Immunization Practices (ACIP) used an ethical framework to make what one member described as a series of Solomonic decisions at a meeting on Sep. 22, 2020.
“When and if a safe and effective COVID-19 vaccine is approved by the Food and Drug Administration, healthcare workers would be tier one recipients,” ACIP recommended. “This group includes some 20 million people who work in hospitals, long-term care facilities, assisted living facilities, skilled nursing facilities, outpatient settings, home healthcare, pharmacies, EMS, public health and other groups.”
After healthcare workers, the subsequent 1B priority groups for COVID-19 vaccination were open to further refinement, but the order described at the meeting placed non-healthcare essential service workers next, followed by people with high-risk medical conditions, and those older than 65 years of age.
Some ethical models for pandemic vaccine uptake have broken out frontline medical workers, but ACIP argued for a broader immunization strategy throughout healthcare. The ACIP healthcare category includes those not directly involved in patient care but potentially exposed to infectious agents while working in a healthcare setting. Healthcare workers drew “1A” status, akin to the old military services draft, but the tone of discussions clearly suggested broad reticence to making such a newly developed vaccine compulsory. Indeed, there was an undercurrent of skepticism about whether healthcare workers would be immunized voluntarily unless safety and efficacy truly can be assured.
In comments before the meeting, William Schaffner, MD, ACIP liaison member for the National Foundation of Infectious Diseases and professor of preventive medicine at Vanderbilt University, told Hospital Employee Health that there is distrust of the vaccine process even in healthcare.
“There is a lot of skepticism in the medical community, and I don’t just mean doctors — I mean nurses and other staff — about the process whereby vaccines will be evaluated both for effectiveness and safety,” says Schaffner.
The politicization of the pandemic threatens to undermine the response even if a safe and effective vaccine is developed.
“I’ve had exchanges with people through email and phone, and virtually everyone around the country is saying, ‘we are seeing medical colleagues express both annoyance and real skepticism about the vaccine evaluation process,’” Schaffner says. “Even among healthcare workers, we are going to have to do an awful lot of education to provide data and reassurance in order for them to take the vaccine."