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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Essential Workers, Those 75 and Older next Up for COVID-19 Vaccine

By Gary Evans, Medical Writer

A Centers for Disease Control and Prevention (CDC) advisory panel has designated essential workers and those 75 years of age and older as the next priority groups to receive COVID-19 vaccine in the United States.

The move came at an emergency meeting on Dec. 20, 2020, with the Advisory Committee on Immunization Practices (ACIP) voting to continue a rationing process while vaccine stocks are insufficient. CDC recommendations are not mandatory, but represent the best ACIP consensus recommendations to state and local health officials administering the vaccines.

The Food and Drug Administration (FDA) has approved two “messenger RNA” vaccines for COVID-19, both having an efficacy of approximately 95%. At a Dec. 10, 2020 meeting, the FDA approved the use of the vaccine developed by Pfizer Inc. (NYC) and BioNTech (Mainz, DEU) in the United States for those age 16 years and older. The FDA followed at a Dec. 17 meeting with approval of a vaccine by Moderna Inc. (Cambridge, MA) for those age 18 years and older.

Given limited supplies and ongoing distribution challenges, ACIP is recommending priority groups get the vaccine based on medical and ethical models to provide the greatest societal benefit.

As an update to the recent "1a" recommendations to vaccinate healthcare workers -- including long-term care workers -- and residents of nursing homes, ACIP designated the next priority groups for immunization while vaccine supplies are limited as follows. The estimated total population in each group is listed in parentheses.

1b: persons age 75 years and older (21 million) and frontline essential workers (30 million). The latter group includes, for example, first responders, firefighters, police, teachers, food and agriculture, manufacturing, corrections workers, postal workers, public transit, and grocery store workers.

1c: persons age 65 to 74 years (32 million); persons age 16 to 64 years with high-risk medical conditions like heart disease and diabetes (110 million); and other essential workers (37 million). The latter group includes, for example, transportation, food service, construction, finance, communications, energy, media, legal, public safety engineers, and water and wastewater.

Eventually there should be adequate supplies for national vaccination, but in the interim ACIP has had some extended, tortured debates on the benefits and risks of choosing which group should be immunized before another. The panel has received some criticism for the selection of healthcare workers and long-term care residents, with some saying these groups do not sufficiently represent minority and ethnic groups at higher risk of COVID-19 infection. Others say in choosing frontline workers ahead of those aged 65 to 74, ACIP shows bias against White people that comprise the majority of that age group.

ACIP Chairman José Romero, MD, addressed this issue in a statement he read before the full committee.

“There has been disinformation and statements made to impugn and undermine the work that the ACIP has carried out over these last nine months -- specifically, over the last two months – that has caused doubt among the American public as to our motives and decisions,” he said. “It has been said that our recommendations are excluding specific racial groups. It is important that the public understands that throughout the long period of deliberations, thoughtful discussions and careful evaluation of the data, the ACIP has struggled painfully to deal with distribution of a limited resource of vaccines. Our attempt has been always to achieve equitable, ethical distribution of that resource. We have never targeted a specific ethnic nor racial group for receipt of the vaccine. All of our decisions and recommendations for the priority groups take into account the burden of disease within those groups. And within those groups, white, Caucasian individuals predominate. The statements being made and carried by various outlets undermine the careful work that we have provided, and undermine the trust of the American public in our committee. I want to emphasize again – we have never focused on any particular racial group in coming to our recommendations.”