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People who are ages 75 and older and frontline essential workers should be next in line to get a COVID-19 vaccine, a federal advisory committee to the Centers for Disease Control and Prevention determined Sunday.
Those groups follow frontline health care workers and nursing home residents, who have already begun receiving the limited supplies of vaccines available.
The CDC's Advisory Committee on Immunization Practices held a vote Sunday to determine the order of high-risk priority groups for Phase 1 of COVID-19 vaccine distribution, which encompasses the first months of vaccine distribution. Federal officials anticipate having enough doses to immunize around 100 million people in the U.S. by the end of February 2021 — around a third of the U.S. population.
"This was a really difficult decision for me, because I truly wish everyone could get the vaccine today," said Dr. Peter Szilagyi, a pediatrician at UCLA and a voting member of the panel.
Sunday's vote passed with 13 in favor and 1 against. It established the group's recommendation for the remainder of Phase 1 — Phases 1b and 1c.
The group recommended in early December that health care workers and residents of long-term care facilities be the first recipients of COVID-19 vaccines, in Phase 1a. That stage of vaccine distribution kicked off last week when the first COVID-19 vaccine shipments started arriving at large hospital systems around the country.
According to Sunday's vote, adults ages 75 and older, along with frontline workers key to societal functioning such as teachers, police officers, firefighters, prison officers, and grocery store workers, should be prioritized in Phase 1b, a stage that is expected to start in January, according to CDC estimates of vaccine availability.
In Phase 1c, which may start in February, access to COVID-19 vaccines would expand to include adults 65 and older, along with people with underlying medical conditions that put them at higher risk of getting severely ill from COVID-19, and other essential non-frontline workers including those who work in construction, waste, trucking and food service.
The group's recommendation may not align with public expectations, warned Molly Howell, immunization program manager for the North Dakota Department of Health. "We will need some very clear communication and talking points as to why frontline essential workers, who may be younger and healthier, are being vaccinated over [people ages 65 to 74] and those with multiple underlying health conditions," she said during the meeting, citing a recent poll showing public support for prioritizing seniors and immunocompromised individuals.
Group members supporting the proposal emphasized that Phases 1b and 1c are expected to proceed in rapid succession. "I know there's a tremendous amount of angst in who exactly goes into Phase 1b versus 1c," said Szilagyi. But, he added, "We are likely to pass through Phase 1b very quickly," possibly within a month.
Vaccine rollout phases are also expected to overlap. "It is not necessary to fully complete vaccination in one phase before moving to the next phase," said the CDC's Sara Oliver. She suggested that state and local health departments could decide to widen the pool of vaccine recipients if vaccine appointments for the current phase are going unfilled or if vaccine supply grows more quickly than expected.
The group's voting members and liaisons also made pleas for Congress to provide money to fund vaccine distribution. "A COVID-19 vaccination program is not just about vaccines, but about getting those vaccines to the people who need them," said Dr. Jeffrey Duchin, a health officer for Seattle and King County in Washington state, who represented county health officials at the meeting. "Operation Warp Speed has delivered Cadillac vaccines to us, but they've come with empty gas tanks and we have a long and difficult road ahead."
So far, the federal government has provided around $340 million to states and territories to help fund COVID-19 vaccine planning efforts. State health officials say they need around $8.4 billion to expedite vaccine delivery. Additional funding for vaccine distribution is included in the $900 billion COVID-19 relief package that Congress is expected to pass.
Once the advisory group's recommendations are accepted by CDC Director Robert Redfield, they are expected to be published in the CDC's "Morbidity and Mortality Weekly" later this week and will be shared as official CDC guidance.
In Phase 2 of vaccine distribution, supply is expected to expand to the point where a COVID-19 vaccine is available to anyone in the U.S. who wants one. Government officials anticipate this could begin as early as the spring.