Health care workers on the frontlines against the coronavirus and residents of long-term care facilities should get the first doses of vaccines, a Centers for Disease Control and Prevention (CDC) advisory committee decided Tuesday.
The Advisory Committee on Immunization Practices (ACIP) decision — which received 13 votes of approval and one against — will help guide Washington state forward with its plan to distribute doses to its residents, once one or more vaccines have been approved as safe and effective against the novel coronavirus.
“It’s possible doses might be available later this month,” said Dr. Jeff Duchin, health officer with Public Health – Seattle & King County, saying the committees’ vote allows state and local health agencies “move forward with planning on how to allocate the first doses.”
The state Department of Health is working to refine its interim plan to distribute vaccines, which was first published in October, and additional details are due to the CDC Friday. The pharmaceutical companies Moderna and Pfizer this month will seek emergency use authorization for their vaccines from the federal Food and Drug Administration.
About 21 million people in the United States are health care workers and about 3 million people live in skilled nursing, assisted living or other residential care facilities, according to documents presented in the committee meeting.
“We need to protect our health care providers. They’ve been putting their lives on the line for us during this outbreak,” said Duchin, who served on a work group that made recommendations on vaccine priority to the committee.
Duchin said residents of long-term care facilities represent 1% of the U.S. population, but about 6% of cases and some 40% of COVID-19 deaths.
“We know, here in King County, the devastation COVID-19 can bring to long-term care facilities,” Duchin said. Early in the pandemic here, the coronavirus ravaged facilities like the Life Care Center of Kirkland, where 39 people died in a four-week span.
The advisory committee’s decision to place health care workers at the front of the line to receive vaccines was not a surprise. More debate focused on whether residents in long-term care should receive the same priority, as committee members weighed protecting a population vulnerable to COVID-19 with vaccines that will have limited data on how they work in older populations with weaker immune systems.
But most members of the independent committee of experts decided the COVID-19 death rates in long-term care facilities made vaccinating those communities paramount.
“Ultimately, I was persuaded by the tremendous burden in terms of mortality and hospitalization for residents of facilities,” said committee member Dr. Robert Atmar, an infectious disease specialist in Houston, adding that early data provided “some hope” vaccine candidates could be effective for people in long-term care.
“We are acting now, in the way that maximizes benefits and minimizes harms at this moment,” said Dr. Beth Bell, a global health professor at the University of Washington and a committee member.
The panel’s deliberations highlighted the complex challenges state leaders will face in distributing the first doses of vaccine.
Clinical trial data suggests early vaccine candidates could cause temporary, but noticeable reactions.
“The two first in line [for approval] pack a punch,” Duchin said, adding that a reaction is an indication of effectiveness. “People are more likely to have a sore arm and have symptoms like fever and muscle aches after this vaccine than after a flu vaccine.”
The panel suggested that health care employers think closely about scheduling staffers for vaccination, should fevers, or other reactions, preclude doctors or nurses on the same unit from reporting to work.
Washington state officials last Wednesday said they expect some 200,000 doses of Pfizer’s vaccine to be delivered by year’s end, should it be approved as safe and effective.
Regular shipments will begin in January, said Michele Roberts, the state Department of Health’s acting assistant secretary, who has oversight for coronavirus vaccines. The state did not yet have an estimate for the Moderna vaccine. Both vaccines will require two doses, with several weeks in between their administration. Initially, the doses will likely be distributed to hospitals.
As of last Wednesday, 54 health providers had completed applications to administer the vaccines. More were finishing applications or awaiting approval, Roberts said.
The state’s interim vaccine-distribution plan estimated Washington had about 500,000 high-risk workers in health care settings and 33,000 residents in long-term care.
Roberts has said the federal government indicated the vaccine itself will be provided to every American at no cost, but health-care providers could charge insurers fees to administer the vaccine or for an office visit.
The state must submit to the CDC on Friday a list of health care providers who will receive a first allocation of the vaccine, according to Cory Portner, a health department spokesman.
Both Moderna and Pfizer say their vaccines are more than 94% effective and report no serious side effects.
An FDA panel and the CDC’s advisory committee will scrutinize safety and effectiveness data from the companies’ third-phase clinical trials.
Duchin said those meetings will assess whether the data is as promising as described and guide the most effective way to roll out the vaccine to other populations, such as essential workers and people with underlying health conditions and increased risk.
Duchin said it was a “relief” to have vaccines reporting such high effectiveness and no apparent safety concerns.
“It’s a speck of light at the end of this long and gnarly tunnel,” Duchin said, saying vaccines wouldn’t stop the outbreak immediately, but that they could represent “the beginning of the end.”