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December 21, 2020

Who's next in line for a coronavirus vaccine? Here's what a key CDC panel says.

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    On Sunday, the Advisory Committee on Immunization Practices (ACIP), which is a panel of outside experts that advises CDC on vaccines, made its recommendations on which Americans should be next in line to get available doses of authorized coronavirus vaccines. However, there are still many steps in the distribution process that could determine how the vaccines are allocated.

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    ACIP recommends which Americans should be next in line for coronavirus vaccines

    Earlier this year, ACIP recommended that health care workers and residents and staff of long-term care facilities should be the first group of Americans to receive authorized vaccines against the novel coronavirus. Those two groups of Americans, who together represent nearly 24 million people, are at high risk for contracting the virus.

    However, ACIP at that time did not recommend which Americans should be in the next priority group for receiving an authorized vaccine. The group said it would wait until FDA authorized a coronavirus vaccine and more robust data from late-stage clinical trials on vaccine candidates became available.

    Over the past two weeks, FDA has authorized two vaccines against the novel coronavirus: one developed by Pfizer and BioNTech, and another developed by Moderna. The federal government quickly began distributing those vaccines, and health care organizations have been administering the vaccines to staff, as well as residents of long-term care facilities. CDC on Sunday said slightly more than 500,000 Americans had received their first doses of an authorized vaccine against the coronavirus.

    Amid the first round of U.S. vaccinations, ACIP on Sunday voted 13-1 to recommend that people ages 75 and older and frontline essential workers should be the next two groups of Americans eligible to receive authorized coronavirus vaccines. According to ACIP, there are about 50 million people in that group, which could include agriculture workers; first responders; grocery store workers; manufacturers; postal workers; correctional facility personnel; public transit staff; teachers and other education workers, such as day care workers; and other frontline essential workers.

    ACIP's recommendation also detailed the group's suggestions for prioritizing who should receive the vaccines after people ages 74 and older and frontline essential workers. According to the panel, the next Americans who should be eligible for authorized coronavirus vaccines, in order of recommended priority, are:

    • People older than 64, people ages 16 and older with medical conditions that place them at comparatively higher risk of dying from Covid-19, and essential workers who are not considered frontline; and
    • All other people ages 16 and older.

    According to Inside Health Policy, that first group consists of about 129 million people and could include essential workers who aren't considered frontline, but who work in industries such as construction, energy, engineering, finance, food services, information technology and communication, legal, logistics and transportation, media, and water and wastewater.

    What experts are saying about the recommendations

    Peter Szilagyi, a pediatrician at UCLA and a member of ACIP, said he "voted for this recommendation because in [his] opinion, it follows the evidence about the risk from coronavirus and the ethical principles that we have developed on ACIP to maximize the benefits and minimize harms, promote justice, and to minimize health inequities." He added, "We are trying to thread the needle here."

    Helen Talbot, a member of the panel and an infectious-disease specialist at Vanderbilt University, said, "I feel very strongly we do need to have that balance of saving lives and keeping our infrastructure in place."

    However, ACIP member Henry Bernstein, a pediatrician and professor at the Zucker School of Medicine at Hofstra/Northwell who was the only panelist to vote against the recommendations, said he did so because he believed people ages 65 and older should be included in the next priority group of eligible Americans. According to STAT News, Bernstein said data has shown that the effects of Covid-19 among people ages 65 to 74 are not very different than the disease's effects among people ages 75 and older.

    What happens next—and why ACIP's recommendation isn't set in stone.

    Now that ACIP has finalized its suggestions, CDC Director Robert Redfield will review the recommendations and ultimately decide whether to approve them. If Redfield approves the recommendations, CDC will use the recommendations to issue guidance on who should get priority access to authorized coronavirus vaccines in America. That guidance will be intended to help states determine their vaccination distribution plans, though states are not required to follow the guidance.

    According to Inside Health Policy, ACIP recognized that, because America has limited doses of authorized vaccines against the coronavirus, states and localities may need to sub-prioritize groups of essential workers. If so, states and localities should consider where coronavirus transmission rates are highest and which workers are at the highest risk of developing severe cases of Covid-19, based on worker demographics.

    Currently, U.S. officials project the country will have enough doses of authorized coronavirus vaccines to inoculate about 100 million people by the end of February, which is about half of the 202 million people who would be covered in the first three priority groups recommended by ACIP, STAT News reports.

    "What we are providing governors and health officials with is a framework which is supported by evidence and will address this limited supply of vaccine that we have at this time," Jose Romero, ACIP chair and a pediatric infectious disease specialist, said.

    CDC releases guidelines on coronavirus vaccines and allergic reactions

    Separately, CDC on Saturday said the federal government is monitoring reports of a few people who experienced allergic reactions after receiving an authorized vaccine against the novel coronavirus, and the agency released guidance on how people with histories of allergic reactions should proceed when it comes to getting vaccinated.

    In the guidance, CDC said anyone who experienced a severe allergic reaction—meaning they required treatment with epinephrine or hospital care—after receiving a first dose of an authorized coronavirus vaccine should not get the second dose of the vaccine. In addition, CDC advised that people who've had severe allergic reactions to any of the ingredients contained in an authorized vaccine should avoid that vaccine, and instead consider getting an authorized coronavirus vaccine that does not contain those ingredients. Further, CDC recommended that individuals who've had severe allergic reactions to other vaccines in the past should consult with their health care provider before receiving an authorized coronavirus vaccine.

    According to CDC, people with histories of severe allergic reactions to animals, food, environmental allergens, latex, and oral medications should receive an authorized coronavirus vaccine.

    America's surging coronavirus epidemic

    The developments come as America's coronavirus epidemic has continued to surge to new heights. On Friday, the country reported another record-high number of new cases of the novel coronavirus, with more than 251,000 new cases reported in a single day.

    According to data compiled by the Times, U.S. officials as of Monday morning had reported a total of about 17.8 million cases of the virus since America's epidemic began—up from about 17.2 million cases reported as of Friday morning.

    According to the Times, the United States' average daily number of newly reported coronavirus cases over the past week was 216,070—which is up by 10% when compared with the average from two weeks ago.

    As of Monday morning, data from the Times showed that the rates of newly reported coronavirus cases were "staying high" in Puerto Rico; the U.S. Virgin Islands; Washington, D.C.; and 32 states that have had a daily average of at least 15 newly reported cases per 100,000 people over the past week. Those states are Alabama, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Maryland, Massachusetts, Mississippi, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Virginia, Washington, and West Virginia.

    Meanwhile, the Times' data showed that, as of Monday morning, the daily average number of newly reported cases over the past seven days was "going down" in 17 states that had been seeing comparatively higher rates of coronavirus transmission. Those states are Alaska, Colorado, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Missouri, Montana, Nebraska, New Mexico, North Dakota, South Dakota, Utah, Wisconsin, and Wyoming.

    Hawaii has had comparatively low case rates, but it was seeing those rates "going up" as of Monday morning, according to the Times. In Guam, meanwhile, rates of newly reported coronavirus cases were "staying low" as of Monday morning, the Times' data showed.

    U.S. hospitalizations for Covid-19 also have remained high, according to data from The Atlantic's COVID Tracking Project. The data showed that 113,663 Americans with Covid-19 were hospitalized for treatment on Friday, including 21,761 who were receiving care in an ICU and 7,695 who were on a ventilator.

    As of Monday morning, U.S. officials had reported a total of about 317,800 U.S. deaths linked to the virus since the country's epidemic began, up from about 310,935 deaths reported as of Friday morning.

    (Cohen/Wilkerson, Inside Health Policy, 12/20 [subscription required]; Branswell, STAT News, 12/20; Goodnough/Hoffman, New York Times, 12/21; Singh, Reuters, 12/19; Williams, The Hill, 12/19; DePasquale, New York Times, 12/21; New York Times, 12/21; "The COVID Tracking Project," The Atlantic, accessed 12/21).

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