September 2, 2020

Here's who should get a coronavirus vaccine first, according to a key advisory group

Daily Briefing

    The National Academies of Sciences, Engineering, and Medicine (NASEM) on Tuesday released a draft plan for distributing a vaccine against the novel coronavirus in the United States. The draft plan prioritizes Americans based on their risk of infection, with health care workers among the first to receive the vaccine.

    Q&A: Ezekiel Emanuel on the path to a coronavirus vaccine

    US new coronavirus cases near 6.1M, deaths approach 185K

    The draft plan comes as U.S. officials as of Wednesday morning reported a total of 6,088,800 cases of the novel coronavirus virus since the country's epidemic began—up from 6,044,600 cases reported as of Tuesday morning.

    Data from the New York Times shows that Guam and 11 states—Alabama, Connecticut, Iowa, Kansas, Minnesota, Montana, Nebraska, North Carolina, North Dakota, South Dakota, and West Virginia—saw their average daily numbers of newly reported coronavirus cases rise over the past 14 days.

    The Times' data also shows that the average daily numbers of newly reported coronavirus cases over the past two weeks remained mostly stable in Washington, D.C., and 27 states: Arkansas, Colorado, Delaware, Hawaii, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Virginia, and Wisconsin.

    In addition, the Times' data shows that Puerto Rico; the U.S. Virgin Islands; and 12 states saw their average daily numbers of newly confirmed coronavirus cases decrease over the past 14 days: Alaska, Arizona, California, Florida, Georgia, Idaho, Louisiana, Nevada, Oregon, Texas, Washington, and Wyoming.

    U.S. officials as of Wednesday morning also had reported a total of 184,564 deaths linked to the coronavirus since the country's epidemic began—up from 183,474 deaths reported as of Tuesday morning.

    According to the Times' data, 12 states saw their average daily numbers of newly reported deaths linked to the coronavirus rise over the past 14 days: Alabama, Arkansas, Hawaii, Idaho, Iowa, Kentucky, Maryland, Missouri, Nebraska, New Mexico, Virginia, and West Virginia.

    NASEM recommends 4 phases of vaccine distribution

    As the coronavirus continues to spread throughout America and related deaths continue to rise, researchers are scrambling to develop a vaccine against the virus, with some companies already conducting late-stage trials on coronavirus vaccine candidates. Some Trump administration officials have said the United States could have an authorized coronavirus vaccine by the end of this year, though some public health experts have pushed back on those claims and said its more likely the country will have an authorized coronavirus vaccine early next year.

    Still, as the country nears the point of having a vaccine, public health experts and federal officials have begun discussing how to go about distributing the inoculation in the United States—and NASEM on Tuesday released a draft proposal for doing so.

    NASEM created the plan at the request of CDC and NIH. The proposal aims to serve as a guide for more detailed plans on how the United States should prioritize coronavirus vaccinations once a vaccine candidate is approved. For example, NASEM's proposal is intended to serve as a model for the Advisory Committee on Immunization Practices, which is an expert panel responsible for developing vaccination guidance for CDC and local, state, and tribal health authorities.

    NASEM's draft proposal outlines a four-phase distribution plan that prioritizes Americans who are at the highest risk of contracting the coronavirus or developing a severe case of Covid-19, the disease caused by the virus.

    Phase 1

    During the first distribution phase outlined in the proposal, the vaccine would be available to:

    • High-risk health care workers;
    • First responders;
    • Americans of all ages with comorbid and underlying medical conditions, including patients with heart or kidney failure and body mass indexes of 40 or higher, that place them at a higher risk of developing severe cases of Covid-19; and
    • Older adults who live in congregate or overcrowded housing, such as nursing homes and skilled nursing facilities.

    "Front line health care workers are particularly important in stemming the [coronavirus] pandemic and preventing death and severe illness," NASEM wrote in the draft plan. Further, NASEM noted, "From the beginning of the pandemic, many frontline workers have worked in environments where they have been exposed to the virus, often without adequate [personal protective equipment]."

    NASEM said the first distribution phase would make the vaccine available to about 15% of the U.S. population.

    Phase 2

    During the second distribution phase, the vaccine would be available to:

    • Older adults not included in the first phase;
    • People of all ages with underlying conditions that put them at a moderately higher risk of developing severe cases of Covid-19;
    • People living in homeless shelters, prisons, jails, and detention centers; and
    • Essential workers such as teachers and school staff.

    NASEM said the vaccine would be available to between 30% to 35% of the U.S. population under the second distribution phase.

    Phases 3 and 4

    During the third distribution phase, the vaccine would be available to children, young adults, and workers in industries "essential to the functioning of society" who are at risk of exposure to the new coronavirus. NASEM said 85% to 95% of Americans would have access to the vaccine by the end of phase three.

    And under the fourth distribution phase, the vaccine would be available to everyone who hasn't yet been vaccinated against the coronavirus.

    Federal government should compensate Americans harmed by vaccine, NASEM says

    NASEM in the draft proposal said a coronavirus vaccine that has been developed and evaluated with the use of taxpayer funds should be available to all Americans regardless of "their social and economic resources, employment, immigration, or insurance status."

    In addition, NASEM said the federal government should fully compensate people are inoculated with the vaccine and experience vaccine-related injuries. "Vaccinated individuals must be assured of compensation, especially for health care costs, for vaccine-related injuries," NASEM wrote, adding, "Failing to do so will lead to distrust and anger if and when adverse events arise."

    Trump admin says US will not join global effort to discover, distribute coronavirus vaccine

    Separately, the Trump administration on Tuesday said it does not plan to join a global effort involving the World Health Organization (WHO) that seeks to develop and distribute a coronavirus vaccine, because the administration does not want its search for a vaccine to be restricted by organizations such as WHO.

    More than 170 countries are considering participating in the Covid-19 Vaccines Global Access (COVAX) Facility, which seeks to speed up the development of a coronavirus vaccine, obtain enough doses of the vaccine for all countries, and distribute the vaccine doses to populations at the highest risk of infection.

    But Judd Deere, a spokesperson for the White House, on Tuesday said the United States won't take part in that effort.

    "The United States will continue to engage our international partners to ensure we defeat this virus, but we will not be constrained by multilateral organizations influenced by the corrupt [WHO] and China," Deere said.

    Deere's comments come after the Trump administration earlier this year withdrew the United States from WHO, effective July 6, 2021. President Trump in April accused WHO of "severely mismanaging and covering up the spread of the [new] coronavirus" (Branswell, STAT News, 9/1; Lovelace, CNBC, 9/1; Owens, "Vitals," Axios, 9/2; Wang, Inside Health Policy, 9/1 [subscription required]; Rauhala/Abutaleb, Washington Post, 9/1; Riechmann, Associated Press, 9/1; New York Times, 9/2).

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