Discussions have begun to identify priority groups for primary vaccination against covid-19, a disease caused by the virus. These discussions, which were attended by federal health officials and external experts, are based on planning developed during the 2009 H1N1 flu pandemic. The highest priority will be given to healthcare workers and emergency workers and the high-risk population. This proposed group will also include adults, residents of long-term care facilities and people with basic medical conditions.
As officials and experts compete to end the pandemic, they face the threatening nature of setting vaccination priorities. Clinical trials of at least two experimental vaccines have shown encouraging results, and this week we moved on to final-stage testing for safety and efficacy in 30,000 participants. U.S. officials have said that if the vaccine proves effective, the first doses may be available by the end of the year.
Experts believe that the decision will take place over the next few months and will probably be controversial. Officials and experts need to address a range of issues, including the extent to which race and ethnicity should be addressed due to the disproportionate influence of covid-19 on colored communities. Apart from doctors and nurses, will the staff of cafeterias and cleaners in hospitals be considered necessary staff? What about teachers who continue to work in schools so that parents and others can return to work?
“It’s going to be controversial, and not everyone likes the answer,” said Francis Collins, director of the National Institutes of Health, referring to the prioritization process. He spoke last week at a meeting of a committee of experts that helps plan. “There will be a lot of people who think they should have been at the top of the list, and not everyone can be.”
This committee of experts is developing a framework to assist the Federal Advisory Commission and the CDC in setting final vaccination priorities. Experts are from an independent advisory group, the National Academies of Sciences, Engineering and Medicine and the National Academy of Medicine. The board, which should have the initial draft ready by the end of August and the final version by the end of September, was formed at the request of the NIH and CDC directors.
The overview of the proposed priority groups, outlined by the Federal Advisory Board, includes subsets within those that should be most attentive. At the top of the list: An estimated 12 million critical health workers and other workers. The first doses fall into the subset described as “high-risk medical personnel, national security and other necessary personnel” required to protect health infrastructure and important public functions, according to presentations and discussions at the June meeting of the Advisory Committee on Immunization Practices. .
But what we are talking about is beyond the scope of the first shots. The process of prioritizing is a chance for health professionals and scientists to adjust their sometimes unrealistic expectations about when the vaccine is likely to be available.
It is also an opportunity to restore public confidence in government and institutions at a time when “there is a deep feeling that people feel they are not protected by the people and institutions that should protect them,” said Monica Shoch-Spana, a medical anthropologist at the Health Center. John Hopkins. She led a working group that recently released a report on vaccinations against 19-year-olds.
“We have a socially, politically and racially fragmented society that is under the stress of a disease that causes illness and death. And we saw the unevenness – I’m polite – the answer to that, “said Shoch-Span.” If once the public’s perception of justice and fairness was important, it would be now. “
Top federal officials need to make sure the public hears a clear and consistent message and show that the government is capable of keeping its promises, Shoh Span said. During the 2009 H1N1 pandemic, when demand was high, forecasts of vaccine supply during the second wave of the disease were overly optimistic. At the time of receipt of adequate supply of vaccine demand fell.
In addition to key workers and those most affected by health inequalities, Collins said the list of priorities should include the military and the areas where the virus is most active. He said the committee should consider giving preference to volunteers in clinical trials for the vaccine who received a placebo instead of a dose of the vaccine.
“I think we probably owe them, as a result of their participation in the trial, some special priority for access to the vaccine, if that’s successful,” Collins said.
A meeting of the CDC’s Immunization Advisory Committee on Wednesday discussed the priority groups that focused on key staff, including medical staff. At its next meeting in August, the committee plans to review other high-risk groups, including people in long-term care facilities.
According to Sarah Mbaye, of the Medical Service of the National Center for Immunoprophylaxis and Respiratory Diseases, workers with the highest risk of exposure to infectious diseases are divided into six categories:
· Health care (home and medical staff)
· Practitioners (doctors, dentists, nurses and pharmacists)
· Security service (police officers and firefighters)
· Personal hygiene and service (child care workers, hairdressers and fitness trainers)
· Community support (social workers, internships and health workers)
· Education, training and library (teachers and librarians K-12)
People with color are more likely to work in jobs that are considered important or at increased risk of disease, she said.
It also provided more detailed information on the risks faced by medical staff. The CDC uses a broad definition that includes people who are not directly involved in patient care: office, diet, environmental services, laundry, security, maintenance, engineering services management, administrative accounts, and volunteer staff.
Citing a recent study of the severity of severe covi-19 illness among medical staff, Mbay said 39 percent were at high risk or over 65 years old. Those who work in ancillary roles, such as paramedics or home health assistants or others with a bachelor’s degree, have the highest baseline performance. These groups in general, she said, also have a higher proportion of workers who are African American, Latin, uninsured or have lower incomes.
One committee member, Paul Hunter, an associate professor of family medicine at the University of Wisconsin School of Medicine and Public Health, suggested this summary: “If I looked at the data correctly, if you are middle-aged to a senior African-American paramedic with diabetes and hypertension, I think you on the first list to get vaccinated. ”
Consideration of race or ethnicity as criteria for vaccine priority has provoked considerable debate.
During a June meeting, Jose Romero, a pediatric infectious disease specialist at the Arkansas Children’s Research Institute who heads the CDC’s immunization commission, spoke about the Black, Latin, and Native American communities that have been severely affected by the coronavirus. According to the latest CDC report, the death toll in 19 years is twice as high among people under the age of 65 as among white Americans.
“If we fail to view this issue of racial and ethnic groups as a high priority risk, anything that comes out of our group will be perceived very suspiciously and with a lot of reservations,” he said.
Another committee member, Sharon Frey, an infectious disease specialist at the University of St. Louis Medical School, agreed that it was important to include racial and ethnic groups in the high-priority group. We should consider the urban poor and the working poor, who often have other basic medical conditions, live in crowded homes and are unable to rent jobs, “because they need to bring money home to feed their families,” Frey said.
Nancy Messonier, director of the CDC’s National Center for Immunoprophylaxis and Respiratory Diseases, said Wednesday that racial and ethnic differences have long existed in the routine provision of immunizations for adults, with significantly lower vaccination rates among blacks and Latinos.
“Today’s social situation is likely to exacerbate the problems associated with this lower vaccine coverage,” she said. “As we begin to plan for covid immunization, we need to remember that this is the starting point, and we need to take seriously that we need new and more robust strategies to increase vaccine uptake when it becomes available.”