Who will get the coronavirus vaccine as soon as it becomes available is starting to come into focus. A report released Friday breaks the U.S. population into four groups and assigns each a place in line.
Not unexpectedly, people who risk their lives to care for those suffering from COVID-19 – the “jump start” group – will have first dibs, along with police, firefighters and paramedics.
The recommendations come from a federal panel working on a fair and just vaccine allocation plan since July. The first group, called Phase 1a, includes front-line health workers, ambulance drivers, hospital and clinic cleaners and first responders — about 5% of the total U.S. population.
The National Academies of Sciences, Engineering, and Medicine was tasked with looking at the ethical questions associated with distributing a lifesaving vaccine in the midst of a pandemic. The report was requested by the National Institutes of Health and the Centers for Disease Control and Prevention.
The United States already is making millions of doses of COVID-19 vaccine before it’s even known which candidate will end up working. Even so, rationing at the beginning will be needed because it will take time to get shipping and delivery systems up and running smoothly.When a vaccine or vaccines will be ready isn’t know. It could be as soon as November but after the first of the year is most likely, scientists say.
The panel’s goal is to develop a rollout plan that maximizes the benefit to society by focusing on those at highest risk for severe illness or death from COVID-19.
“We hope these guidelines serve as the impetus for one of the most consequential peacetime efforts this country has ever seen,” said committee co-chair William Foege, emeritus distinguished professor of international health at Emory University and former CDC director.
Ultimately the decision of how coronavirus vaccine will be allocated rests on CDC’s Advisory Committee on Immunization Practices, whose guidelines will be informed in part by Friday’s report. As soon as the Food and Drug Administration authorizes a new vaccine, the advisory committee offers guidelines on how it should be distributed, to whom and when.
People in Phase 1a are critical to keeping the health care system functioning and are at high risk of exposure to sick patients. They’re also at higher risk of then transmitting the virus to others, including family members.
The second phase of vaccine distribution — Phase 1b — covers about 10% of the population. It includes people of all ages with underlying conditions like cancer, serious heart conditions, and sickle cell disease that put them at significantly higher risk of severe COVID-19 disease or death.
This group includes people with two or more chronic conditions that put them at higher risk, including kidney disease, chronic obstructive pulmonary disease, obesity or diabetes.
This phase also includes people 65 and older living in nursing homes, long-term care facilities, homeless shelters, group homes, prisons or jails.
Phase 2 covers between 30% to 35% of people in United States. It includes teachers, school staff and childcare workers and critical workers in high-risk settings who can’t avoid high-risk exposure to COVID-19, such as those working in the food supply system and public transit.
Also included are all people over 65, because they account for about 80% of all reported COVID-19 deaths.
Additionally, those who have one underlying condition that puts them at moderately higher risk, as well as people in homeless shelters or group homes and staff who work in those settings will have access to vaccine in this stage. People under 65 who are in prisons, jails, and detention centers and staffers also are included.
Phase 3 covers between 40% and 45% of the population. It includes young adults and people who work in industries such as higher education, hotels, banks, exercise facilities and factories.
Whether children are included in this group will depend if COVID-19 vaccines have been tested for safety and efficacy in younger age groups.
Finally, Phase 4 will include everyone elseresiding in the U.S. who did not have access to the vaccine in prior phases, between 5% and 15% of the population.
“In these uncertain and challenging times, the integrity of the COVID-19 vaccine development, allocation, and distribution processes will be critical to ensuring widespread access to vaccines that are safe and effective, and convincingly so for the public,” said National Academy of Medicine President Victor J. Dzau.
The committee explicitly acknowledged the virus has disproportionally hit Black, Hispanic and Native American communities due to long-standing disparities in access to health care and poverty. In addition, people in these communities often have front-line jobs they cannot do from home, putting them at higher risk for contracting COVID-19.
Because these communities face higher rates of hospitalization and death, the committee recommended special effort be made to deliver vaccine to people in high-vulnerability areas.
“At this moment there is an awakening to the power of racism, poverty, and bias in amplifying the health and economic pain and hardship imposed by this pandemic,” said committee co-chair Helene Gayle, president and CEO of the Chicago Community Trust. “We saw our work as one way to address these wrongs and do our part to work toward a new commitment to promoting health equity.”