ACIP: Prioritize Health Care Personnel, LTC Residents for COVID-19 Vaccination

With a decision by the FDA on whether to authorize the use of 2 coronavirus disease 2019 (COVID-19) candidates expected in the coming weeks, the CDC’s Advisory Committee on Immunization Practices (ACIP) COVID-19 Vaccines Work Group met on December 1 to discuss the phased allocation of future vaccines to priority groups.

The meeting, led by Kathleen Dooling, MD, MPH, and Sara Oliver, MD, MSPH, covered interim guidance for first-phase vaccination efforts and clinical considerations for first-phase population groups.^1,2

Based on current number of confirmed COVID-19 cases in the United States, the committee recommends prioritizing health care personnel (HCP) and long-term care facility (LTCF) residents as the first priority group to receive the vaccine, according to Dooley. The committee also factored ethical and scientific considerations into its recommendation. The work group proposed an interim phase 1 sequence, which includes HCP and LTCF residents first – phase 1a – followed by essential workers and adults with high-risk medical conditions and those over the age of 65. The proposed HCP to receive priority vaccination include those in hospitals, LTCFs, outpatient clinics, home health care, pharmacies, emergency medical services, and public health, according to ACIP.¹

As of December 2, at least 247,000 confirmed COVID-19 cases have been reported among HCP, with 864 deaths.3 Additionally, the presentation pointed to data showing that LTCF residents and staff are disproportionately affected by COVID-19, accounting for 6% of cases and 40% of deaths in the US.¹

“This represents interim guidance for Phase 1a– allocation policy will need to be dynamic and adapt as new information such as vaccine performance and supply and demand become clear,” according the presentation.¹

Dr Oliver discussed clinical considerations for first-phase groups who will receive the vaccine, including sub-prioritization, reactogenicity, and considerations for implementation. Because initial doses for any COVID-19 vaccine will be limited, “we expect a constrained supply environment for some months and need to make the best use of available vaccine,” Oliver reported.² 

According to the presentation, areas of sub-prioritization for HCP should include individuals with direct patient contact who are unable to telework, personnel working in residential care or LTCFs, and personnel without known infection in the previous 90 days. The committee also indicated the need for considerations for HCP who are pregnant or breastfeeding, as data demonstrate potentially increased risks of maternal illness and preterm birth due to COVID-19. However, there is no current data on use of mRNA vaccines in pregnant/breastfeeding women. The committee is awaiting FDA review and assessment before issuing further guidance around the use of COVID-19 vaccines in this population.² 

Regarding implementation, the committee recommends:²

• Ensuring vaccine access to HCP who are not affiliated with hospitals.
• Staggering vaccination of personnel from similar units or positions.
• Planning for personnel to have time away from clinical care if HCP experience systemic symptoms post-vaccination.

Measures to stop the possible spread of COVID-19, such as masks and social distancing, will still be necessary.

References:

1. Dooling K. Phased Allocation of COVID-19 Vaccines. ACIP Meeting. December 1, 2020. Accessed December 2, 2020. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/COVID-02-Dooling.pdf
2. Oliver S. Clinical Considerations for Populations Included in Phase 1a. ACIP Meeting. December 1, 2020. Accessed December 2, 2020. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/COVID-03-Oliver.pdf
3. CDC COVID Data Tracker. CDC. Updated December 2, 2020. Accessed December 2, 2020. https://covid.cdc.gov/covid-data-tracker/#health-care-personnel