A vaccine could be available in a matter of weeks—but it won't be distributed on a first-come, first-served basis.

By Claire Gillespie
December 03, 2020
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A COVID-19 vaccine could be available in the US in a matter of weeks, pending emergency approval from the Food and Drug Administration (FDA). But it won't be rolled out to everybody at once. On Tuesday, the Advisory Committee on Immunization Practices (ACIP), an independent committee advising the Centers for Disease Control and Prevention (CDC), voted overwhelmingly (13 to 1) in favor of making health care workers and residents and staff of long-term care facilities the top priority, known as Phase 1a.

It's positive news, of course, as the two vaccine front-runners developed by Pfizer and Moderna go through the federal approval process. But you may still have questions on why the ACIP came to this conclusion about vaccine priority and distribution, and how these plans will start to unfold. Here's what you need to know.

Why are health care workers and residents of long-term care facilities first on the list?

"Health care workers and the residents of long-term care facilities are logical choices, widely supported as the right place to start while supplies of a COVID-19 vaccine are limited," Richard Seidman, MD, MPH, chief medical officer at L.A. Care Health Plan, the largest publicly operated health plan in the country, tells Health.

As Dr. Seidman points out, the ACIP's goals for the prioritization of COVID-19 vaccine included decreasing deaths and serious disease as much as possible and preserving the functioning of society. "The committee also established ethical principles including maximizing benefits and minimizing harm," he says. "We all rely upon health care workers to be available to provide care for us when we need them. Our health care workforce is being stretched very thin as cases and hospitalizations are increasing to the highest levels seen since the beginning of the pandemic in many parts of the country."

Nikki Mulligan, PharmD, infectious disease pharmacist for Riverside University Health System in California, compares the prioritizing health care workers for COVID-19 vaccination to being on an airplane and putting your oxygen mask on before helping your neighbor or child with theirs.

"Keeping health care providers healthy and able to come into the hospital day after day ensures that the community's sickest and most vulnerable patients have the necessary resource of nurses, physicians, pharmacists, and the many supporting roles that keep our health care system running," Mulligan tells Health. "This means ensuring that there are enough nurses on our hospital's COVID-19 units to check vitals, give medications, monitor for acute changes, and make patients as comfortable as possible. The security of COVID-19 vaccination also eases the mental toll on our health care providers that perform high risk procedures or must staff COVID-19 units for 12-hour shifts in our COVID-19 units. Health care workers are a vulnerable population to COVID-19 simply due to COVID-19 exposure every day they show up to work."

Regarding residents of long-term care facilities specifically, Dr. Seidman says the numbers speak for themselves, pointing out that they've been particularly hard hit by the pandemic. "They account for less than 10 percent of known cases but more than 40 percent all deaths due to COVID-19," he says.

"Protecting those in the community at highest risk of severe COVID-19 consequences is equitable and representative of our values as a community," Mulligan says. "For a disease that has disproportionately impacted our elderly and those with chronic diseases, prioritization of these community members for vaccine distribution is an admirable attempt to address these disparities."

Will the COVID-19 vaccine be mandatory for these groups?

We still don't know. "There are good arguments for and against mandating COVID vaccination once it is available," Dr. Seidman says. "I think it's more likely that employers of health care workers will mandate COVID vaccination, just as many mandate the flu vaccine, while allowing for requests for exemptions to the mandate, or accommodations like being required to wear a mask."

Dr. Seidman thinks it's less likely that all residents of long-term care facilities will be mandated to be vaccinated. "Even if mandated, patients and families can refuse to be vaccinated, making the alternative approach of strongly recommending, encouraging and incentivizing immunization worth consideration," he explains.

Mulligan says that Riverside University Health System as an institution will not mandate vaccination for health care workers or members of the community based on ethical grounds. But given the available information regarding the risks and benefits of COVID-19 vaccination, she highly recommends vaccinating when you are offered an immunization. "Regardless of your own risk of severe COVID-19 disease, stopping the rapid spread of COVID-19 through our community by vaccinating is essential to protect the vulnerable and allow our communities to recover," she adds.

So, what happens now?

The ACIP recommendation has been adopted by CDC director Robert Redfield, which means the next step is the issue of emergency use authorizations (EUAs), which may happen by mid-December, per BioCentury. As soon as an EUA is issued, vaccine shipments could start within 24 hours. According to Sara Oliver, an epidemic intelligence service officer at the CDC, the agency expects about 40 million vaccine doses to be available in the US by the end of December—that's enough to vaccinate 20 million people.

It's important to note that, even with the ACIP and CDC recommendations, individual states are not required to follow those strategies, though they oftentimes do. "I expect the states to largely align their policies with the national recommendations, but will also exercise their ability to modify them to best meet the needs and priorities in their states, as they see them," Dr. Seidman says.

Mulligan agrees that while there will be some level of guidance from a national level, individual states and their governors will likely enact a COVID-19 vaccine response that best matches their needs, capabilities, and communities. "These may be looser or more far-reaching than national recommendations," she adds.

After the EUA is issued, it's expected that the committee will meet again to discuss the next stages of vaccine allocation. The CDC has proposed Phase Ib to include essential workers (such as law enforcement, teachers, firefighters, and corrections officers) and Phase Ic to include adults age 65 and older, plus adults with high-risk medical conditions.

The BioNTech vaccine, which was made in the US and funded by Pfizer, has already been approved in the UK. The FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC), a panel of independent experts, will meet on Dec. 10 to review Pfizer's data and make a recommendation to the FDA about whether to authorize the vaccine in the US, reports CNN. The following week, VRBPAC will consider another US-developed vaccine, which was funded by Moderna.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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