Adults over 75, frontline essential workers should be in second Covid-19 vaccine priority group, says CDC advisory panel

An expert panel that advises the Centers for Disease Control and Prevention recommended Sunday that adults aged 75 and older, as well as frontline essential workers, be designated as the second priority group to be vaccinated against Covid-19.

The Advisory Committee on Immunization Practices also voted to recommend that the third stage of the national vaccination program should focus on adults 65 to 74, people 16 to 64 years old with high-risk medical conditions, and essential workers not included in the second phase of vaccination.

The committee defined frontline essential workers as first responders, teachers and other education workers including day care workers, food and agriculture workers, correctional facility staff, postal workers, public transit workers, and people who work in manufacturing and in grocery stores.

The vote came after hours of data presentations and debate, and pleas from members of the public to move up individual groups in the priority listing.

“I voted for this recommendation because in my opinion, it follows the evidence about the risk from coronavirus and the ethical principles that we have developed on ACIP to maximize the benefits and minimize harms, promote justice, and to minimize health inequities,” said Peter Szilagyi, a pediatrician at UCLA.

“We are trying to thread the needle here.”

Szilagyi and multiple members of the committee said the work to decide who gets priority access to Covid-19 vaccines has been agonizing. 

“This is without a doubt the hardest vote that I have taken in my 6 1/2 years on this committee,” said chair Jose Romero, secretary of health for Arkansas.

The committee voted 13 to 1 to approve the groups to be included in Phase 1b and Phase 1c of the vaccination program. Phase 1a, which is currently ongoing, gives top priority to health care workers and residents and staff of nursing homes.

The lone dissenter, Henry Bernstein, a pediatrician and professor at the Zucker School of Medicine at Hofstra/Northwell, said he felt that adults aged 65 and older should have been in Phase 1b. The toll the virus takes on people 65 to 74 is not substantially different from its impact on people 75 and older, he argued.

The ACIP recommendations now go to CDC Director Robert Redfield, who must sign off on them in order for them to become CDC guidance. However, state and local health authorities make the final decisions on how to roll out vaccination in their locales.

At the end of Sunday’s meeting it was announced that more than half a million people in the country have already been vaccinated with the Pfizer Covid-19 vaccine. Moderna’s vaccine, which was given an emergency use authorization Friday evening by the Food and Drug Administration, will begin to be rolled out this week.

The ACIP’s Covid vaccines work group, which proposed the priority groups, explained it was trying to balance the prevention of illness and death with trying to maintain societal functioning as well as equity. Frontline essential workers are in jobs where they cannot work from home; they may not even be able to practice social distancing because of the demands of their work.

Previously the committee had talked about putting all essential workers ahead of seniors — an idea which drew pushback from Health and Human Services Secretary Alex Azar, among others. 

But the entire essential workers group, which is based on a list drawn up by a division of the Department of Homeland Security, represents about 87 million people — too big a group at a time when vaccine supplies are scarce. Essential workers who will have to wait for Phase 1c for vaccine include people who maintain water and wastewater systems, people who work in the IT and communications sector, members of the media, and public safety workers.

Operation Warp Speed, the federal government’s program to fast-track vaccine production, estimates there will be enough vaccine to vaccinate 20 million people in December, another 30 million in January, and an additional 50 million by the end of February.

Phase 1a of the vaccination effort, which began last week, involves offering vaccine to 24 million people. In Phase 1b, 49 million people will be eligible to receive vaccine. Phase 1c is a much larger group, including roughly 129 million people. In total, the first three priority groups will cover 202 million people — double the number of people the country expects to have vaccine for by the end of February.

Many members of the committee stressed that more funding for vaccination work needs to flow to the states from the federal government. Groups like the Association of Immunization Managers have estimated that the vaccine rollout will cost upward of $8 billion, but states have received less than a half a billion dollars for the work so far.

“Today, state and local public health departments are on life support. We’re hamstrung and stymied by the lack of necessary federal funding to allow us to take advantage of these newly available vaccines,” said Jeffrey Duchin, a nonvoting member of the committee representing the Infectious Diseases Society of America.

“Operation Warp Speed has delivered two Cadillac vaccines to us,’’ he said. “But they’ve come with empty gas tanks and we have a long and difficult road ahead of us.”

This story has been updated with more detail from Sunday’s meeting.