- A task force released recommendations this week on who should get vaccinated first when a COVID-19 vaccine becomes available.
- People at high risk for contracting COVID-19, such as frontline workers in healthcare facilities and people who have underlying health conditions, are more likely to get the vaccine first.
- The group said the vaccine should be released in four phases.
When a vaccine is ready to be administered, there won’t be enough doses to vaccinate the entire U.S. population, so experts have to figure out who will be first in line.
A task force organized by the National Academies of Sciences, Engineering, and Medicine released recommendations this week on who should get vaccinated first when a COVID-19 vaccine becomes available.
The report, released Tuesday as a draft, prioritizes people at high risk: frontline workers in healthcare facilities along with people who have underlying health conditions greatly increasing their risk of COVID-19 complications and mortality. Older adults living in crowded settings, such as nursing homes, would also be at the front of the line.
It’ll serve as a guide for more a specific, detailed vaccination campaign. The Advisory Committee on Immunization Practices (ACIP) is also working on a similar vaccination plan that prioritizes frontline healthcare workers.
“The vaccine’s primary purpose is to prevent severe disease,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University School of Medicine, told Healthline. “Severe disease is the criterion, and in that regard, everyone knows that older persons, persons with underlying illness, adults who are [marginalized] — those are the populations most severely affected by this virus and so it is to those populations that the vaccine will first be directed.”
How groups were prioritized
Drawing from past vaccination campaigns during the 2009 H1N1 flu outbreak and 2014–2016 Ebola outbreak in West Africa, the task force developed four pieces of criteria to inform who’ll get access to a vaccine first.
They are as follows:
- Risk of acquiring infection: people who have a greater risk of being in an environment where COVID-19 spreads
- Risk of severe morbidity and mortality: people who have a higher risk of experiencing severe complications or death from the disease
- Risk of negative societal impact: people whom society depends on for essential tasks
- Risk of transmitting disease: people who have a greater chance of spreading the disease to others
Using the criteria, the task force outlined four phases in which various groups of people could qualify for the vaccine.
“You can’t give it to everybody simultaneously, we won’t have enough [doses], so we’re going to have to decide who is first, second, third in line,” Schaffner said.
The task force recognizes that people of color — specifically Black, Hispanic, and American Indian people — have been disproportionally impacted by COVID-19.
The framework laid out was designed to address the underlying factors putting groups at risk — occupation, living situation, underlying health issues — and ensure vaccine equity.
The recommendations will be updated as researchers learn more about which vaccines work best in whom, according to Schaffner.
Phase 1: Frontline workers, qualifying seniors, high-risk groups
In Phase 1, first responders, healthcare workers in high-risk settings — like hospitals or nursing homes — people with serious comorbidities that significantly increase their risk, and older adults in congregate settings like nursing homes would take priority.
Frontline healthcare workers work in high-risk settings where they provide essential care for people battling COVID-19. A recent United Kingdom study found that frontline workers are 12 times more likely to get COVID-19 than the general population.
A vaccine would allow these workers to continue their work safely and cut the chances they’d contract and spread the virus at work, says the task force.
Dr. Eric Cioe-Peña, Northwell Health’s Director of Global Health, says healthcare workers are the most nonrenewable resource available during a health crisis.
“I said many times in March and April, you can build more ventilators, you can’t build more nurses,” Cioe-Peña told Healthline.
Schaffner says most other countries prioritize healthcare providers who provide direct care to COVID-19 patients.
First responders — like police, firefighters, and emergency medical services workers — are also included in phase 1 as they’re essential to society’s functioning and urgently needed for emergency situations, the task force states.
Older adults in nursing homes have been hit hard during the pandemic. The Centers for Disease Control and Prevention (CDC) estimates that 80 percent of COVID-19 deaths have been in people age 65 and up. In addition, nursing home staff have a known role in spreading the disease in these environments and many, at least 800, have died from the disease.
“Often because of staffing shortages, you have few people taking care of many residents, and the residents that are in nursing homes tend to be sicker than their peers not living in nursing homes,” says Cioe-Peña.
People with two or more serious underlying conditions — cancer, kidney disease, obesity, heart disease, to name a few — have the greatest risk for developing complications from COVID-19.
The task force’s rationale: Nearly 75 percent of patients hospitalized for COVID-19 had two or more underlying conditions. Sixty percent had three or more.
Phase 2: Essential workers, all seniors, people living in group settings
Phase 2 would green light the vaccine to essential workers in industries impacting the functioning of our society and economy (think: food supply workers and postal workers) along with school teachers.
“This group makes sure the rest of the fabric of the essential services in society is preserved,” Cioe-Peña said. Many essential workers have acquired COVID-19 on the job, according to the report.
Phase 2 also includes people with underlying conditions that moderately increase their risk.
“People with underlying conditions still have the highest risk of a poor outcome with COVID-19,” says Cioe-Peña, noting that this group also requires more resources like ventilators and oxygen support.
Finally, in phase 2, are all other older adults, people in shelters or group homes, and individuals who reside or work in prisons, jails, or detention centers.
Not only do many of these individuals have underlying conditions, but congregate living areas are prime settings for disease transmission, according to the report.
Phase 3: Kids and other essential workers
Phase 3 includes young adults and kids along with remaining essential workers not included in phase 2.
The report says there’s evidence young adults ages 18 to 30 are fueling the pandemic via asymptomatic and pre-symptomatic transmission. A vaccine would lower their risk of passing the virus to friends and family.
Kids, though unlikely to experience severe disease, are thought to play a big role in community transmission, too, especially when they attend camp, day care, or school.
A vaccine will help schools safety reopen while cutting the chances children would give the virus to teachers or bring it home to their families.
“They are low risk in that their risk of complications is extremely low — they are in phase 3 not 4 because they will likely contribute to the spread of the disease within families,” says Cioe-Peña.
Schaffner reminds that the vaccine’s key purpose is to prevent severe illness, which with COVID-19, greatly affects older adults and people with underlying health issues.
Phase 4: The general population
The final phase, phase 4, would allow all remaining U.S. citizens to get vaccinated.
Everyone is at risk of acquiring an infection and the task force hopes to see high vaccination rates in the general population.
“The more people who are protected, the less readily this virus will be able to move through our population and be transmitted and find people who are seriously ill,” says Schaffner.
The vaccine will also be given in two doses a month apart, which could further complicate the process.
The bottom line
A U.S. task force has released recommendations regarding who should get vaccinated first when a COVID-19 vaccine becomes available.
Since there will be limited doses of the vaccine at first, health officials need to prioritize groups that are most at risk. Frontline healthcare workers and people with serious underlying health issues will likely be first in line to get vaccinated.