ACIP makes recommendations for allocating initial supplies of COVID-19 vaccine
The Advisory Committee on Immunization Practices (ACIP) recommended, as interim guidance, that both 1) healthcare personnel and 2) residents of long-term care facilities be offered COVID-19 vaccine in the initial phase of the vaccination program, reported the Centers for Disease Prevention and Control (CDC).
In its deliberations, ACIP considered scientific evidence of SARS-CoV-2 epidemiology, vaccination program implementation, and ethical principles. The interim recommendation might be updated over the coming weeks based on additional safety and efficacy data from phase III clinical trials and conditions of the U.S. Food and Drug Administration (FDA) emergency use authorization (EUA).
Federal, state, and local jurisdictions should use this guidance for COVID-19 vaccination program planning and implementation. ACIP will consider vaccine-specific recommendations and additional populations when an FDA–authorized vaccine is available.
ACIP advises the CDC on population groups and circumstances for vaccine use. ACIP convened on Dec. 1, 2020, in advance of the completion of FDA’s review of the EUA application, to provide interim guidance to federal, state, and local jurisdictions on allocation of initial doses of COVID-19 vaccine.
Evidence-based information addressing COVID-19 vaccine topics including early allocation has been explicitly and transparently reviewed during seven public ACIP meetings. To inform policy options for ACIP, the COVID-19 Vaccines Work Group, comprising experts in vaccines and ethics, held more than 25 meetings to review data regarding vaccine candidates, COVID-19 surveillance, and modeling, as well as the vaccine allocation literature from published and external expert committee reports.
Healthcare settings in general, and long-term care settings in particular, can be high-risk locations for SARS-CoV-2 exposure and transmission. Healthcare personnel are defined as paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials. As of Dec. 1, 2020, approximately 245,000 COVID-19 cases and 858 COVID-19-associated deaths had been reported among U.S. healthcare personnel. Early protection of healthcare personnel is critical to preserve capacity to care for patients with COVID-19 or other illnesses.
Long-term care facility (LTCF) residents are defined as adults who reside in facilities that provide a range of services, including medical and personal care, to persons who are unable to live independently. LTCF residents, because of their age, high rates of underlying medical conditions, and congregate living situation, are at high risk for infection and severe illness from COVID-19. As of Nov. 15, 2020, approximately 500,000 COVID-19 cases and 70,000 associated deaths had been reported among residents of skilled nursing facilities, a subset of LTCFs serving residents with more complex medical needs.
With respect to vaccination program implementation, vaccines that require cold and ultracold storage, specialized handling, and large minimum order requirements are most feasibly maintained in centralized vaccination clinics, such as acute healthcare settings, or through the federal Pharmacy Partnership for Long-term Care Program. ACIP’s ethical principles for allocating initial supplies of COVID-19 vaccine, namely to maximize benefits and minimize harms, promote justice, and mitigate health inequities, support the early vaccination of healthcare personnel and LTCF residents.
Approximately 21 million U.S. healthcare personnel work in settings such as hospitals, LTCFs, outpatient clinics, home healthcare, public health clinical services, emergency medical services, and pharmacies. Healthcare personnel comprise clinical staff members, including nursing or medical assistants and support staff members (e.g., those who work in food, environmental, and administrative services). Jurisdictions might consider first offering vaccine to healthcare personnel whose duties require proximity (within six feet) to other persons. If vaccine supply remains constrained, additional factors might be considered for subprioritization. Public health authorities and healthcare systems should work together to ensure COVID-19 vaccine access to healthcare personnel who are not affiliated with hospitals.
Approximately three million adults reside in LTCFs, which include skilled nursing facilities, nursing homes, and assisted living facilities. Depending upon the number of initial vaccine doses available, jurisdictions might consider first offering vaccination to residents and healthcare personnel in skilled nursing facilities because of high medical acuity and COVID-19–associated mortality among residents in these settings.
Monitoring vaccine safety in all populations receiving COVID-19 vaccine is required under an EUA Authorization. Vaccines are being studied in older adults with underlying health conditions; however, LTCF residents have not been specifically studied. ACIP members called for additional active safety monitoring in LTCFs to ensure timely reporting and evaluation of adverse events after immunization. ACIP will consider vaccine-specific recommendations and additional populations for vaccine allocation beyond Phase 1a when an FDA-authorized vaccine is available.
