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An influential government advisory committee met on Tuesday to answer one of the most pressing questions in the coronavirus outbreak in the United States: Who should be on the front line when the first shots are available?
The Advisory Committee on Immunization Practices would vote on a proposal that would prioritize healthcare professionals and nursing home patients.
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The two groups together represent approximately 23 million Americans out of a US population of approximately 330 million.
When the virtual meeting began, panel member Dr. Beth Bell of the University of Washington noted that on average, one person is dying of COVID-19 per minute in the United States right now, “so I guess we won’t take action. too soon. “
By the end of the month, the Food and Drug Administration will consider approving two vaccines made by Pfizer and Moderna. Current estimates predict that by the end of 2020 no more than 20 million doses of each vaccine will be available. And each product requires two doses.
As a result, the shoots will be rationed in the early stages.
The advisory board will meet again at some point to decide who should be next in line. Possibilities include: teachers, police, firefighters and workers in other essential sectors such as food production and transportation; seniors; and people with underlying medical conditions.
Experts say the vaccine probably won’t be widely available in the United States until spring.
The 15-member group of external scientific experts, created in 1964, makes recommendations to the director of the Centers for Disease Control and Prevention, who almost always approves them.
The recommendations are not binding, but for decades they have been widely heard by doctors and have determined the scope and funding of U.S. vaccination programs.
It will be up to the state authorities whether to follow the guide. It will also be left to them to make further more detailed decisions if necessary, such as whether to put the doctors and nurses in the emergency room ahead of other health care workers if vaccine stocks are low.
The outbreak in the United States has killed nearly 270,000 people and caused over 13.5 million confirmed infections, with deaths, hospitalizations and cases skyrocketing in recent weeks.
About 2 million people live in nursing homes and other long-term care facilities in the United States. Those patients and the staff caring for them accounted for 6 percent of the nation’s coronavirus cases and a staggering 39 percent of deaths, CDC officials say.
The number of healthcare professionals covered by the panel’s recommendation would be approximately 21 million.
This is a broad category that includes medical personnel who care for – or come into contact with – patients in hospitals, nursing homes, clinics and doctors’ offices. It also includes home health workers and paramedics. Depending on how state officials apply the panel’s recommendations, it could also include housekeeping staff, food service employees, and medical record employees.
The government estimates that people working in the healthcare sector account for 12% of Covid-19 cases in the United States, but only about 0.5% of deaths. Experts say it’s imperative to keep health workers on their feet so they can administer the shots and look after the growing number of infected Americans.
For months, members of the immunization panel had said they wouldn’t vote until the FDA approved a vaccine. This is the usual procedure for the panel, with a few exceptions, such as during a flu outbreak in 2009. But late last week, the group suddenly scheduled an emergency meeting for Tuesday.
Panel chairman Dr Jose Romero said the decision stems from an awareness that states are facing a deadline for Friday to place initial orders for Pfizer vaccine and determine where they should be delivered. The committee has decided to meet now to provide guidance to state and local officials, he said.
But some panel members and other experts also worried about comments from Trump administration officials suggesting different priorities for vaccines.
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Then last week, US Secretary of Health and Human Services Alex Azar pointed out that ultimately the governors will decide who in their states gets the hits. Vice President Mike Pence echoed this opinion.
The comments raised longstanding concerns during the Trump administration that vaccination decisions would be dictated by political concerns rather than science.
Asked if Azar’s comment played a role in scheduling the meeting, Romero said; “We don’t live in a bubble. We know what he said. But that wasn’t the main reason this was done. “
Jason Schwartz, a professor of health policy at the Yale School of Public Health, said it makes sense for the committee to take the unusual step of getting his recommendation first.
“Without that formal recommendation, it creates a vacuum from which states could go in all sorts of different directions,” said Schwartz, who isn’t on the panel.
Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, Tennessee, who is not on the panel, agreed that the panel’s decision to make recommendations before the FDA meeting is unusual.
“As you can see, the wagon is a bit ahead of the horse here as we don’t have an approved vaccine yet,” Schaffner said. “But ACIP is already evaluating who should receive this vaccine it should be, and when, it is approved.”
HHS officials said they will distribute initial doses to states based on population, and it is possible that some states may not receive enough to cover all of their health workers and nursing home residents.
As a result, governors may have to decide which health workers or which regions get the shots first, Schwartz said.
“It is up to states to understand the finer details,” he said.
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