Washington, DC—Pharmacists will be on the front lines vaccinating Americans against COVID-19 once a product is approved by the FDA. A new report provides information on who they likely will be vaccinating at what point.
The National Academies of Sciences, Engineering, and Medicine released the final report of a consensus study advising a four-phased equitable-allocation framework for the vaccine. The committee creating the document was formed in July in response to a request to the National Academy of Medicine from the National Institutes of Health and the CDC.
The authors point out that, even if one or more safe and effective COVID-19 vaccines is authorized for use, it is very unlikely that sufficient quantities will be immediately available to vaccinate most of the U.S. population. That’s why the report urges a four-phased approach for the initial period when vaccine demand exceeds supply. The goal is to maximize societal benefit by reducing morbidity and mortality caused by the transmission of SARS-CoV-2.
Here is what the group recommends:
• Phase 1a covers approximately 5% of the population and includes front-line health workers (in hospitals, nursing homes, or providing home care); workers who provide healthcare-facility services such as transportation and environmental services who also risk exposure to bodily fluids or aerosols; and first responders. The rationale is that this has a critical role in maintaining healthcare system functionality, involves workers with a high risk of exposure to patients exhibiting symptoms of COVID-19, and who have a higher risk of then transmitting the virus to others, including family members.
• Phase 1b covers approximately 10% of the population and includes people of all ages with comorbid and underlying conditions—e.g., cancer, serious heart conditions, and sickle cell disease—that put them at significantly higher risk of severe COVID-19 disease or death. Also included in this phase are older adults (aged 65 years and over) living in congregate or overcrowded settings, including nursing homes, long-term care facilities, homeless shelters, group homes, prisons, or jails. Early vaccination is important for members of these groups, according to the National Academies, because they face “the joint risk factors of severe disease and reduced resilience associated with advanced age and of acquisition and transmission due to their living settings, in which they have limited opportunity to follow public health measures such as maintaining physical distance.”
• Phase 2 covers approximately 30% to 35% of the population and includes K-12 teachers and school staff, including administrators, environmental services and maintenance workers, and bus drivers, as well as childcare workers, who play a vital role in children’s education and development. Also included are critical workers in high-risk settings who cannot avoid a high risk of exposure to COVID-19, such as workers in the food-supply system and public transit. In addition, this phase includes people of all ages with comorbid and underlying conditions that put them at moderately higher risk, defined as having one of the conditions listed by the CDC as being associated with increased risk of severe COVID-19, and potentially some rare diseases as well. Phase 2 also includes people in homeless shelters or group homes for people with disabilities and those in recovery, as well as staff who work in those settings, people in prisons, jails, and detention centers and staff working in those settings. All older adults not included in Phase 1 should be included in Phase 2, as adults aged 65 years and older account for approximately 80% of reported deaths related to COVID-19, the authors emphasize.
• Phase 3 covers approximately 40% to 45% of the population, and includes young adults, children, and workers in industries such as colleges and universities, hotels, banks, exercise facilities, and factories that are both important to the functioning of society and pose moderately high risk of exposure because there are likely to be some protective measures implemented in these work settings. The report notes that broad immunization of children will depend on whether COVID-19 vaccines have been adequately tested for safety and efficacy in these age groups.
• Phase 4 covers everyone residing in the U.S. who did not have access to the vaccine in prior phases.
“Inequities in health have always existed, but at this moment there is an awakening to the power of racism, poverty, and bias in amplifying the health and economic pain and hardship imposed by this pandemic,” said committee cochair Helene Gayle, MD, MPH, president and CEO of the Chicago Community Trust. “We saw our work as one way to address these wrongs and do our part to work toward a new commitment to promoting health equity.”
The National Academies urge the government to assure that COVID-19 vaccine is available with no out-of-pocket cost to assure equity and decrease vaccine hesitancy. It also urges the creation and funding of a COVID-19 vaccination risk-communication and community-engagement program.
Specifically, it says the CDC should quickly develop and launch a national, branded, multidimensional COVID-19 vaccine-promotion campaign.
“Despite the committee’s intense effort, this framework should still be regarded as an evolving document—meant to be adapted and refined in the face of continuing improvement in our understanding of the dynamics of the pandemic,” said Committee Cochair William H. Foege, MD, MPH, emeritus distinguished professor of international health at Emory University and former CDC director. “We hope these guidelines serve as the impetus for one of the most consequential peacetime efforts this country has ever seen, as well as a springboard to resuming our place as a leader in global health.”
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