Draft Report on COVID Vaccine Allocation Expected by September

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It's a tough assignment, and an historical one, but a committee of the National Academies of Sciences, Engineering, and Medicine and the National Academy of Medicine says it expects to have draft recommendations on how to prioritize distribution of a vaccine for SARS-CoV-2 by late August.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) will make the final recommendation to the US federal government on allocation and distribution for Americans, but, given the weightiness of the topic, both the CDC and the National Institutes of Health (NIH) asked the National Academies to give its expert opinion first — assuming that one or more vaccine candidates will pan out.

"Basically, we need to be prepared for success," said Francis Collins, MD, director of the NIH, on July 24 at the first public meeting of the 17-member Committee on Equitable Allocation of Vaccine for the Novel Coronavirus. But Collins added that, given that it's likely there won't be enough doses for everybody in the world on day one, the key is to set a distribution framework.

"This is going to be controversial. Not everybody is going to like the answer," said Collins, adding, "There will be many people who feel they should have been at the top of the list, and not everybody can be."

Collins, for his part, suggested that individuals at high risk because of chronic illness, as well as healthcare workers, those working in essential industries, and the military should likely be prioritized. He said that people participating in vaccine trials should be considered initially also. "I think probably we owe them as a consequence of their participation in the trial some sort of priority in terms of access to the vaccine if proven to be successful," he said.

Panel co-chairman Helene Gayle, MD, MPH, said there would be several additional public sessions. "These sessions are incredibly important," said Gayle, who is president and CEO of the Chicago Community Trust.

She noted that public input would be incorporated into the panel's deliberations. Among other topics, the committee is considering how to determine who receives the vaccine first and what populations should be prioritized as more vaccine becomes available. The panel is also exploring how to ensure equity among nations and how communities of color in the United States can be ensured access.

The committee will also address vaccine hesitancy.

Commitment to Transparency

Committee members and government officials said transparency would be paramount in creating any distribution framework.

"This effort must be transparent, science-based, and objective," said National Academy of Medicine President Victor Dzau, MD. "Its recommendations must be trusted by the public," he said.

"Our goal here is to have transparency so the American public has confidence in the recommendations," said CDC Director Robert Redfield, MD. He noted that the agency had begun a new program "to strengthen the public trust in vaccines and prevent vaccine-preventable disease outbreaks." He said the CDC has been "knee deep" in dealing with measles vaccine hesitancy and does not want to see a repeat. Redfield added that he hoped the National Academies' process would give the American public confidence.

The ACIP has a long history of public meetings and open process, said Chair Jose Romero, MD. "Paramount for the ACIP is vaccine safety and transparency of deliberations and of arrival at recommendations," he said.

An ACIP COVID-19 work group had its first meeting in April and has been meeting weekly since mid-May. It has been sifting through safety and immunogenicity data from vaccines in trials, the epidemiology of COVID-19, identifying potential populations to be vaccinated, and discussing vaccination prioritization plans in the event of too few initial doses.

Hinting at a potential for political interference, National Academies committee member Reed V. Tuckson, MD, managing director of Tuckson Health Connections, LLC, asked Romero whether ACIP had complete autonomy in what it presented to the CDC and whether, if a report was not approved by the CDC director, it would still be made public.

"To my knowledge, that has never occurred," said Romero. He said that because all ACIP meetings are held publicly and are archived, the public would always have access to what had transpired.

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