COVID-19 Vaccine Should Go to HCWs First, NAS Panel Says

Alicia Ault

October 02, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Anticipating an initial short supply of COVID-19 vaccines, a prominent scientific advisory committee recommends that the first vaccines be given to the ~15% of Americans who are at highest risk for infection or serious illness.

These include primarily healthcare workers, first responders, individuals with underlying health conditions, and those older than 65 years who are living in congregate settings.

Some 130 COVID-19 vaccines are in development worldwide, with 43 in human trials. The US government's Operation Warp Speed program has been assisting development of six vaccines, four of which are in late-stage phase 3 trials.

"But even under the best circumstances, experts are speculating that we may have an effective vaccine by end of the year or early next year," said National Academies of Sciences, Engineering and Medicine President Victor Dzau, MD.

"We all know that doses will be limited, certainly initially at the beginning," he said at a briefing at which the National Academies committee's recommendations were unveiled.

Healthcare workers would be in the first of four phases of the vaccination campaign, according to the recommendations.

The committee began meeting in July. It issued draft recommendations on September 1, and after hearing 5 hours of public testimony and receiving some 1400 written comments, it released its final recommendations.

Committee co-chair Helene Gayle, MD, MPH, president and CEO of the Chicago Community Trust, urged the US Department of Health and Human Services to adopt the recommendations and to create national guidelines.

"We feel like that it is so important that a national framework be laid so that there is coordination of this" with local, tribal, state, and territorial health authorities, said Gayle. She noted that such a process "is the way national public health exists in this country."

Co-chair William Foege, MD, MPH, emeritus distinguished professor of international health at the Rollins School of Public Health, Emory University, Atlanta, Georgia, noted that the National Academies' imprimatur was "so important for the trust factor" with regard to how the public might view the recommendations, because it is a long-lived independent body.

The National Institutes of Health and the Centers for Disease Control and Prevention (CDC) requested the National Academies' input.

In addition to recommending a plan as to who should receive vaccines first, the National Academies panel also advises on how the federal government should address health disparities that the pandemic has exposed, as well as vaccine hesitancy. It will also create a campaign to promote acceptance of the COVID vaccine.

Tackling Racism Head On

The National Academies urges health authorities to make efforts to reach the most socially and economically vulnerable residents during every vaccination phase by using the CDC's Social Vulnerability Index or the more specific COVID-19 Community Vulnerability Index.

This would help address COVID-19's disproportionate impact on people of color, said the panel.

"It's racism that is the root cause of this problem," said Foege. "This virus has no concept of color, but it has a very good concept of vulnerabilities," he said.

The panel said the second vaccination phase would include one third of Americans: kindergarten through 12th grade teachers and staff, childcare workers, food supply and public transit workers, and others in high-risk settings, along with people of any age who have underlying conditions that put them at moderate risk for COVID-19.

It should also include staff and individuals in homeless shelters or group homes for those with disabilities or in recovery, as well as all adults older than 65 years who were not included in the first phase.

Just fewer than half of Americans would be in phase 3, including young adults, children, and employees of colleges, universities, hotels, banks, exercise facilities, factories, and other environments that pose a moderately high risk for exposure. The final phase would cover all those who did not have access to vaccination in prior phases.

Promote Acceptance and Alliances

The National Academies committee said the CDC should quickly develop a national, branded, COVID-19 vaccine promotion campaign using evidence-based social marketing, behavioral science, and risk and health communication techniques. The agency should focus on promoting the vaccine in communities of color and other hesitancy hot-spot communities, said the panel.

"We know that there is a huge amount of scepticism because of the speed of the development of the vaccine, because of some of the confusing statements that have been made," Gayle explained.

"We really want to make sure that people are very clear, understand the science, and that we can do everything to minimize the kind of hesitancy that we know exists in the American public and particularly among groups who might have the most to benefit from vaccine."

The committee also urged the federal government to re-up alliances with international groups such as the World Health Organization and GAVI, the nonprofit vaccine organization started by Bill and Melinda Gates. Foege and Gayle said that the United States could learn from other nations, and vice versa.

"GAVI has now turned out to be the single biggest program with experience in delivering vaccines in the world," said Foege.

Noting that this is a global pandemic, Gayle said cooperation is critical, as is supporting equitable vaccine allocation worldwide. "We want the US government to commit to a leadership role in demonstrating equity," she said.

The panel recommended that the United States work with Gavi's COVAX to promote the development and distribution of COVID-19 vaccines worldwide. That would include "ensuring that some meaningful proportion of the US vaccine supply should be made available for global allocation," Gayle said.

The National Academies committee expects that its recommendations will be incorporated by the CDC's Advisory Committee on Immunization Practices, which will be the final official arbiter of vaccine allocation and distribution in the United States.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.