Debate continues over who should get new COVID vaccines first

Washington, D.C. Newsroom, Dec 2, 2020 / 09:30 am

A federal health advisory committee proposed on Tuesday that health care workers and long-term care facility residents should be the first to receive a COVID vaccine, as a Catholic ethicist warned that vulnerable people, like the elderly, cannot be pushed to the back of the line.  

The Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control (CDC) met virtually on Tuesday to discuss and vote on the "allocation of initial supplies of COVID-19 vaccine," or who should be the very first to receive the vaccine.

The meeting occurred after pharmaceutical companies Pfizer and BioNTech, and Moderna, submitted their vaccine candidates for emergency use authorization by the U.S. Food and Drug Administration (FDA); the FDA is expected to grant authorization in early December.

Once the vaccine is approved and distributed, the CDC committee said on Tuesday that health care personnel and residents of long-term care facilities should be among the first to receive it.

According to CDC working group co-lead Kathleen Dooling, residents and staff of long-term care facilities accounted for six percent of the COVID cases in the U.S., but 40% of the deaths. Skilled nursing facilities alone accounted for more than 69,000 deaths so far.

Vaccination of these populations is important, she said, because of the ethical policy of "maximizing benefits" while "minimizing harm," protecting health care personnel, preserving health care capacity, preventing the spread of the virus among high-risk populations and easing the burden on hospitals.

Dr. Charles Camosy, a theology professor at Fordham University, tweeted on Tuesday that it was "so important" for the committee to prioritize not only health care workers, but nursing home residents and staff. Camosy has written before that the neglect of care of the elderly in nursing homes-manifested in a "wildfire of infection and death" during the pandemic-is an element of the "throwaway culture" condemned by Pope Francis.

The "real challenge," Camosy said, is determining who would receive the vaccine after the initial administration phase. Under the CDC group's proposed "Phase 1b," which the committee briefly discussed on Tuesday, "essential workers" would receive it, with vulnerable adults-the elderly and those with high-risk medical conditions-being next in line after them.

Camosy argued that the "sick and the elderly" who are not in nursing homes should be prioritized for the vaccine over younger, healthier "essential" workers.

In August, CNA discussed who should get a COVID vaccine first with an ethicist from the  National Catholic Bioethics Center.

"All of those who come into contact with many different people through their ordinary line of work, they would be first in line," bioethicist Edward Furton told CNA. People in this group might include first responders, physicians, nurses, and other health care workers, police officers, and public transit employees.

On Wednesday, the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) issued a statement calling on governors to follow the ACIP proposal putting nursing home residents and staff among the first in line for the vaccine.

"More than 100,000 long term care residents have died from this virus in the U.S. and our nursing homes are now experiencing the worst outbreak of new cases since last spring with more than 2,000 residents succumbing to this virus each week," stated Mark Parkinson, president and CEO of AHCA/NCAL. 

Under the ACIP proposals discussed and voted on Tuesday afternoon, the first phase of vaccine allocation (1a) would target health care personnel at hospitals, outpatient clinics, public health services, and long-term care facilities.

Residents of the long-term care facilities, which include nursing homes, assisted living centers, and other residential care facilities, would also be prioritized for a vaccine.

The next vaccine phase would target "essential workers," who cannot work remotely. After that, vulnerable adults would be prioritized for a vaccine, or adults with high-risk medical conditions or seniors age 65 and over.

Within the first bracket, ACIP members discussed who should get a vaccine first in long-term care settings, or if both residents and staff should receive vaccines simultaneously.

Executive secretary Dr. Amanda Cohn said that most facilities might conduct vaccinations simultaneously, but some jurisdictions might vaccinate the personnel first because of supply issues.

Liaison representative Dr. Robert Gluckman endorsed the policy of vaccinating long-term care residents and staff simultaneously.

"If elderly are to be vaccinated," he added, they would need guidance on any adverse effects or side effects of the vaccine.

The board members also discussed "sub-prioritization," or who among health care workers should receive the vaccine first. There would be enough doses to vaccinate 20 million people by the end of December, members said, and sub-prioritization would be necessary earlier in the month when doses are still limited.

Those with direct patient contact who are unable to telework, such as those providing services or handling infectious materials in inpatient or outpatient settings, should possibly be prioritized, Dr. Sarah Oliver said in her presentation.

Long-term care personnel, and personnel without a known infection in the previous 90 days, should also be prioritized, Oliver said.