The CDC advisory group has decided who will receive the coronavirus vaccine first

Tough decisions have to be made. Who gets the vaccine first? Who gets it next? Who has to wait months?

“This will be ACIP’s unprecedented vote,” said Dr. William Schaffner, a board member since 1982.

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The members of the group have been consulting, consulting with bioethicists and other experts for months.

“The discussions are detailed and the consultations are extensive. I can assure you that the discussions between all my colleagues were very cunning,” Schaffner said.

Vaccinations are expected to begin in mid-to-late December. The board will vote on Tuesday on whether the first group to be vaccinated should be health workers and those living in nursing homes.

If these two groups are the first – or “Phase 1a” in the CDC’s terminology – then other priority groups will have to wait, including those with the underlying disease, basic workers such as police and firefighters, and the elderly, who are not in a nursing home.

Those who do not fall into one of these categories will have to wait even longer, probably until spring.

Vaccinations by numbers

So far, two pharmaceutical companies, Pfizer and Moderna, have applied to the U.S. Food and Drug Administration for approval for their Covid-19 vaccines.

General Gustave Perna, chief operating officer for Operation Warp Speed, said last week he could expect 6.4 million doses in mid-December and then more in the coming weeks.

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“I’m sure we’ll get as close to 40 million as possible by the end of the year,” he said.

But hundreds of millions of doses – not tens of millions of doses – are needed for priority groups alone.

In the United States, about 3 million people live in nursing homes and other long-term care facilities; about 21 million health workers; about 53 million senior citizens; about 87 million essential workers; and more than 100 million people suffer from a disease that puts them at high risk for Covid-19 complications such as diabetes and severe obesity, according to an ACIP report.

That’s about 261 million people. The Pfizer and Moderna vaccines will require two doses, several weeks apart, so eventually these priority groups will need more than 500 million doses.

Making a historic decision

Schaffner said he could only think of another time – the H1N1 flu pandemic in 2009 – that the ACIP had to identify priority groups because there wasn’t enough vaccination to go around initially.

At the time of the current epidemic, a panel working group met weekly to discuss various options.

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“The committee is working very hard to be transparent, thorough and thoughtful so that we can do the most good for most people,” he said.

The ACIP has 14 voting members – Schaffner, as the liaison member is not one of them – including paediatricians, infectious disease experts and a lawyer.
The panel will be guided by a number of issues, according to an ACIP COVID-19 Vaccines Work Group presentation last week. For example, which group has already been burdened the most by Covid-19? Which group is most at risk for infection? Which group would benefit most from the vaccine?
The group has already received guidance from the Board of the National Academy of Sciences, which published a report in September that first responders in health care facilities and high-risk workers should be vaccinated first.

Vaccination schedule

ACIP will vote on the ranking on Tuesday because states have until Friday to submit their vaccination orders, a CDC spokesman said.

Friday is the “closed and loaded” date, said Claire Hannan, executive director of the Association of Immunization Managers, who is helping states with their immunization plans.

“These things will be checked on December 4 and in place,” she said.

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Dr. Anthony Fauci said last week that vaccinations will begin towards the end of December, “very likely a little before the Christmas holidays.”

Vaccination of individuals who do not belong to high-risk groups is likely to begin in late April and continue to “go into May, June, July,” said Fauci, director of the National Institute of Allergic and Infectious Diseases.

Another federal official said it didn’t take that long.

Asked how many Americans are expected to vaccinate against Covid-19 by June, Paul Ostrowski, director of transportation, manufacturing and distribution for Operation Warp Speed, told MSNBC that “one hundred percent of Americans who want to be vaccinated had vaccination at that time. ”

Next steps

Both Pfizer and Moderna vaccines have shown approximately 95% efficacy, an amazing number that exceeds almost all expectations.

Vaccines must be licensed or approved by the U.S. Food and Drug Administration before they can be marketed. An independent panel of experts advising the FDA is scheduled to review Pfizer and Moderna’s application on December 17th.

The FDA will then decide “from day to week” whether to issue a permit for the emergency use of vaccines, says Dr. Peter Marks, director of the FDA’s Center for Biological Assessment and Research.

Then the ACIP line.

Despite the committee voting on Tuesday, a CDC spokesman said it will meet and vote again a day or two after the FDA’s license is issued.

States do not have to follow ACIP recommendations, instead they can produce their own frameworks for ranking vaccines, according to a CDC spokesman. Historically, however, states have followed ACIP recommendations.

“I don’t see states deviating from ACIP guidelines,” Hannan said.

CNN’s John Bonifield and Sierra Jenkins contributed to this report.