Who is first in line to receive a COVID-19 vaccine?

The first available SARS-CoV-2 vaccines should be reserved for front-line healthcare workers and first responders, according to draft recommendations from the National Academies of Sciences, Engineering and Medicine (NASEM) released Tuesday.

After this “rapid onset phase,” people of any age with underlying comorbidities or conditions that put them at increased risk of severe COVID-19 outcomes would be prioritized, along with older adults living in long-term care facilities. term. These groups combined would comprise approximately 15% of the entire US population.

NASEM’s 114-page document was released ahead of a public hearing on Wednesday afternoon, and is intended to serve as a framework for policy makers planning a fair distribution of what will initially be a limited supply of vaccines across the Operation Warp Speed: an estimated 10 to 15 million. doses, which could cover 3% to 5% of the US population.

Phase 2, to be implemented when hundreds of millions of vaccine doses are available, would include vaccinating critically-risk workers at high risk of exposure (those in meat processing, supermarket workers, etc.), along with teachers and other school personnel. older adults lost during the initial phase, and people with underlying conditions are at a moderately higher risk of poor outcomes. People living in homeless shelters, group homes, prisons, jails and detention facilities would also be included, as would the staff of those facilities. Phase 2 would cover an additional 30% -35% of the total US population.

“In the initial phases, more emphasis is placed on preventing morbidity and mortality and maintaining health and emergency services to help prevent morbidity and mortality than reducing transmission,” the committee stated. “[A]As more vaccine cycles become available, an increasing focus on reducing transmission, starting with high transmission settings and moving to the general population, would ensure long-term sustainable control of COVID-19. “

Phase 3 would include younger adults, children, and workers in other industries, putting them at higher risk of exposure, along with anyone living in the US lost during the earlier phases.

The NASEM criteria for ‘equitable allocation’ focused on those at greatest risk of infection, severe morbidity or death from infection, and of transmitting the infection to others.

Those at high risk of negative social impact were also included in the equation. “People have higher priority insofar as the social function and the lives and livelihoods of other people depend directly on them and they would be in danger if they got sick,” the committee wrote.

People’s wealth or income was not considered.

While Black, Hispanic, American Indian and Alaska Native communities have been hard hit by the COVID-19 pandemic, the guide does not specifically prioritize these populations for earlier vaccination.

“There is currently no evidence that this is biologically mediated, but rather reflects the impact of systemic racism leading to higher rates of comorbidities that increase the severity of COVID-19 infection and socioeconomic factors that increase the likelihood of contracting COVID-19. infection, “the committee said. wrote.

Instead, the framework seeks to focus on these underlying factors – frontline jobs, crowded living conditions, inability to work from home – which can lead to higher infection rates and subsequent morbidity and mortality, and was based on the Index of CDC Social Vulnerability to prioritize vulnerable geographic areas. areas within the draft framework phases.

The draft document was produced at the request of the National Institutes of Health and the CDC, and draws on lessons learned from previous mass vaccination campaigns for the 2009 swine flu pandemic and the 2013 West African Ebola epidemic. -2016.

“Without transparency about the allocation criteria, their ethical justification, the deliberative process used to formulate them and fair procedures, it will be difficult to generate and maintain the trust that is indispensable for public cooperation with a mass vaccination program,” the committee. set.

The final report is expected early this fall, and it will also address vaccine vacillation, demand and promotion issues, as well as other considerations.