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CDC's team of advisers set to decide who gets coronavirus vaccine first

Two Covid-19 vaccines are expected to be ready by the end of the month, and already one thing is clear: There won't be enough vaccines to go around.To...

Posted: Dec 1, 2020 12:19 PM

Two Covid-19 vaccines are expected to be ready by the end of the month, and already one thing is clear: There won't be enough vaccines to go around.

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

Those historic choices will be left to the Advisory Committee on Immunization Practices, a panel of independent advisers to the US Centers for Disease Control and Prevention. They'll meet Tuesday afternoon to vote on who gets the vaccine first.

"This is an unprecedented vote that ACIP will be making," said Dr. William Schaffner, a member of the panel since 1982.

Members of the group have been deliberating for months, consulting with bioethicists and other experts.

"The discussions have been elaborate and consultations broad. I can assure you discussions among all my colleagues have been very trenchant," Schaffner said.

Vaccinations are expected to begin in mid- to late December. The panel is set Tuesday to vote on whether the first group to be vaccinated should be health care workers and residents of nursing homes.

If those two groups are first -- or "Phase 1a" in CDC parlance -- then other high priority groups will have to wait, including people with underlying medical conditions, essential workers such as police officers and firefighters, and elderly people who are not in nursing homes.

Those who don't fit into any of these categories will have to wait even longer, likely until the spring.

Vaccines by the numbers

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

Gen. Gustave Perna, chief operating officer of Operation Warp Speed, said last week that he anticipates 6.4 million doses could be available in mid-December, and then more doses available in the coming weeks.

"I do feel confident that we're going to get to as close as we can to 40 million at the end of the year," he said.

But hundreds of millions of doses -- not tens of millions of doses -- are needed for just the high priority groups.

In the United States, there are some 3 million people living in nursing homes and other long-term care facilities; about 21 million health care workers; about 53 million senior citizens; some 87 million essential workers; and more than 100 million people with medical conditions that put them at high risk for complications of Covid-19, such as diabetes and severe obesity, according to an ACIP report.

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

Making an historic decision

Schaffner said he can think of only one other time -- the H1N1 flu pandemic in 2009 -- that ACIP has had to set priority groups because there initially wasn't enough vaccine to go around.

During the current pandemic, the panel's working group has met weekly to deliberate on the various options.

"The committee is trying very hard to be transparent and thorough and thoughtful so that we can provide the greatest good for the greatest number," he said.

ACIP has 14 voting members -- Schaffner, as a liaison member is not one of them -- including pediatricians, infectious disease experts, and a lawyer.

The panel will be guided by several questions, according to a presentation last week by the ACIP COVID-19 Vaccines Work Group. For example, which group has already suffered the biggest burden from Covid-19? Which group is at the highest risk of becoming infected? Which group would most benefit from the vaccine?

The group has already received guidance from a National Academy of Sciences panel, which in September issued a report saying first responders and high-risk workers in health care facilities should be first to receive the vaccine.

Vaccination timeline

ACIP is voting on the prioritization Tuesday because by Friday, states need to submit their orders for vaccines, according to a CDC spokesperson.

Friday is the "locked and loaded" date, said Claire Hannan, executive director of the Association of Immunization Managers, which is helping states with their immunization plans.

"These things have to be checked off and in place December 4," she said.

Dr. Anthony Fauci said last week that he expects vaccinations to begin toward the latter part of December "very likely some time a bit before the Christmas holidays."

Vaccinations for people who do not fall into high-risk groups will likely start at the end of April and continue "going into May, June, July," said Fauci, the director of the National Institute of Allergy and Infectious Diseases.

Another federal official said it wouldn't take that long.

Asked about his expectations for how many Americans will be vaccinated against Covid-19 by June, Paul Ostrowski, director of supply, production and distribution for Operation Warp Speed, told MSNBC that "a hundred percent of Americans that want the vaccine will have had the vaccine by that point in time."

Next steps

Both the Pfizer and the Moderna vaccines have shown about 95% efficacy, a stunning number beyond almost anyone's expectations.

Before they're put on the market, the vaccines need to get authorization or approval from the US Food and Drug Administration. An independent panel of experts that advises the FDA is scheduled to review Pfizer's application on December 10 and Moderna's application on December 17.

The FDA will then take "days to weeks" to decide whether to issue emergency use authorization to the vaccines, according to Dr. Peter Marks, director of the FDA's Center for Biologics Evaluation and Research.

Then, it's ACIP's turn.

Even though the committee is voting Tuesday, it will meet and vote again a day or two after the FDA issues its authorization, according to the CDC spokesperson.

States do not have to abide by ACIP's recommendations, and instead can come up with their own frameworks for vaccine prioritization, according to the CDC spokesperson. However, historically, states have abided by ACIP's recommendations.

"I don't see states deviating from the ACIP guidance," Hannan said.

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 248189

Reported Deaths: 5411
CountyCasesDeaths
DeSoto16841171
Hinds15890312
Harrison13037191
Rankin10439205
Jackson10128177
Lee8721135
Madison8071160
Jones6166108
Forrest5870117
Lauderdale5724177
Lowndes5238109
Lafayette486192
Lamar475363
Washington4734122
Bolivar3941106
Oktibbeha388179
Panola360475
Pontotoc358752
Monroe3487103
Warren337895
Union337457
Marshall336065
Neshoba3325150
Pearl River319492
Leflore2980104
Lincoln293385
Sunflower277569
Tate266659
Alcorn260651
Itawamba258858
Pike258176
Hancock253557
Prentiss242450
Scott241043
Yazoo237754
Copiah237449
Tippah236246
Simpson232367
Leake227864
Coahoma223154
Grenada215770
Covington208871
Marion206171
Adams201666
Winston198061
George197438
Wayne196130
Attala191658
Newton186542
Chickasaw181243
Tishomingo179659
Holmes167867
Jasper165134
Clay156732
Stone140218
Tallahatchie138234
Clarke136460
Calhoun133321
Smith118823
Yalobusha113834
Walthall111136
Noxubee109622
Greene108929
Montgomery108134
Carroll103721
Lawrence101217
Perry99131
Amite96425
Webster90624
Claiborne85125
Tunica84521
Jefferson Davis83825
Humphreys81524
Benton80323
Kemper75720
Quitman6758
Franklin65315
Choctaw59613
Wilkinson58125
Jefferson53019
Sharkey42417
Issaquena1586
Unassigned00

Alabama Coronavirus Cases

Cases: 417528

Reported Deaths: 6030
CountyCasesDeaths
Jefferson61313888
Mobile29768542
Madison26637185
Tuscaloosa20580268
Montgomery18696304
Shelby18310113
Baldwin16002179
Lee12261101
Morgan12093112
Etowah11604157
Calhoun10982200
Marshall10108107
Houston8474129
Cullman7960104
Limestone790174
Elmore7723101
DeKalb764697
St. Clair7460120
Lauderdale745183
Talladega6102108
Walker5852174
Jackson574441
Blount526483
Colbert525670
Autauga510355
Coffee434256
Dale391081
Franklin363445
Chilton333565
Covington326167
Russell323810
Escambia312442
Dallas300296
Clarke278233
Chambers277869
Tallapoosa2599107
Pike245829
Marion240549
Lawrence240447
Winston223835
Bibb213047
Geneva197431
Marengo197329
Pickens195231
Hale173742
Barbour171236
Butler167958
Fayette166026
Cherokee159630
Henry151119
Monroe144417
Randolph138535
Washington136526
Clay125246
Crenshaw118044
Lamar116619
Cleburne116023
Macon113335
Lowndes108735
Wilcox101221
Bullock98128
Perry95419
Conecuh92920
Sumter88726
Greene75323
Coosa60414
Choctaw51224
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