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CDC's vaccine advisers meet to plan next step of Covid-19 vaccine distribution

Dr. José Romero says he's received a few letters.As chairman of the Advisory Committee on Immunization Practices, Romero may be the single most influ...

Posted: Dec 20, 2020 9:02 AM

Dr. José Romero says he's received a few letters.

As chairman of the Advisory Committee on Immunization Practices, Romero may be the single most influential person deciding who will get a coronavirus vaccine -- and when -- in the coming months.

People know it, and they've been lobbying Romero, and other members of the committee, which guides the US Centers for Disease Control and Prevention on vaccine allocation.

It was ACIP that decided frontline health care workers and the frail, vulnerable residents of long-term care facilities should be the at the front of the line for the scanty first vaccines.

On Sunday, they meet to decide who comes next.

In the mix: essential workers, people over age 65, and people with chronic conditions that put them at higher risk of severe disease if they get infected. There are tens of millions of people in each group, and there won't be enough vaccine to cover everyone right away. Choices must be made.

"We are dealing with these decisions knowing there is not enough vaccine," said Romero, a pediatric infectious diseases specialist who is also secretary of health for the state of Arkansas.

ACIP has been tasked with setting out a four-phase rollout of vaccine, but there's still so little vaccine available that Phase 1 has been subdivided into Phases 1a, 1b and 1c. Phase 2, Romero said, may not even be discussed until February.

Phase 1b is likely to include essential workers -- but that's a group that includes 87 million people. US Health and Human Services Secretary Alex Azar estimates the United States can vaccinate 50 million people by the end of January -- including the 20 million or so the US hopes to have vaccinated in December.

So who goes next?

The CDC outlined a list that included the food and agriculture sector, transportation, energy, police, firefighters, manufacturing, information technology and communication, water and wastewater.

But how about camp counselors?

"Childcare staff in out-of-school educational and recreational settings such as camps and community centers are critical for continued support to serve the nation's health care, first responders, frontline and essential workers, as well as in assisting in the continued economic recovery of our country," the American Camp Association argued in its letter to Romero.

And truckers?

"Our workforce represents a central and critical link in the nation's supply chain, and will play an essential role in the imminent COVID-19 vaccine distribution process. As the trucking industry is called upon to deliver vaccines across the country, it is imperative that truck drivers have prioritized access to the vaccine to minimize the potential for supply chain delays and disruptions," Bill Sullivan, Executive Vice President of Advocacy for the American Trucking Associations, wrote in a letter to ACIP.

Airlines, too.

"We are not asking for aviation workers to be on top of the list, but we need governments to ensure that transportation workers are considered as essential when vaccine roll-out plans are developed," said International Air Transport Association CEO Alexandre de Juniac.

Teachers do not want to be left out.

"Our public schools are vital to California's full recovery from this pandemic and we cannot safely and fully return to face-to-face instruction without putting our public-school workers at the top of the priority list," the California Teachers Association said in a statement.

"The vaccine rollout should include school-based vaccination sites where school staff and students' parents, guardians, and household members who are essential workers have the option to be vaccinated, providing greater wrap around protection for our public school communities."

But how can these people, many of them young and healthy adults, be put in front of the elderly and sick, who are at much higher risk of severe illness if they do get infected?

These will include people with obesity -- more than 40% of the US population -- diabetes, heart conditions, lung disease, kidney disease, cancer, sickle cell disease and other conditions.

Should patients with rare diseases go first because they are both vulnerable and few in number? Should smokers have to wait because their lifestyle choice is not technically a disease?

"We understand that our decisions are going to be scrutinized," Romero said. "I expect that people are going to criticize me for my decision."

In deciding to include residents of long-term care facilities in Group 1a, the committee looked at data that showed these patients made up 40% of deaths from Covid-19. Romero said ACIP will similarly look for data in deciding who to recommend goes in Groups 1b and 1c.

"I go into these meetings with an open mind. I just want to see the data," he said.

A team of cancer experts say they've got that data, having reviewed 28 different studies showing the risk of dying from Covid-19 is higher in cancer patients.

"After reviewing 28 publications that included relevant information on fatality rates of patients with cancer who developed COVID-19, we conclude that patients with an active cancer should be considered for priority access to COVID-19 vaccination, along other particularly vulnerable populations with risk factors for adverse outcomes with COVID-19," they wrote in a position paper published in Cancer Discovery Saturday.

And then there's the issue of disparities.

"The idea is that we want to minimize harm from the vaccine and maximize its benefits. We want to address health care disparities. We want to make sure there is equity," Romero said.

The National Council on Disability makes its argument for people with intellectual and developmental disabilities. "Individuals with intellectual and developmental disabilities (I/DD) should be included in the list of high-risk diagnoses used to determine vaccine priority. Compared to individuals without I/DD, individuals with I/DD face alarmingly higher complication and mortality rates from COVID-19, with mortality rates up to 15 percent," the group argued in a statement.

The committee has been charged specifically to think about these factors in deciding.

"How do characteristics of the vaccine and logistical considerations affect fair access for all persons?" the committee was asked in an initial document at the start of its round of meetings in November.

"Does allocation planning include input from groups who are disproportionately affected by Covid-19 or face health inequities resulting from social determinants of health, such as income and health care access?"

For Romero, it's good guidance.

"It is a complex decision to make. Yes, everything counts. You don't discount one factor."

And states have the flexibility to adapt the guidance. Legally, they don't have to follow it at all.

"The states have the option to not use our recommendations," Romero said. But he hopes they will.

"If we document that our decisions are based on the current epidemiological disease data that we have, they will be sound and they will allow the governors to accept them."

Minnesota Coronavirus Cases

Data is updated nightly.

Cases: 454989

Reported Deaths: 6163
CountyCasesDeaths
Hennepin943781502
Ramsey40624748
Dakota33540354
Anoka31357368
Washington20533237
Stearns18091190
St. Louis13970250
Scott1217799
Wright11791107
Olmsted1078075
Sherburne829669
Carver704439
Clay658884
Rice624274
Kandiyohi558072
Blue Earth548033
Crow Wing490478
Otter Tail464268
Chisago459538
Benton423688
Winona394548
Douglas379366
Nobles374647
Mower373729
Goodhue356863
Polk330760
McLeod328147
Beltrami315748
Morrison314545
Lyon305539
Becker288939
Itasca287343
Isanti285643
Carlton284043
Steele278910
Pine270315
Freeborn254123
Todd233730
Nicollet229438
Brown218034
Mille Lacs215645
Le Sueur214216
Cass210724
Meeker201333
Waseca193216
Wabasha17463
Martin171926
Roseau166417
Hubbard150738
Redwood141127
Houston140014
Dodge13934
Renville138440
Chippewa133032
Cottonwood129018
Fillmore12698
Wadena120818
Rock112012
Aitkin111433
Sibley10997
Faribault109416
Watonwan10688
Pennington101016
Kanabec99618
Pipestone96823
Yellow Medicine94916
Murray9117
Jackson87310
Swift84518
Pope7475
Stevens7078
Marshall70315
Clearwater68814
Lake66315
Lac qui Parle66116
Wilkin6339
Koochiching60610
Lincoln4912
Unassigned47369
Big Stone4693
Grant4388
Norman4258
Mahnomen4167
Kittson37420
Red Lake3204
Traverse2613
Lake of the Woods1961
Cook1160

Iowa Coronavirus Cases

Data is updated nightly.

Cases: 311430

Reported Deaths: 4433
CountyCasesDeaths
Polk46841465
Linn18065279
Scott15872172
Black Hawk14090243
Woodbury13129181
Johnson1230052
Dubuque11625159
Pottawattamie9166115
Dallas908972
Story881038
Cerro Gordo473572
Webster472477
Sioux459757
Warren459339
Clinton458168
Marshall431162
Buena Vista396330
Muscatine396178
Des Moines395143
Plymouth353270
Wapello350798
Jasper332859
Lee324632
Marion309353
Jones274950
Henry267131
Carroll258434
Bremer250148
Crawford234724
Boone222917
Washington222933
Benton213650
Mahaska197937
Jackson195032
Tama190259
Dickinson188829
Kossuth180644
Delaware176236
Clay172521
Wright167124
Fayette166024
Hamilton162330
Buchanan162224
Winneshiek160820
Harrison158562
Hardin157931
Cedar155619
Clayton153849
Butler151724
Page147115
Floyd141636
Cherokee140127
Mills138517
Lyon137533
Poweshiek135224
Hancock131924
Allamakee130930
Iowa127722
Madison123910
Calhoun12349
Grundy122628
Winnebago122229
Jefferson122125
Mitchell116837
Louisa116230
Cass115243
Chickasaw113712
Appanoose112640
Sac112215
Union111623
Emmet111332
Humboldt106819
Shelby105527
Guthrie104424
Franklin103618
Unassigned10160
Palo Alto92411
Montgomery89124
Keokuk86326
Howard85919
Monroe82220
Clarke8129
Pocahontas78211
Ida76030
Davis70321
Greene6977
Adair69620
Monona68518
Lucas66710
Osceola64711
Worth6194
Taylor5999
Fremont5246
Van Buren50215
Decatur4974
Ringgold45111
Audubon4228
Wayne42021
Adams3003
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