Groups Jockey for COVID-19 Vax 'High Priority' Status

The wide swath of groups receiving the highest priority for any potential COVID-19 vaccine should expand to include particular races and ethnicities, as well as certain occupations, advocates told the National Academies of Sciences, Engineering and Medicine (NASEM) on Wednesday.

In addition to race/ethnicity, experts advocated for priority vaccine access for a larger population of older people, other healthcare workers beyond the medical setting, such as pharmacists and dentists, and public service workers.

On Tuesday, NASEM released part of their draft recommendations for COVID-19 vaccine allocation, comprised of a four-phase approach that placed "high-risk workers in healthcare facilities" and "first responders" at the top of the list, followed by people with comorbidities and underlying conditions, and older adults living in "congregate or overcrowded settings."

It did not, however, specifically prioritize particular sociodemographic groups such as Black Americans -- in whom COVID-19 has been especially deadly -- because committee members believed their risk comes primarily from higher rates of comorbidities, which the prioritization scheme already addresses.

NASEM then allowed experts and advocates from different industries to have their say at a public comment hearing.

Committee co-chair Helene Gayle, MD, laid out the primary goal of the recommendations: to maximize societal benefit by reducing morbidity and mortality caused by COVID-19.

"We've always started with science and then asked the question of how do we look at ethics," said committee co-chair William Foege, MD. "This committee did it backwards. We started with the ethics and we started with equity."

He added the pandemic has "laid bare the problem of equity in this society" and "showed us what systemic racism can do to people."

Gayle noted vaccine access within the four phases should be prioritized for "geographic areas identified as vulnerable through CDC's Social Vulnerability Index."

But Elizabeth Ofili, MD, of the Association of Black Cardiologists, said the vulnerability indices may not capture particular racial/ethnic minorities, and added the recommendations, "should prioritize ethnic minorities most severely impacted by COVID-19."

Experts included advocates from the Alaskan Native/American Indian community and the Asian Pacific Islander/Native Hawaiian community, both of whom advocated to be included as high-risk, given their risk factors, social considerations such as multi-generational housing and lack of access to adequate healthcare.

Other communities potentially at high risk included people with disabilities, and people experiencing homelessness.

Brendan Flinn, of LeadingAge, an advocacy group for geriatric service providers, noted the 1.1 million adults living in affordable housing and federally-assisted community housing, who also could be considered high-risk.

"Independent living facilities, assisted living facilities and memory care" should not be "overlooked," said Mark Parkinson, of the American Health Care Association and National Center for Assisted Living.

Defining "Essential Workers"

Many "phase 2" workers, including pharmacists, dentists and staff in eldercare facilities, including ombudsmen, should be among the healthcare workers outside medical settings to receive high priority for the vaccine, experts argued.

Peter Matz, of the Food Industry Association, which also represents supermarket pharmacies, went a step further and said pharmacists should be involved in the administration of COVID-19 vaccines.

"We should empower pharmacists to become part of the COVID-19 solution. They should be given phase 1 priority," he said, noting the federal government should authorize pharmacists to provide vaccinations.

Dentists also advocated to be including in phase 1, with Kathleen O'Loughlin, DMD, of the American Dental Association encouraging the committee "to recognize dentists as a critical part of the healthcare workforce."

Randi Weingarten, of the American Federation of Teachers, urged NASEM to "reconsider" their placement of teachers.

"As noted in the draft, schools are necessary for maintaining core societal function," she said.

While first responders, such as firefighters and emergency medical services personnel, are phase 1, David Gershner, of Dayton Metropolitan Medical Response system, argued to expand that definition to include "dispatch and EMA personnel," as "the emergency sector cannot function without them."

Other groups whose advocates pushed for a move to phase 1 were people experiencing homelessness and correctional facility workers.

Foege said after a number of panels that a common message was to "listen to the grassroots."

"We're going to take that seriously," he said, but reminded those assembled that NASEM's role was only to make recommendations. The decisions will ultimately be made by the CDC's Advisory Committee on Immunization Practices (ACIP), and "the state, county and city level."

Gayle noted that operational concerns about vaccine rollout, and community involvement, vaccine hesitancy and global implications would not be addressed at this hearing, but would be included within NASEM's final report.

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