Submitted by Lewis County Public Health & Social Services

Last month we talked about how vaccines are developed and planning underway to distribute them once available. This month, we are excited over the news that one or more COVID-19 vaccines are nearly ready for use. Just like any other new product, supplies will be scarce at first, then become more plentiful in the weeks and months to come. That is why so much analysis and planning have gone into vaccine distribution. The small quantities available at first must be prioritized to make sure that the vaccine is used where it can be the most effective.

The Advisory Committee on Immunization Practices (ACIP) is a national advisory group to U.S. Centers for Disease Control and Prevention (CDC). On December 1, 2020, ACIP approved an interim recommendation that healthcare workers and nursing home residents and staff should receive the first COVID-19 vaccine doses available. Specific groups totaling approximately 24 million people across the U.S. and just under 1,000 in Lewis County include:

Health Care Personnel

·         Hospitals

·         Long-term care facilities

·         Outpatient clinics

·         Home health care

·         Pharmacies

·         Emergency medical services

·         Public health

Long-term Care Facility Residents

·         Skilled nursing facilities

·         Assisted living facilities

·         Other residential care

As of November, at least 243,000 confirmed COVID-19 cases and 858 deaths had been recorded nationwide among healthcare workers. Long-term care facility residents and staff made up only 6% of cases, but 40% of COVID-19 deaths in the U.S. COVID-19 exposure (inside and outside the healthcare setting) reduces available healthcare workers due to quarantine, infection and illness. Vaccination has the potential to reduce absenteeism in critically needed health professions.

The ACIP recommendation now goes to the CDC Director and the Food and Drug Administration (FDA) for review and approval. If the ACIP recommendation is accepted, the CDC will urge states to follow. States are not bound by the recommendations, but they do carry strong weight in the public health community.

A national Harris Poll conducted in August 2020 asked U.S. adults who should receive priority when a COVID-19 vaccine is available. Healthcare workers were ranked the top group by 73 percent of those polled. Seniors age 55+ were ranked second by 71 percent.
How ACIP arrived at its decision involved a process nearly as lengthy as the vaccine development itself. Beginning in April 2020, an ACIP Vaccines Work Group set the following goals for recommending which groups should receive COVID-19 vaccines if supply is limited:

·         Decrease death and serious disease as much as possible

·         Preserve the functioning of society

·         Reduce the extra burden the disease is having on people already facing disparities

·         Increase the chance for everyone to enjoy health and well-being

The group began studying the epidemiology of COVID -19 and consulting with experts in ethics and health equity. The group used this research to develop a decision-making process for distributing limited vaccine quantities. The process was guided by four ethical principles.

Maximize benefits and minimize harms. Allocation of the COVID-19 vaccine should maximize the benefits of vaccination to both individual recipients and the population overall.

Promote justice. Inherent in the principle of justice is an obligation to protect and advance equal opportunity for all persons to enjoy the maximal health and well-being possible.

Mitigate health inequities. Health equity is achieved when every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.

Promote transparency. The underlying principles, decision-making processes, and plans for COVID-19 vaccine allocation must be evidence-based, clear, understandable, and publicly available.

More detail on the ACIP process and conclusions is available at http://cdc.gov/mmwr/volumes/69/wr/mm6947e3.htm?s_cid=mm6047e3_w.

In addition to ethical considerations, ACIP’s recommendations for initial allocations of the COVID-19 vaccine were based on the vaccine’s safety, effectiveness, and storage and handling requirements. ACIP will continue to evaluate additional vaccines as they are approved by the FDA in order to make recommendations for their use.

As we learn more . . .

Once vaccination of all Phase 1a persons is complete, we’ll move on to the next phases in line, in order. Those details are still under discussion. Once they have been determined, what those phases are and who will be in them will be the topic of future Health Beat columns. In the meantime, until vaccines are available for everyone, we all have the means at our disposal to prevent getting sick – the 3 Ws: Wear a mask; Wash your hands and watch your distance.

For more information on vaccine testing and the approval process, visit https://www.cdc.gov/vaccines/basics/test-approve.html.

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