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Should Nursing Home Residents Be Prioritized For Getting The COVID-19 Vaccine?

Thomas Hansler, 54, receives a COVID-19 vaccination from Yaquelin De La Cruz at the Research Centers of America in Hollywood, Florida.
Thomas Hansler, 54, receives a COVID-19 vaccination from Yaquelin De La Cruz at the Research Centers of America in Hollywood, Florida.

A federal advisory committee to the Centers for Disease Control and Prevention is voting Tuesday to recommend guidelines on who should get COVID-19 vaccines first, when one is authorized for use.

The fifteen voting members of the Advisory Committee on Immunization Practices, along with representatives from federal science agencies and the healthcare industry, are participating in an emergency meeting online to weigh a proposal that the first COVID-19 vaccines should go to health care workers and residents of long-term care facilities, including nursing homes and assisted living.

The issue of which risk groups should be prioritized for a COVID-19 vaccine has been a key topic at the group's regular public meetings over the past several months. The committee's goal is to use a COVID-19 vaccine to reduce severe illness and death from the disease and to lessen disruptions to society and the economy from the pandemic.

In prior meetings, the committee has considered four overlapping groups that might receive priority access to COVID-19 vaccines while immunizations are in short supply. The groups include health care workers and other essential workers who have a higher risk of exposure to the virus. Also, included are people 65 and over and those with certain underlying medical conditions who are more likely to become severely ill if they contract COVID-19.

Health care workers have long been considered to be first in line because they are exposed directly to COVID-19 through their work, and because protecting them and their patients from the virus would help reduce coronavirus spread and keep the health system running.

What's been more controversial is whether to add nursing home residents and other long-term care facility residents, to the initial priority group. (Staffers at these facilities are considered health care workers.) At a public meeting last week, members of the committee agreed that the death toll in this population, a subgroup of the over-65 category, has been severe. Staff and residents at long-term care facilities represent just 6% of confirmed coronavirus cases, but account for nearly 40% of COVID-19 deaths.

Still, some committee members raised concerns about giving newly-authorized COVID-19 vaccines to nursing home residents. "This population is not a population that's been studied in the vaccine trials," said Dr. Robert Atmar, a professor of infectious diseases at Baylor College of Medicine, during last week's meeting.

Older people who are participating in vaccine trials are generally in good health, while nursing home residents are often frail. "Coming back to the science of it, we really are not able to assess the balance of benefits and harms," he said.

Another committee member worried that introducing COVID-19 vaccines first to nursing home residents could erode public confidence in the safety of the vaccines. Given the high mortality rate in long-term care facilities, it's likely that some nursing home patients who receive COVID-19 vaccines could die shortly after, from other causes, said Dr. Helen Keipp Talbot, an associate professor of medicine at Vanderbilt University Medical Center.

"I think you're going to have a very striking backlash of, 'My grandmother got the vaccine and she passed away.' They're not likely to be related, but that will become remembered," she said.

Dr. Talbott suggested running a limited clinical trial in this population before recommending a COVID-19 vaccine for use, to gather data that would show that the vaccine is safe for this group.

Today's vote comes in advance of a COVID-19 vaccine getting authorized by the Food and Drug Administration. The CDC committee previously said it would wait for authorization before making vaccine recommendations. But in recent weeks, it has undergone pressure from the federal government to move faster.

"We are not dependent on any delay from ACIP in terms of helping to advise states," Alex Azar, Secretary of Health and Human Services, said at a November 24 press briefing, discussing his intent to move quickly with the vaccine distribution process.

The committee's guidance will first be reviewed by CDC director Robert Redfield before being officially issued. Then states will use the guidance as they place orders for COVID-19 vaccine doses. Their first orders are due to the federal government Friday.

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