Officials weighing who gets first vaccine doses
Federal health officials are already trying to decide who will get the first doses of any effective coronavirus vaccines, which could be on the market this winter but could require many additional months to become widely available to Americans.
The Centers for Disease Control and Prevention and an advisory committee of outside health experts in April began working on a ranking system for what may be an extended rollout in the U.S. According to a preliminary plan, any approved vaccines would be offered to vital medical and national security officials first, and then to other essential workers and those considered at high risk — the elderly instead of children, people with underlying conditions instead of the relatively healthy.
Agency officials and the advisers are also considering what has become a contentious option: putting Black and Latino people, who have disproportionately fallen victim to COVID-19, ahead of others in the population.
In private meetings and a recent public session, the issue has provoked calls for racial justice. But some medical experts are not convinced that there is a scientific basis for such an option, foresee court challenges or worry that prioritizing minority groups would erode public trust in vaccines at a time when immunization is seen as crucial to ending the pandemic.
“Giving it to one race initially and not another race, I’m not sure how that would be perceived by the public, how that would affect how vaccines are viewed as a trusted public health measure,” said Claire Hannan, executive director of the Association of Immunization Managers, a group represented on the committee.
While there is a standard protocol for introducing vaccines — the CDC typically makes recommendations, and state and local public health departments decide whether to follow them — the White House has pressed the agency at times to revise or hold off on proposals it found objectionable. President Donald Trump, who has been pushing to reopen schools, fill workplaces and hold large public events, has been acutely focused on the political consequences of public health guidance.
Since the beginning of the pandemic, almost every aspect of the administration’s response has involved scarce resources, high demand and claims that the privileged were receiving unfair advantage. The White House recently created Operation Warp Speed, a multiagency effort to accelerate vaccine development that has invested billions of federal dollars in a growing number of companies. At the public advisory committee hearing, held in midJune, a Defense Department representative said the operation would address the distribution plans in coming weeks.
To speed distribution, the most promising vaccines will go into production even before they have cleared the final stages of clinical trials and been authorized for public use by the Food and Drug Administration.
But there will be a gap between the first doses coming off the manufacturing lines and a stockpile large enough to vaccinate the U.S. population. “I would say months,” predicted Dr. José Romero, chairman of the Advisory Committee on Immunization Practices.
The committee, which reports to the CDC director, has long played a key role in determining how to implement new vaccines. The group includes 15 voting members selected by the health secretary who come from immunology, infectious disease and other medical specialties, 30 nonvoting representatives from across the health field and eight federal officials focused on vaccines.
Black and Latino people have become infected with the virus at three times the rate of whites and have died nearly twice as frequently. Many of them have jobs that keep them from working at home, rely on public transportation or live in cramped homes that increase their risk of exposure. They are more likely to suffer from underlying health problems, including diabetes and obesity, that raise the risk of hospitalization and death. Not only do the groups have less access to health services, they also have a documented history of receiving unequal care.
The questions come amid a national uproar over the U.S.’ racist past, which stretches into its response to infectious disease — including the infamous Tuskegee syphilis study, when the government deliberately let hundreds of Black men go untreated even when there was a known cure for the disease.
There may be substantial differences in how racial and ethnic groups view vaccines. A recent Pew survey found that a little over half of
Black adults said they would definitely or probably get a coronavirus vaccine if one were available today, while 44 percent said they would not. Among Hispanic and white adults, 74 percent said they would get the vaccine, while around a quarter said they would not.
Whoever is prioritized for the first doses, it will not matter if the vaccines don’t work for those demographics. And that will not be determined unless the vaccine trials themselves include those groups. So far, several vaccine candidates have entered final phase 3 trials.
At a Senate hearing last week, Dr. Robert Redfield, the CDC director, and Dr. Francis Collins, head of the National Institutes for Health, emphasized the need for racial and other diversity within the trials.
“The last thing we want to be is trying to recommend who gets the vaccine and we don’t have any data on how the vaccine works in the population that we think really needs this vaccine,” Redfield said.