As medical researchers sprint to develop a vaccine for the novel coronavirus, there is a new race underway — for a spot at the front of the line to be inoculated amid what will likely be a gradual rollout of doses.
Advocates for a dizzying array of interest groups have already begun mounting their appeals – to political leaders and the trusted medical groups that will advise the Centers for Disease Control and Prevention (CDC) in developing a plan to begin distributing vials of any vaccine that is approved for use.
Evidence of the intense interest was on full display last week, as dozens of advocates appeared in an open online hearing hosted by the National Academies of Science, Engineering and Medicine – a listening session that lasted 5 hours.
Federal officials have asked the revered nonprofit to develop a priority list that the CDC could use knowing that it is almost certain any vaccine will not reach everyone in the country right away, and there is little way to predict how long a roll-out would take. The CDC said the issue is still being studied, and an advisory group is set to meet again later this month to discuss it.
Among those making the case for early access to a vaccine were advocates for firefighters, hard-hit minority populations, children with rare genetic disorders, prison inmates, the elderly, the homeless, school janitors, Alaskan Native American tribes and emergency dispatchers, to name just a few.
Several raised concerns that any final plan, which prioritizes health workers, first responders and the elderly, who account for the vast majority of coronavirus deaths, would not adequately take into consideration race, which was also a significant factor in disease severity and mortality. Others expressed concern that the draft plan under review, which was well-received overall, had left some categories, such as “educators” too vague — potentially discounting support staff.
Several Democratic lawmakers told ABC News they are intent on policing the process to make sure it is divorced from the influence of politics or lobbying – something they fear could infect the vaccine approval process.
“The initial doses will be limited at least in supply at the very beginning,” said Dr. Victor Dzau, the president of the academy’s Institute of Medicine. “Given this, the scarce vaccine will need to be allocated in ways that are thoughtful, strategic and fair.”
Several leading companies working on vaccines have received funding to begin ramping up production even before they know for certain their candidate will work, and be approved. That process is underway now to try and shorten the gap between an approval and distribution. But how long that will take remains one of many unknowns.
What’s the plan?
The plan discussed would give first access to high-risk workers in healthcare facilities and first responders. After that, the distribution would then roll out in phases, starting with people whose other health conditions put them at “significantly higher risk” of contracting coronavirus, and older adults living in congregate settings – most commonly nursing home residents who have accounted for roughly 40% of all COVID-19 deaths in the U.S.
Each phase adds more groups, such as teachers, the elderly, people with medical risks, the homeless and prison inmates in Stage 2, and children and other essential workers in Stage 3. Everyone else would follow after that – presuming vaccine companies have been able to expand production to cover the entire U.S. population.
“We looked at issues of ensuring maximal benefit, promoting common good, saving the greatest number of lives possible,” said Dr. Helene Gayle, who co-chaired the committee of scientists, including experts in epidemiology, vaccine research, public health, ethics and law. Their final proposal, expected early this fall, will be handed over to the CDC, the agency tasked with rolling out a vaccine.
Ultimately, the decision will fall to the CDC to set priorities. In response to questions, a CDC spokesperson said the agency’s Advisory Committee on Immunization Practices “has not yet made recommendations for COVID-19 vaccines,” though the group met Aug. 26 to study options and will meet again this month. Last week, McClatchy reported that federal officials have informed distributors to expect the elderly, health care workers, frontline essential workers, national security workers and communities of color, to be among the favored groups for the first vaccine doses, but without further detail.
Exactly how that priority list is devised will continue to be a subject of intense scrutiny as several pharmaceutical companies race to complete large-scale trials to show whether vaccines will be both safe and effective.
“This plan must be crafted by public health experts, not politicians, campaign strategists, or corporate lobbyists,” said Sen. Patty Murray, of Washington, the ranking Democrat on the Senate health committee, which will be looking at the vaccine effort during a public hearing Wednesday.
Murray wrote to the Trump administration in August raising concerns about what she said was an opaque process being used by federal health agencies to plan for distributing vaccines. She said in a statement to ABC News that Congress will be watching closely to make sure politics does not influence the process.
“Getting this right will be critical for protecting those most at risk—like people of color, seniors, and those with underlying medical conditions—and the health care professionals and other workers on the frontlines of this crisis,” Murray said.
Some satisfied, others feel left out
Groups that advocate for vulnerable populations are also watching closely. Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit providers of aging services, said there is a reason many advocates for vulnerable populations are worried.
“Since the beginning of this crisis, the government has failed to prioritize older adults and the frontline workers who care for them,” Sloan said.
Sloan said she was pleased with the initial recommendations from the National Academies panel, saying the phase-in framework should help stop the death toll from rising “by targeting vaccines where they are most urgently needed: to older adults in nursing homes and similar settings, as well as the front line workers who are integral to ensuring their health and wellbeing.”
But there remains a wide range of interest groups that want to make sure their constituents are also included – even if they have not garnered as much attention as the coronavirus death toll has climbed.
Dr. Elizabeth Ofili, of the Association of Black Cardiologists, joined the hearing to remind members of the out-sized toll the coronavirus has exacted on people of color, including African Americans, Hispanics and native populations. Any final plan, she advised, “should specifically prioritize ethnic minorities.”
Dr. Winston Wong, who chairs the National Council of Asian Pacific Islander Physicians, said he would consider it “a disappointing omission” if the final recommendations do not address an Asian and Pacific Islander population that he said was disproportionately represented in service sector jobs where there is a high risk of contracting COVID-19, such as low-paying health care occupations.
Others expressed concern about the potential for confusion about who, exactly, would be in such prioritized groups as educators or first responders. Scott DiMauro, a high school teacher in Ohio who spoke on behalf of the National Education Association, wanted to make sure not just teachers but librarians, janitors, and other school staff would be covered.
David Gerstner, a firefighter from Dayton, Ohio, wanted to make sure crucial components of the public safety community – like dispatchers – were covered, too. He recalled how during the H1N1 flu outbreak, some emergency responders were quick to be provided a vaccine, but others were not.
“We tried to talk through every situation,” said Dr. William Foege, an Emory University physician who is co-chair of the National Academies effort. He said the group is working as fast as possible to devise a plan that does not inadvertently omit any vulnerable population – an effort that has been especially challenging given the “overwhelming” uncertainties about a virus that is so new and unproven vaccines that are not even finished being tested.