Professional Documents
Culture Documents
ACIP COVID-19 Vaccines Work Group
ACIP COVID-19 Vaccines Work Group
Phased Allocation
of COVID-19 Vaccines
Kathleen Dooling, MD, MPH
ACIP meeting
December 20, 2020
Frontline
HCP
65-74 years (32M)
LTCF
75+ years (21M)
Implementation Ethics
12
Science
Implementation Ethics
Science
COVID-19 incidence is highest in young adults
National Estimate of COVID-19 Incidence per 100,000 Population,
by Age Group – Data through Dec 16, 2020
85+ 5064
75-84 3147
65-74 2977
Age Group (Years)
50-64 3993
40-49 4543
30-39 4671
18-29 5489
5-17 1944
0-4 1135
*Data sources: CDC COVID-19 data tracker. Population estimates from 2019 US Census Bureau. Data provisional, subject to change.
COVID-19 mortality rates are highest in older adults
National Estimate of COVID-19 Deaths per 100,000 Population, by
Age Group – Data through Dec 16, 2020
85+ 1,118.3
75-84 366.2
65-74 143.5
Age Group (Years)
50-64 50.6
40-49 15.7
30-39 6.3
18-29 2.2
5-17 0.2
0-4 0.3
*Data sources: CDC COVID-19 data tracker. Population estimates from 2019 US Census Bureau. Data provisional, subject to change.
Although overall mortality increases with age, the proportion of deaths
associated with COVID-19 is similar across middle-age and older adults
Deaths from All Causes and Deaths Involving COVID-19, by Age Group
Data through Dec 16, 2020
900000
800000
700000
Number of deaths
600000
500000
400000
300000
200000
11% 10%
100000 9% 10%
9%
0
15–24 25–34 35–44 45–54 55–64 65–74 75–84 85+
Age Group (years)
75+ 25%
Age Group (Years)
55-74 39%
35-54 25%
15-34 12%
0 5 10 15 20 25 30 35 40 45
Percent of COVID-19 Hospitalizations
Data Source: COVID-19 associated hospitalizations reported to Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) surveillance system. COVID-NET is a
population-based surveillance system that collects data on laboratory-confirmed COVID-19-associated hospitalizations among children and adults through a network of over 250 acute-care hospitals in 14 states.
COVID-19-associated hospitalization rates are highest
in older adults
COVID-19-Associated Hospitalization Rates per 100,000 population
Preliminary Weekly Rates as of Dec 5, 2020
120
0-4 yr 5-17 yr 8-49 yr 50-64 yr 65-74 yr 75-84 yr ≥85 yr
Hospitalization rates per 100,000
80
60
40
20
0
10 15 20 25 30 35 40 45
MMWR Week
CI: Confidence Interval; COVID-NET: Coronavirus Disease 2019-Associated Hospitalization Surveillance Network
aModel for number of conditions (variable) is adjusted for age, sex, and race/ethnicity
bReference group is no underlying medical condition; Number of conditions is a sum of underlying medical conditions excluding hypertension; the most recent
10.98
85+ years vs 18–39 years
7.67
75–84 years vs 18–39 years
5.77
65–74 years vs 18–39 years
3.11
50–64 years vs 18–39 years
Male 1.3
Immunosuppression 1.39
Renal disease 1.33
Chronic Lung Disease 1.31
Cardiovascular Disease 1.28
Neurologic disorder 1.25
Diabetes 1.19
-5 0 5 10 15 20
Adjusted Rate Ratios and 95% Confidence Intervals
*COVID-NET Surveillance; Final model adjusted for age, sex, race/ethnicity, smoker, hypertension, obesity, diabetes, chronic lung disease, cardiovascular disease, neurologic
disease, renal disease, immunosuppression, hematologic disorders, and rheumatologic or autoimmune disease. Kim et al, 2020, https://academic.oup.com/cid/advance-
article/doi/10.1093/cid/ciaa1012/5872581 17
Percent seropositive for SARS-CoV-2 IgG antibody, by occupation among
workers in public service agencies — New York City, May–July 2020
High seroprevalence
among many
frontline essential
workers groups
following first wave
of pandemic in NYC
Other includes Dietary Service Staff, Environmental Service Staff and participants who selected Other and were not reassigned to an existing category
Other Health includes Student/Trainee, Respiratory Therapist, Occupational/Speech/Physical Therapist, Therapy Aide/Assistant, Pharmacist, Diagnostic Imaging Technician, Phlebotomist,
Medical Registrar, Orderly, Dietician, Dentist, Clinical Technician, Medical Assistant. Sami et al.Manuscript in preparation.
Half of essential workers are older than 40 years
1. Data Source: American Community Survey, 2019 2. Data source: 2019 Behavioral Risk Factor Surveillance System
Summary of Work Group interpretation: Modeling
In the scenarios considered, differences between strategies is minimal
– Vaccinating older adults first averts slightly more deaths, vaccinating younger adults first
(essential workers or younger adults with high-risk conditions) averts slightly more
infections
– Ethical principles and implementation considerations also contribute to selecting the
optimal sequence in Phase 1b and 1c
Largest driver of impact in averted deaths and infections is the timing of vaccine
introduction in relation to increases in COVID-19 cases
– Emphasizes the need to continue non-pharmaceutical interventions (e.g. wearing a mask,
social distancing to prevent cases so vaccine can have maximum impact)
Vaccine’s ability to prevent transmission will further inform future modeling analysis and
interpretation
Modeling Strategies for the initial Allocation of SARS-CoV-2 Vaccines https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-10/COVID-Biggerstaff.pdf
Impacts of COVID-19 not represented in models:
Late Sequelae of COVID-19
Most commonly reported symptoms include:
fatigue, dyspnea, cough, arthralgia, and chest pain
More serious complications appear to be less common but have been reported:
Cardiovascular: myocardial inflammation, ventricular dysfunction
Respiratory: pulmonary function abnormalities
Renal: acute kidney injury
Dermatologic: rash, alopecia
Neurological: olfactory and gustatory dysfunction, sleep dysregulation, altered cognition,
memory impairment
Psychiatric: depression, anxiety, changes in mood
Implementation Ethics
Implementation
ACIP COVID-19 Vaccine Work Group: Proposed Guiding Principles
E
Q Inclusive clinical trials. Study participants should reflect groups at risk for
COVID-19 to ensure safety and efficacy data are generalizable
U
I
T Efficient Distribution. During a pandemic, efficient, expeditious and
equitable distribution and administration of approved vaccine is critical
Y
Flexibility. Within national guidelines, state and local jurisdictions should have
flexibility to administer vaccine based on local epidemiology and demand
ACIP COVID-19 Vaccine Work Group: Proposed Guiding Principles
1. 2. AP
-NORC Center for Public Affairs Research. Many remain doubtful about getting COVID-19 vaccine. December
2020.https://apnorc.org/projects/many-remain-doubtful-about-getting-covid-19-vaccine.3. ABC/IPSOS poll. December 14,
2020.https://www.ipsos.com/en-us/news-polls/abc-news-coronavirus-poll.
Feasibility
Essential workers
Challenge: reaching workers in rural locations, shift workers, those working multiple jobs or
working in small cohorts
Jurisdiction approaches include on site occupational clinics/pharmacies/Health Dept POD
strike teams
Population surveys report 68% - 87% of respondents supported prioritization of early
allocation of COVID-19 vaccine supply to essential workers (eg. police/fire/rescue and
teachers)1-3
Implementation Ethics
Ethics
Older Adults
Ethical Principle Age 75+ years (21M) Age 65-74 Years (32M)
Maximize benefits and Reduces morbidity and mortality in persons with moderate to high burden of
minimize harms COVID-19 associated hospitalization and death
Promote justice Will require focused outreach to those with limited or no access to healthcare
This represents an interim Phase 1 sequence– allocation policy will need to be dynamic and adapt
as new information such as vaccine performance and supply and demand become clear
Gating criteria will be necessary to move expeditiously from one Phase to the next, if supply
exceeds demand
Following vaccination, measures to stop the possible spread of SARS-CoV-2, such as masks and
social distancing, will still be needed
The U.S. government is committed to making COVID-19 vaccines available to all residents, as
soon as possible
Proposed Phase 1 & 2 allocation, December 2020
Number of Number of unique*
persons in each persons in each Total*
group group
Phase Groups recommended for vaccination (millions) (millions) (millions)
1a Health care personnel 21 21
Long-term care facility residents 3 3 24
1b Frontline essential workers 30 30
Persons aged 75 years and older 21 19 49
1c Persons aged 65 -74 years 32 28
Persons aged 16 -64 years with high-risk conditions 110 81
129
Essential workers not recommended in Phase 1b 57 20
Frontline
HCP
65-74 years (32M)
LTCF
75+ years (21M)
The findings and conclusions in this report are those of the authors and do not necessarily represent the
official position of the Centers for Disease Control and Prevention.