Thursday, December 10, 2020

‘So many unknowns’: Local doctors—and pharmacies—will still decide who gets COVID-19 vaccines

Frontline COVID-19 responders like nurse practitioner Charlotte Thomas at Scripps Mercy Hospital in Chula Vista, California, likely will soon have the chance to receive a vaccine against the disease, but shortages of vaccine doses will complicate deciding who goes next, even among health care workers. Marcus Yam/Los Angeles Times via Getty Images

Jon Cohen
Science Mag

When it comes to prioritizing who should receive the first COVID-19 vaccines in the Unites States and delivering the required doses, “we got a lot of work to do,” President-elect Joe Biden said at a press conference on 4 December. About 1 week from now, if the U.S. Food and Drug Administration authorizes the COVID-19 vaccine made by Pfizer and BioNTech for emergency use as expected, the initial doses of it should begin to reach hospitals like the five run by Scripps Health in San Diego, which Chief Medical Officer Ghazala Sharieff oversees.

And because the demand will surely outstrip supply for many months, the government has asked its vaccine advisers to recommend to Sharieff and her medical colleagues around the country who should go first. Converting those recommendations into practice at the hospital, clinic, or pharmacy level presents many quandaries, especially when it’s not yet clear how many doses will go to each location. “If we get 4000 doses for the hospital system, that’s going to be very constrained,” Sharieff says. (Both the Pfizer-BioNTech vaccine and a second one from Moderna, which this month could also be authorized for emergency use, require two doses.)

The U.S. Centers for Disease Control and Prevention (CDC) has sketched out a prioritization scheme that starts with three phases. On 1 December, its independent Advisory Committee on Immunization Practices (ACIP) nearly unanimously endorsed CDC’s proposal for phase 1a, which calls for initially offering a vaccine to about 21 million heath care workers and 3 million residents of long-term care facilities. But a debate is growing on the order of the next two phases, 1b and 1c, which ACIP has not yet voted on. For phase 1b, CDC suggests vaccinating “essential workers” like teachers, meat packers, police, and bus drivers. Phase 1c in this plan would be adults over age 65 and adults of any age who have high-risk medical conditions. Immunizing essential workers could curb the spread of COVID-19 the most, but the latter group is at greater risk of dying from the disease.  Read more >>