Healthcare workers and residents in long-term care facilities should top the list of first COVID-19 vaccine recipients alongside other U.S. healthcare workers, an influential federal advisory group has concluded.

After eight months of data review and discussion, the Advisory Committee on Immunization Practices on Tuesday voted 13 to 1 to approve a statement saying that “healthcare personnel” and “long-term care residents” should be offered vaccination in the very first phase of a national vaccine rollout program. Residents include those in skilled nursing facilities and assisted living communities, they said.

Members of ACIP, which makes recommendations to the Centers for Disease Control and Prevention, said that the unusually speedy vaccine approval process presented them with weighty ethical and safety considerations.

The single dissenting voter had no objection to including healthcare workers in the recommendation, but expressed reservations that long-term safety data for elderly vaccine recipients was not yet known due to short drug trial timelines. In addition, a “solid safety surveillance network” is not in place to track possible reactions to COVID-19 vaccination in long-term care residents, said Helen Keipp Talbot, M.D., MPH, of Vanderbilt University.

Top priority: Saving lives

Many ACIP members, some of whom had earlier expressed similar concerns, said their approval was driven by the overriding importance of saving lives and preventing as much disease as possible. ACIP’s guidelines for making these recommendations include protecting people who are disproportionately affected by the disease. 

“I believe that my vote reflects maximum benefits and minimum harm, promoting justice and mitigating the health inequalities that exist in regards to the distribution of this vaccine,” said committee chair José R. Romero, M.D., FAAP, chief medical officer of the Arkansas Department of Health.

One member noted that the presence of designated federal pharmacy partners to provide the vaccines in long-term care (including Walgreens, CVS Health and coordinated groups of independent pharmacies) helped to ease concerns of an unwieldy and unmonitored vaccination process in these settings.

CDC to make recommendations

Upon receiving ACIP’s advice, the CDC will, in turn, make final vaccine allocation recommendations to states and other U.S. jurisdictions. Local officials will then choose who receives priority within their jurisdiction, federal agencies said.

“The final say will be the nation’s governors implementing the distribution plans to tell us where to ship,” Health and Human Services Secretary Alex Azar said in a briefing on vaccine deployment last week. “We hope our recommendations will carry weight with them, but at the end of the day, they will make that decision.”

Industry advocates applauded the ACIP vote and want state officials to take heed. 

“The long term care industry … now call[s] on governors from all 50 states to ensure long term care residents and staff are the first group to receive the vaccine within this initial Phase ‘1a’ distribution to save as many lives as possible,” said Mark Parkinson, president and CEO of American Health Care Association and National Center for Assisted Living, on Tuesday.