Now that federal advisers have voted to recommend that long-term care facility residents be first in line to receive the first COVID-19 vaccinations alongside healthcare workers, the single dissenting voter is explaining her concerns.

Loss of confidence in the vaccine could be a problem, Helen Keipp Talbot, M.D., MPH, told medical news outlet STAT. Talbot, who studies vaccines in older adults, had no objection to recommending that healthcare workers be the first immunized group, but she did object to long-term care facility residents being in the first wave. 

Although the vaccine may be safe, comorbidities in the resident population make it likely that recipients will experience symptoms or death from unrelated causes that will be incorrectly associated with the vaccine, said last Tuesday in a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Lack of data is also an issue, Talbot said. Vaccines often are not tested in the vulnerable elderly, and this creates risk for these recipients, she explained. Although older adults were included in the COVID-19 vaccine trials under review, long-term care facility residents were not.

“We need to quit assuming that these vaccines work and actually design them and test them in this population and use them appropriately,” she told STAT.

“If I know it works in a healthy health care worker, I’d rather get all the health care workers vaccinated, so that when they are around the frail elderly, they don’t get the frail elderly sick.”

In addition, a “solid safety surveillance network” is not in place to track possible reactions to COVID-19 vaccination in long-term care residents, Talbot said during the ACIP meeting. 

Talbot, of Vanderbilt University Medical Center, was the lone dissenting vote out of 14 independent ACIP experts who advise the CDC on vaccine approvals.

Her colleagues’ overwhelming decision was based in large part on the outsized number of deaths among long-term care residents, Talbot told STAT. “The number of deaths in that population is far out of proportion to the number infected. And that was the driving reason for that vote,” she said.