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Frontline healthcare workers, emergency services personnel, and the most vulnerable to the virus should be the first to get any eventual coronavirus vaccine, experts recommend in a new report released Wednesday.
People working to make and distribute the vaccine should also be first in line to get one, the team at the Johns Hopkins Center for Health Security recommends.
"The primary reason for including these candidate groups within Tier 1 is that their prioritization would likely avert the greatest overall harm," the Center's report reads.
According to the World Health Organization, 29 vaccines are in human trials around the world; four of them in the US. Federal government health officials say they expect to know whether one or more of them works safely by the end of the year and hope to start distribution sometime at the beginning of next year. But while companies are already ramping up production in case a vaccine does work, there will not be enough to vaccinate everyone right away.
"It may take many months before most US residents have access to vaccination; bottlenecks at various stages of the vaccine manufacturing process (eg, supply of vials or syringes, fill and finish process) could cause further delays in vaccine availability," the report reads.
The US Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices and the National Academy of Medicine are studying the issue of who should get one first.
The Johns Hopkins team, which included health security experts, vaccine researchers, bioethicists, and specialists in patient safety and vaccine access, wanted to inform the discussion.
"It is important to emphasize that we are not providing a set of definitive recommendations about who should be prioritized for vaccination," they cautioned. But they said their candidate groups should be given serious consideration.
Even within priority groups, there will have to be rankings. "There will likely not be enough vaccine supply for all members of Tier 1 candidate groups to be offered vaccines concurrently," the report reads.
First in line: "Those most essential in sustaining the ongoing COVID-19 response," they suggested. After that would come those most essential to maintaining "core societal functions," such as teachers, public transportation workers, and food supply workers.
Also at the front: people most at risk of severe illness or death and their caregivers. It might be more important to vaccinate caregivers, they said, because some at-risk people might not be able to safely get a vaccine, or might not develop a robust immune response.
In the second tier should come health workers not directly involved in the coronavirus response; pharmacy staff; people living far away from health care; electricity, sanitation, and other key workers; delivery staff; deployed military; and police.
"Vaccination will not eradicate SARS-CoV-2 from the planet, and COVID-19 is likely to become an endemic disease, even after widespread vaccination, due to the occurrence of sporadic cases and occasional outbreaks," the report cautions.
There are also cost considerations. "Although there may be no out-of-pocket cost for the vaccine itself for most people (this has not yet been established), related costs—such as travel to a vaccination location or the need to take off from work—could create a financial hurdle for some," the report notes. "More investment and innovation are needed to offer vaccinations at nontraditional sites that are convenient, familiar, and feel safe to many vulnerable and underrepresented populations."
The federal government must coordinate vaccination efforts and make sure policies are equally applied. It's vital that people trust the process is fair and safe, the report says.
It's vital to do it right, the Johns Hopkins team said.
"What is done early in a vaccination campaign will have implications for every aspect of our personal and public life," they wrote.
"We risk-reducing confidence in government, as well as our public health and healthcare systems if the allocation, distribution, and administration of the vaccine is not handled appropriately and clearly communicated," they added.
"If, on the other hand, an allocation strategy is ethical, nationally consistent, fair, and informed by key constituency groups, then vaccination campaign is more likely to go smoothly and be accepted by the public, which would result in many lives saved and faster economic recovery."