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Who Will Get the First Doses of COVID-19 Vaccines?

Now that there are three coronavirus vaccines with promising data, an advisory panel is figuring out who gets the COVID-19 vaccine first. The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC) just released its first guidelines on how the panel is making this crucial decision—and noted four groups who will likely receive the earliest vaccine doses.

Vaccines in development from Pfizer, Moderna, and AstraZeneca all appear to be effective at preventing symptomatic COVID-19 infections in early data, according to reports from the companies. And experts say the first doses of at least one of those vaccines may be available by the end of 2020. But there will likely be a limited amount of doses at first, meaning ACIP will have to advise the CDC as well as local governments and public health authorities on how to prioritize high-risk groups and effectively distribute the vaccine.

The panel is using four ethical principles to make its decision about who gets the COVID-19 vaccine first while doses are limited, according to a new report published this week. Those principles include maximizing benefits and limiting harms (meaning prioritizing groups of people who will get the greatest benefit from a vaccine), promoting justice (including removing barriers to health care that could prevent people in high-risk groups from getting the vaccine), mitigating health inequities (which involves prioritizing the needs of those in certain racial or socioeconomic groups that are disproportionately affected by the virus), and promoting transparency about the plans for allocating the vaccine.

Based on these ethical principles as well as scientific evidence and considerations about the best ways to actually deliver the vaccine, ACIP determined that four groups of people should have first access to the vaccine:

  • Health care personnel, which includes an estimated 21 million people working in health care settings.
  • Other essential workers, including 87 million people “who conduct operations vital for continuing critical infrastructure,” such as those who work in food, transportation, and education.
  • Adults with underlying health conditions (such as diabetes and heart disease) that put them at a higher risk for COVID-19 complications, which could include more than 100 million people.
  • Adults over the age of 65, who are also considered to be high-risk, which includes about 53 million people.

While the vaccine is limited, “the benefits of vaccination will be delayed for some persons,” the panel’s report says. “However, as supply increases, there will eventually be enough vaccine for everyone.” Ultimately, there will be enough vaccine doses available in the U.S. for anyone who wants one (likely by mid-2021). But getting to that point will take time—and we’ll have to keep up the other public health strategies we have in the meantime, including wearing masks in public, social distancing, avoiding crowds, and washing our hands frequently.

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