Thread by @JeromeAdamsMD

This week @cdcgov’s advisory committee on immunization practices met to discuss who should get a #COVID19 vaccine 1st- & it sparked some new questions. Here’s a🧵with some info on key groups.

ACIP recommended nursing home residents be first in line, & I STRONGLY agree... 1/?

1)Nursing home & long-term care facility residents are <1% of the population but 40% of the #COVID19 deaths, so this is truly the MOST at risk group.
2)We can more easily vaccinate them in 1 place.
3)There’s also only 1.5 million in this group vs 20 million vaccine doses.
2/?

Concerns about prioritizing nursing homes:
-Older people often don’t have as robust a response to vaccines (I’m not personally worried about this as older people were in trials, & vaccines tested showed greater than 90% efficacy- even if it drops to 75%- that’s still great).
3/?

There is also a concern that because many people spend their last days (ie die) in nursing homes anyway, we will see people die soon after vaccinations -& it will have NOTHING to do with the vaccine, but could erode public vaccine safety confidence. People need to know this. 4/?

Regarding healthcare workers:
they are on the front lines so it is natural we would want them vaccinated early.

Interestingly enough, data suggests healthcare workers mostly have rates of infection and death from #COVID19 that are lower than their surrounding communities. 5/?

But we must remember, 1 healthcare worker with COVID can potentially spread it to many other vulnerable people.

And one healthcare worker lost to #covid may mean hundreds of patients who then can’t be cared for.
That’s why this group is so important. (Also easier to vax)
6/?

More on healthcare workers:
There are over 20 million healthcare workers vs 20 million total initial vaccine doses so we can’t vaccinate all of them on first go round. Who in this group gets it first? States will decide this. 7/?

cdc.gov/coronavirus/20…

And a often overlooked point is that many (most?) healthcare workers infected with #Covid19 have been aides, techs, sanitation workers, and other support staff (i.e. lower paid and more likely to be people of color).
Will they truly be prioritized? 🤔
8/?

Children: #COVID vaccines initially will not be available for those <18. Historically vaccines are tested in adults first & once proven safe, further tested in kids -so this is normal. Kids also at lower risk for COVID complications based on what we know. Studies are ongoing. 9/?

Bottom line is that kids will likely be among the last groups to get a #covid19 vaccination. Schools can be safe, but this is a group for whom we especially need to socialize masks, as well as expectations that they will need to do it in public settings well into next year. 10/?

For pregnant women:
Again, vaccines are usually first tested in otherwise healthy adults and then tested in pregnant women. So the vaccine will not be initially approved in this group. The way we protect them is by protecting the people around them. Also get your flu shot! 11/?

In summary, I think ACIP got it right – we must immunize for impact.

And that means nursing homes and long-term care facilities followed by healthcare workers. With limited doses early on we maximize benefit by vaccinating the right people first. 12/?

We must continue encouraging people to join studies so we can learn more about #COVID vaccines in all groups- and even within the sub groups, we must keep an eye to those disproportionately affected (ie racial and ethnic groups). But help (& hope) is on the way, so hang on! FIN

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