Plan: Nursing homes, health staffs to get first doses of virus vaccine

FILE - In this March 16, 2020, file photo, vials used by pharmacists to prepare syringes used on the first day of a first clinical trial of the potential vaccine for COVID-19 rest on a lab table at the Kaiser Permanente Washington Health Research Institute in Seattle. An influential scientific panel on Tuesday, Dec. 1, is set to tackle one of the most pressing questions in the U.S. coronavirus epidemic: When the first doses of COVID-19 vaccine become available, who should be at the front of the line for shots? (AP Photo/Ted S. Warren, File)
FILE - In this March 16, 2020, file photo, vials used by pharmacists to prepare syringes used on the first day of a first clinical trial of the potential vaccine for COVID-19 rest on a lab table at the Kaiser Permanente Washington Health Research Institute in Seattle. An influential scientific panel on Tuesday, Dec. 1, is set to tackle one of the most pressing questions in the U.S. coronavirus epidemic: When the first doses of COVID-19 vaccine become available, who should be at the front of the line for shots? (AP Photo/Ted S. Warren, File)

NEW YORK -- The first doses of a coronavirus vaccine should be given to an estimated 21 million health care workers and 3 million residents and staff members of nursing homes and other long-term-care facilities, a federal advisory panel recommended Tuesday afternoon.

Those groups were deemed the highest priority by the Advisory Committee on Immunization Practices because the vaccine will initially be in short supply after it is cleared by federal regulators. Health care personnel are a top priority because of their exposure to the virus and their critical role in keeping the nation's hospitals and clinics functioning.

Residents and employees of long-term-care facilities were prioritized because they account for nearly 40% of deaths linked to covid-19, the disease caused by the coronavirus.

The recommendations for the highest priority groups, known as Phase 1A, will be sent to Robert Redfield, director of the Centers for Disease Control and Prevention, who also informs Health and Human Services Secretary Alex Azar. If the recommendations are approved, they will become official CDC recommendations on immunization in the United States and provide guidance to state officials, who are working to meet a Friday deadline for vaccine-distribution planning.

The panel voted 13-1 to recommend that those groups get priority in the first days of any coming vaccination program, when doses are expected to be limited. The two groups encompass about 24 million people.

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Later this month, the Food and Drug Administration will consider authorizing emergency use of two vaccines made by Pfizer and Moderna. Current estimates project that no more than 20 million doses of each vaccine will be available by the end of this year. And each product requires two doses. As a result, the shots will be rationed in the early stages.

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The Advisory Committee on Immunization Practices will meet again at some point to decide who should be next in line. Among the possibilities: teachers, police officers, firefighters and workers in other essential fields such as food production and transportation; the elderly; and people with underlying medical conditions.

Tuesday's action merely designated who should get shots first if a safe and effective vaccine becomes available. The panel did not endorse any particular vaccine. Panel members are waiting to hear the FDA's evaluation and to see more safety and efficacy data before endorsing any particular product.

Experts say the vaccine will probably not become widely available in the U.S. until the spring.

As the virtual meeting got underway, panel member Dr. Beth Bell of the University of Washington noted that on average, one person is dying of covid-19 per minute in the U.S. right now, "so I guess we are acting none too soon."

About 3 million people are living in nursing homes, long-term chronic care hospitals, and other U.S. long-term-care facilities. Those patients and the staff members who care for them have accounted for 6% of the nation's coronavirus cases and a staggering 39% of the deaths, CDC officials say.

Despite the heavy toll, some board members at Tuesday's meeting said they hesitated to include such patients in the first group getting shots.

Dr. Helen Keipp Talbot, an infectious-diseases researcher at Vanderbilt University who was the lone committee member to vote against the proposal, cited flu research that found that vaccinating the staff of long-term-care facilities has the greatest impact on preventing its spread there.

Dr. Richard Zimmerman, a University of Pittsburgh flu vaccine researcher who watched the meeting online, echoed Talbot's concerns.

"I think it was premature" to include nursing home residents as a priority group, said Zimmerman, a former Advisory Committee on Immunization Practices member. "Their vote seems to assume that these people will respond well to the vaccine. ... I don't think we know that."

Committee members were unanimous in voicing support for vaccinating health care workers -- about 21 million people, according to CDC officials.

EMERGENCY MEETING

For months, members of the immunization panel had said they wouldn't take a vote until the FDA approved a vaccine, as is customary. But last week, the group scheduled an emergency meeting.

The panel's chairman, Dr. Jose Romero, said the decision stemmed from a realization that the states are facing a Friday deadline to place initial orders for the Pfizer vaccine and determine where they should be delivered. The committee decided to meet now to give state and local officials guidance, he said.

But some panel members and other experts had also grown concerned by comments from Trump administration officials that suggested differing vaccine priorities.

Dr. Deborah Birx of the White House coronavirus task force said in a meeting with CDC officials last month that people 65 and older should go to the head of the line, according to a federal official who was not authorized to discuss the matter and spoke to The Associated Press on condition of anonymity.

Then last week Azar stressed that ultimately governors will decide who in their states get the shots. Vice President Mike Pence echoed that view.

Asked whether Azar's comment played a role in the scheduling of the meeting, Romero said: "We don't live in a bubble. We know what he said. But that wasn't the primary reason this is being done."

Health and Human Services Department officials have said they will distribute initial doses to states based on population, and it's possible that some states won't receive enough to cover all of their health-care workers and nursing home residents.

CDC officials said they are optimistic that such shortages will last only a few weeks.

Still, governors and local officials may have to decide which health care workers or regions get shots first, said Jason Schwartz, a professor of health policy at the Yale School of Public Health.

"It's up to states to figure out the more granular detail," he said.

Additionally, Stephen Hahn, the head of the FDA said Tuesday that the agency would take the time needed to "get this right," despite increasing pressure from President Donald Trump to speed up the process.

"No one at FDA is sitting on his or her hands. Everyone is working really hard to look at these applications and get this done," Stephen Hahn, the head of the FDA, told ABC in an interview on Instagram Live. "But we absolutely have to do this the right way."

Hahn's comments came not long after he was summoned to the White House by Trump's Chief of Staff Mark Meadows as the agency weighs this week's decision to allow emergency use of the first vaccines that could begin the long road to defeating the coronavirus in the U.S.

FIELD HOSPITALS

During the resurgence in the coronavirus, states have begun reopening field hospitals to handle an influx of patients that is pushing health care systems -- and their workers -- to the breaking point. Hospitals are bringing in mobile morgues. And funerals are being live-streamed or performed as drive-by affairs.

Health officials fear the crisis will be even worse in coming weeks, after many Americans ignored pleas to stay home over Thanksgiving and avoid people who don't live with them.

"I have no doubt that we're going to see a climbing death toll ... and that's a horrific and tragic place to be," said Josh Michaud, associate director of global health policy at the Kaiser Family Foundation. "It's going to be a very dark couple of weeks."

Nearly 37,000 Americans died of covid-19 in November. That toll was far lower than the 60,699 recorded in April but perilously close to the next-highest total of almost 42,000 in May, according to data compiled by Johns Hopkins University. Deaths had dropped to just over 20,000 in June after states closed many businesses and ordered people to stay home.

The fast-deteriorating situation is particularly frustrating because vaccine distribution could begin within weeks, Michaud said.

The outbreak in the U.S. has killed more 270,000 people and caused more than 13.7 million confirmed infections, with deaths, hospitalizations and cases rocketing in recent weeks.

QUARANTINE TIME

As virus cases rise across the nation, the CDC is set to shorten the recommended length of quarantine after exposure to someone who is positive for covid-19.

According to a senior administration official, the new guidelines will allow people who have come in contact to someone infected with the virus to resume normal activity after 10 days, or 7 days if they receive a negative test result. That's down from the 14-day period recommended since the onset of the pandemic.

The official, who spoke on the condition of anonymity to preview the announcement, said the policy change has been discussed for some time, as scientists have studied the incubation period for the virus. The policy would hasten the return to normal activities by those deemed to be "close contacts" of those infected with the virus.

While the CDC had said the incubation period for the virus was thought to extend to 14 days, most individuals became infectious and developed symptoms between four and five days after exposure.

The new guidance was presented Tuesday at a White House coronavirus task force meeting for final approval.

EUROPEAN EFFORTS

Separately, the European Union drug agency said Tuesday that it may need four more weeks to approve its first coronavirus vaccine, even as authorities in the United States and Britain continue to aim for a green light before Christmas.

The European Medicines Agency plans to convene a meeting by Dec. 29 to decide if there is enough safety and efficacy data about the vaccine developed by Pfizer and BioNTech for it to be approved. The regulator also said it could decide as early as Jan. 12 whether to approve a rival shot by American pharmaceutical company Moderna Inc., which submitted its request to U.S. and European regulators this week.

If its vaccine is approved, Germany-based BioNTech said the shot's use in Europe could begin before the end of this year -- but that seems quite ambitious, given that the EU Commission usually needs to rubber-stamp the regulator's decision. Still, the agency has also left open the possibility that the date of that meeting will be brought forward if data comes in faster.

Any approval granted by the European regulator will be conditional on companies submitting further information to confirm that the vaccine's benefits outweigh the risks.

On Tuesday, officials in Germany, France and the Netherlands cautioned that vaccine programs likely won't start until the end of the year.

"With the information we got in recent days we have to assume that approval will only happen around the turn of the year," German Health Minister Jens Spahn said.

"It has moved because some studies obviously need a little longer to be submitted," he said. "What's important is to be prepared."

Information for this article was contributed by Mike Stobbe, Frank Jordans, Maria Cheng, Samuel Petrequin, Kirsten Grieshaber, Mike Corder, Sylvie Corbet, Zeke Miller, Jonathan Lemire, Jill Colvin, Matthew Perrone, Tammy Webber, Heather Hollingsworth, Alan Clendenning, David Caruso, Jeff McMillan and Juliet Williams of The Associated Press; and by Lena H. Sun and Isaac Stanley-Becker of The Washington Post.

FILE - In this July 27, 2020, file photo, Nurse Kathe Olmstead, right, gives volunteer Melissa Harting, of Harpersville, N.Y., an injection as a study of a possible COVID-19 vaccine, developed by the National Institutes of Health and Moderna Inc., gets underway in Binghamton, N.Y. An influential scientific panel on Tuesday, Dec. 1, is set to tackle one of the most pressing questions in the U.S. coronavirus epidemic: When the first doses of COVID-19 vaccine become available, who should be at the front of the line for shots? (AP Photo/Hans Pennink, File)
FILE - In this July 27, 2020, file photo, Nurse Kathe Olmstead, right, gives volunteer Melissa Harting, of Harpersville, N.Y., an injection as a study of a possible COVID-19 vaccine, developed by the National Institutes of Health and Moderna Inc., gets underway in Binghamton, N.Y. An influential scientific panel on Tuesday, Dec. 1, is set to tackle one of the most pressing questions in the U.S. coronavirus epidemic: When the first doses of COVID-19 vaccine become available, who should be at the front of the line for shots? (AP Photo/Hans Pennink, File)
FILE - In this March 16, 2020, file photo, pharmacist Michael Witte holds a tray with a syringe containing a shot that will be used in the first clinical trial of a potential vaccine for COVID-19 at the Kaiser Permanente Washington Health Research Institute in Seattle. An influential scientific panel on Tuesday, Dec. 1, is set to tackle one of the most pressing questions in the U.S. coronavirus epidemic: When the first doses of COVID-19 vaccine become available, who should be at the front of the line for shots? (AP Photo/Ted S. Warren, File)
FILE - In this March 16, 2020, file photo, pharmacist Michael Witte holds a tray with a syringe containing a shot that will be used in the first clinical trial of a potential vaccine for COVID-19 at the Kaiser Permanente Washington Health Research Institute in Seattle. An influential scientific panel on Tuesday, Dec. 1, is set to tackle one of the most pressing questions in the U.S. coronavirus epidemic: When the first doses of COVID-19 vaccine become available, who should be at the front of the line for shots? (AP Photo/Ted S. Warren, File)

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