The FDA has approved both the Pfizer and the Moderna COVID-19 vaccines for emergency use in the US, and the first wave of shipments has been arriving at facilities across the country. Public officials estimate that around 40 million doses will be available by the end of the month, which would be enough for about 20 million people to get vaccinated with two doses administered 21 days apart.
When recommending these drugs for emergency approval, the Vaccine Advisory Committee told the FDA that the first shipments should be reserved for healthcare workers and elderly nursing home residents, which amounts to around 24 million people.
Clearly, there won’t be enough vaccines to go around during the first wave of shipments. It’s up to the states and individual facilities to decide who gets the drug first, using the guidelines. As the first doses go out, many different kinds of healthcare workers are advocating for their right to get vaccinated as soon as possible.
So, exactly who is included in the first round of shipments?
The Vaccine Advisory Committee Speaks
When the committee issued its ruling earlier this month, it offered a broad definition of healthcare worker that includes roughly 21 million people working in a range of settings and functions, including doctors, nurses, cafeteria and food service workers, custodians, and other essential employees.
Members of the committee widely agreed that the first doses should go to healthcare workers, but the language they used was vague at best.
“Broadly speaking, the intent was how do we preserve health-care capacity?” said Grace Lee, a member of the CDC’s Advisory Committee on Immunization Practices and associate chief medical officer for practice innovation at Stanford Children’s Health.
Public health professionals wanted to make sure doctors and nurses were well enough to continue the fight against the pandemic, considering the U.S. is already in the middle of a provider shortage.
In addition to preventing serious illness, it’s also about preventing the spread of the virus among healthcare workers. “You want to keep other patients from becoming sicker and then putting a strain on the healthcare system, so it would make sense to try to prevent those workers from becoming sick with COVID as well,” Lee said.
However, Lee says these guidelines were meant to be flexible, so institutions and communities could implement the vaccine as they see fit. “Health care is very local in some ways and so you have to be able to respond to what is critical and important on the ground,” she added.
To Each State Their Own
With not enough vaccines to go around to every healthcare worker during the first round of shipments, states and institutions have had to make tough decisions.
In New York for example, facilities have been told they must prioritize ICU and ER staff when administering the first doses of the vaccine.
In California, dentists and oral healthcare providers are advocating for their right to get vaccinated. The California Dental Association (CDA) sent out a memo urging state officials to include them in the first round of doses, after some dentists and oral hygienists expressed their concern that they may be overlooked in some cities and counties across the state.
The American Dental Association has weighed in on the matter, saying it believes dentists should be included, but that other healthcare workers will likely come first.
In Colorado, the state changed its guidelines to include anyone that has close direct contact with coronavirus patients for more than 15 minutes, which will include a wide variety of health workers, regardless of where they work.
Alison Whelan, the chief medical education officer of the Association of American Medical Colleges, which oversees a wide variety of medical schools, has been caught up in the fight to include med students in the first wave of vaccines.
“Health centers have to follow the state rules and different states are interpreting the CDC guidelines differently,” Whelan said. “There are some that are saying, ‘Yes, students are essential healthcare workers and should be included as you do the first round.’ Others have said that they’re students, more like college students, and should fall in that line, which we don’t agree with.”
Some in the industry have said medical students should wait their turn at the back of the line, while others strongly disagree, stating that students do come in contact with COVID-19 patients.
Janis Orlowski, the chief healthcare officer at AAMC, says:
“As we take a look at these last couple of weeks where hospitals quite frankly are flooded with patients and we need all hands on deck, what we know, which has been true in the past, is that students, even though they’re in a learning environment, they have very good skills, especially the more senior medical students.”
In Texas, a battle has erupted over whether school nurses should be included in the first round of vaccinations and in New York, home healthcare workers had been fighting to be included in the first round. They recently won their fight to make the vaccination list after a lengthy public dispute with officials.
“We were very vocal going to [the] governor, going to other government officials saying we should be treated as frontline workers,” said Joe Pecora Jr., vice president of Home Healthcare Workers of America. “It was very good news to find out that we are eligible for phase one.”
It’s clear that many healthcare workers are eager to get the vaccine. However, some may have to wait until the New Year.