U.S. advisors recommend four phases for distributing coronavirus vaccine nationwide

The National Academies of Sciences, Engineering, and Medicine on Tuesday released a draft proposal for distributing a coronavirus vaccine in the U.S. if and when one is approved for public use.

The vaccine would be distributed in four phases, with health-care workers and vulnerable Americans, like the elderly and those with underlying health conditions, getting it first, according to the group. They devised the proposed guidelines at the request of the National Institutes of Health and Centers for Disease Control and Prevention.

The first phase would cover about 15% of the population, the group said. 

“Front line health care workers are particularly important in stemming the pandemic and preventing death and severe illness,” the group wrote in a section of the report titled “Rationale.” “From the beginning of the pandemic, many frontline workers have worked in environments where they have been exposed to the virus, often without adequate PPE.”

Phase two would include essential workers, teachers, homeless shelters as well as people in prisons, jails and detention centers. All older adults not included in phase one would be vaccinated in phase two. 

The group defines prisoner as “anyone who is deprived of personal liberty against his or her will following a conviction of a crime.”

“Data show that persons in state and federal prisons are at a 5.5-fold greater risk of Covid-19 compared to the general U.S. population,” the group wrote. 

Phase three would include young adults, children and workers in industries “essential to the functioning of society” and who are at risk of exposure to the virus. About 85% to 95% of the country would be vaccinated by the end of phase three, according to the group. Phase four would include everyone not vaccinated yet. 

As drugmakers race to find a safe and effective vaccine by the end of the year, scientists and infectious disease experts worry about who will get the vaccine first and how. The U.S. will initially have a limited supply of vaccine doses that won’t be widely available until “several months” into 2021, according to Dr. Anthony Fauci, the nation’s leading infectious disease expert

Many medical experts have said the vaccine should go to the most at-risk groups first, including health-care workers and the elderly as well as poor and minority communities, which have been disproportionately impacted by the virus. 

Earlier this month, President Donald Trump told reporters at a White House press briefing that a coronavirus vaccine should probably go to the elderly or the most vulnerable people first, though he added he would rely on a doctor’s expertise for that decision.

The National Academies noted in its draft that data has shown people of color have been disproportionately impacted by the virus.

There is no evidence that this is “biologically mediated, but rather reflects the impact of systemic racism leading to higher rates of comorbidities that increase the severity of Covid-19 infection and the socioeconomic factors that increase likelihood of acquiring infection,” the group said.

The group also said since the vaccines under development have received taxpayer funds, it is essential that the vaccines are delivered to all individuals whatever “their social and economic resources, employment, immigration or insurance status.”

The U.S., as part of the Trump administration’s Operation Warp Speed initiative, has already invested billions of dollars in six potential vaccines, including from drug companies Pfizer and Moderna, which entered phase three trials last month.

“Individuals whose legal status is uncertain should be reassured that their coming forward to receive a vaccine will not lead to deportation or be used against them in immigration proceedings.”

The group also said it was concerned late-stage trials for vaccines have excluded pregnant women, who are often at risk of adverse outcomes associated with Covid-19 than non-pregnant women.

The public can provide feedback on the framework during a four-day public comment period that begins at 12 p.m. ET on Tuesday, Sept. 1, and concludes at 11:59 p.m. ET on Friday, Sept. 4.

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