Phase 1 allocation COVID-19 vaccine: Work Group considerations - PowerPoint PPT Presentation

ACIP COVID-19 Vaccines Work Group Phase 1 allocation COVID-19 vaccine: Work Group considerations Kathleen Dooling, MD MPH September 22, 2020 For more information: www.cdc.gov/COVID19

Work Group Considerations: Goals of the COVID-19 Vaccine Program  Ensure safety and effectiveness of COVID-19 vaccines  Reduce transmission, morbidity, mortality of COVID-19 disease  Help minimize disruption to society and economy, including maintaining healthcare capacity  Ensure equity in vaccine allocation and distribution

Work Group Considerations: Proposed Guiding Principles Safety is paramount . Vaccine safety standards will not be compromised in efforts to accelerate COVID-19 vaccine development or distribution E Inclusive clinical trials . Study participants should reflect groups at risk for Q COVID-19 to ensure safety and efficacy data are generalizable U I Efficient Distribution . During a pandemic, efficient, expeditious and T equitable distribution and administration of approved vaccine is critical Y Flexibility . Within national guidelines, state and local jurisdictions should have flexibility to administer vaccine based on local epidemiology and demand

Administration of COVID-19 vaccine will require a phased approach Limited Doses Available Large Number of Doses Available Continued Vaccination Projected short period of time for when doses are limited Volume doses available (per month) • Likely sufficient supply to meet demand • Sufficient supply to meet demand • Constrained supply, central distribution • Additional vaccine products allow a wider range • Cold chain & handling may require specialized Key of administration locations equipment and high throughput factors • Harness vaccine provider networks with • Broad administration network required Phase 1a: Healthcare personnel proven ability to reach critical (pharmacies, doctors offices, public health Likely populations clinics, mobile clinics, FQHCs) admin Phase 1b may include: Essential Workers, • Enhance series completion • Focus on increasing access for critical strategies High risk Medical Conditions, Adults 65+ populations

Possible groups for Phase 1 vaccination August ACIP meeting Phase 1a: -HCP High Risk Medical Conditions Phase 1b: Essential workers >100M -Essential Workers ~80M -High Risk Med Conditions - Adults ≥ 65 years old Healthcare personnel September ACIP meeting ~20M -Explore groups for phase 1b -risk for COVID-19 -overlap between groups Adults ≥ 65 years old -racial and ethnic composition ~53M -Summary of Work Group considerations

Questions: 1) If constrained vaccine supply necessitates High Risk Medical Conditions sequencing of groups in >100M Essential workers Phase 1b, what are the most ~80M important information gaps Healthcare we need to fill for ACIP to personnel make sequencing ~20M recommendations? Adults ≥ 65 years old 2) What is the correct balance ~53M of national guidance and local flexibility?

Phase 1a: Healthcare personnel

Estimated Healthcare personnel ~17-20M Population  All paid and unpaid persons serving in healthcare Examples: settings who have the potential for direct or  Hospitals indirect exposure to patients or infectious materials  Long term care facilities (assisted living facilities & skilled nursing facilities)  Includes persons not directly involved in patient  Outpatient care but potentially exposed to infectious agents  Home health care while working in a healthcare setting  Pharmacies  EMS  Public health https://www.bls.gov/ooh/healthcare/home.htm

Healthcare personnel: Summary of Work Group Considerations BENEFITS EQUITY VALUES FEASIBILITY ACCEPTABILITY & HARMS - ↑ representation of -HCPS included as early -Large health systems have -Moderate/high rates ? some racial minority phase group in all values- occupational health depts to of influenza vaccine groups in subsets of based allocation facilitate vaccine clinics acceptance. Support HCPs frameworks considered -May have -80C freezers -high scientific literacy -LTCF -home healthcare -Rural and LTCF, small clinics, ? home healthcare workers may be difficult to reach Challenge

Phase 1b: Essential workers (non-healthcare)

Estimated Essential Workers ~60M Population (non-Healthcare)  Workers who are essential to continue critical Examples: infrastructure and maintain the services and  Food & Agriculture functions Americans depend on daily  Transportation  Education  Workers who cannot perform their duties remotely  Energy and must work in close proximity to others should  Water and Wastewater be been prioritized  Law Enforcement  Sub-categories of essential workers may be prioritized differently in different jurisdictions depending on local needs https://www.cisa.gov/publication/guidance-essential-critical-infrastructure-workforce

Essential Workers (non-healthcare): COVID-19 Risk  By July 2020, 23 states reported outbreaks in 239 meat or poultry processing plants, resulting in ~16,000 cases in workers 1 9% of workers diagnosed as cases by May (range =3%- 25%) –  By mid- September, Corrections and Detention Facilities reported ~126,000 cases in residents and ~27,000 cases in staff 2 In an analysis of 16 U.S. prisons and jails, 56% identified their first case of COVID -19 among – staff members as opposed to incarcerated/detained persons 3  In NYC, seroprevalence among Correctional facilities workers and Fire Department workers exceeded that of the general population 4 1. MMWR July 10, 2020 https://www.cdc.gov/mmwr/volumes/69/wr/mm6927e2.htm?s_cid=mm6927e2_w 2. UCLA COVID -19 Behind Bars Data Project https://law.ucla.edu/academics/centers/criminal-justice-program/ucla-covid-19-behind-bars-data-project 3. Hagan et al. MMWR – projected publication date August 7. Results of Mass Testing for SARS-CoV- 2 in 16 Prisons and Jails — Six U.S. Jurisdictions, April –May 2020 4. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-07/COVID- 06 -Oliver- 508.pdf

Overlap: Essential Worker & High-Risk Medical Conditions COPD CKD ~3% ~2% Cancer ~4% Essential ~30% Obesity workers (BMI>30) ~4% ~7% CVD Diabetes

Selected essential industries by high risk medical conditions 50 Percent Prevalence among Industry Workers Cancer 45 40 Coronary heart disease 35 Chronic kidney 30 disease 25 COPD 20 15 Diabetes 10 Obesity (BMI≥30 5 kg/m2) 0 Grocery, Food manufacturing Transit, postal, Trucking convenience, and messengers, and drug stores couriers https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a3.htm?s_cid=mm6936a3_w

Racial and Ethnic minorities in selected essential industries 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Rail Pharmacies & Truck Supermarkets & Child Day Care Postal Service Community Food Grocery & Related Individual & Bus Service & Services to Transportation Drug Stores Transportation Other Grocery Services & Housing, Product Merchant Family Services Urban Transit Buildings & Stores Emergency Wholesalers Dwellings Services Source: American Community Survey. CEPRs Analysis of American Community Survey, https://cepr.net/a-basic-demographic-profile-of-workers-in-frontline-industries/

Racial and Ethnic minorities in selected essential industries 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% All Workers All Frontline Grocery, Public Transit Trucking, Building Cleaning Childcare & Social Industries Convenience, & Warehouse, & Services Services Drug Stores Postal Service Black Hispanic AAPI Other Source: American Community Survey. CEPRs Analysis of American Community Survey, https://cepr.net/a-basic-demographic-profile-of-workers-in-frontline-industries/

~23% of essential workers live in low-income families (income <2X poverty line) 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Public Transit Trucking, Warehouse & Child Care & Social Grocery, Convenience & Building Cleaning Postal Service Services Drug Stores Services Source: American Community Survey. CEPRs Analysis of American Community Survey, https://cepr.net/a-basic-demographic-profile-of-workers-in-frontline-industries/

~10% of essential workers have no health insurance 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Public Transit Child Care and Social Grocery, Convenience Trucking, Warehouse & Building Cleaning Services & Drug Stores Postal Service Services Source: American Community Survey. CEPRs Analysis of American Community Survey, https://cepr.net/a-basic-demographic-profile-of-workers-in-frontline-industries/

Overlap: essential workers and adults ≥65 years High Risk Medical Conditions Essential workers >100M ~80M Healthcare personnel ~20M ~16% of essential workers are ≥65 years old or live Adults ≥ 65 years old with someone who is ~53M Source: American Community Survey. CEPRs Analysis of American Community Survey, https://cepr.net/a-basic-demographic-profile-of-workers-in-frontline-industries/