Confusion spreads over system to determine priority access to Covid-19 vaccines

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Confusion spreads over system to determine priority access to Covid-19 vaccines
STAT 22 July 2020
By Helen Branswell @HelenBranswell
As manufacturers around the world race to develop Covid-19 vaccines, a parallel effort has begun to figure out who in the United States should get them first — and how those doses should be distributed.
But already the effort is being complicated by tensions over who gets to make those critical decisions, with some groups feeling sidelined and multiple new actors crowding the stage.
On Tuesday, the National Academy of Medicine, tasked by top U.S. health officials, named an expert panel to develop a framework to determine who should be vaccinated first, when available doses are expected to be scarce. But that panel is ostensibly encroaching on the role of the Advisory Committee on Immunization Practices, a panel that has made recommendations on vaccination policy to the Centers for Disease Control and Prevention for decades, including drawing up the vaccination priority list during the 2009 H1N1 flu pandemic.
There is also the matter of Operation Warp Speed, the government’s vaccine fast-tracking program that has claimed authority over, among other things, distribution decisions when it comes to Covid-19 vaccines.
Amid so many players, public health experts are expressing concern and confusion.
“It seems to me like we’ve just assigned four different air traffic control towers to land the same plane,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy. “Between ACIP, and this new committee, the group working within Operation Warp Speed and just in terms of input from the general community, it’s not clear to me who will make the final decision and how that process will unfold.”
The health of untold numbers could hang in the balance, given that initial batches of vaccine are likely to be available only for a sliver of the population. Additionally, most vaccines will probably be given in two-dose regimens, meaning any figure of available doses would have to be divided in half to see how many people could be vaccinated.
There is no doubt that health care workers will be offered vaccines first. But after that, tough decisions will have to be made about the order in which other frontline workers — which? how many? — are offered priority access to vaccine and who will follow, in what order.
Normally, such decisions would fall to ACIP, which months ago set up a working group to monitor the evolving science on Covid-19 and the vaccines being developed to protect against it. But it’s not clear what task ACIP will be handed here.
“We haven’t been given a firm answer as to what our role will be. We are continuing with our routine planning and discussion, and we will come up with what we think are appropriate guidelines for prioritization. But that we’ve not been given assurances that we will actually be contributing to that,” said José Romero, the panel’s chairman…