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Who is a healthcare worker? In the eyes of Dr José Romero, it’s an intensive care nurse, a pulmonologist, an ambulance driver. But it is also the hospital’s housekeeping staff, workers who bring patients meals, and the aides who care for the elderly in long-term care homes.
Romero is the chair of the US Centers for Disease Control and Prevention’s (CDC) vaccine advisory panel, a closely watched group whose recommendations on how to prioritize vaccines will form the backbone of state and local plans for distribution.
Ultimately, states and even individual hospitals will need to make decisions about who gets the first, very limited doses of a Covid-19 vaccine. But the deliberations of Romero and his colleagues will weigh heavily.
And over eight months of discussion, “justice” remains a guiding principle, Romero told the Guardian in an interview.
“When we talk about healthcare personnel, we’re not just talking about doctors and nurses,” he said “We’re talking about those persons who help deliver the care in an indirect way.”
These concerns reflect the intersection of two of the defining events of 2020 – the disproportionate impact of Covid-19 on the working class, racial and ethnic minorities and women, and the harsh spotlight the virus cast on decades-long health inequalities that proved to be an inflection point in calls for racial justice.
“We are not prescriptive, we do not give doses, but we make it very clear, those persons in those groups,” including “lower-wage earners” should be included in early vaccinations, Romero said.
“We want to make sure the hospitals understand that they are part of our group of healthcare providers, and we’ve said that over and over again,” said Romero. “We believe very, very strongly in that.”
The panel, formally called the Advisory Committee on Immunization Practices (Acip), made its first recommendation last week about who should receive the first, very limited quantities of any Covid-19 vaccine. Healthcare workers and residents of long-term care homes will be in the earliest priority group, called “phase 1a”.
The federal government is expected to immediately distribute 6.4m doses of the leading vaccine candidate, if it is approved by the US Food and Drug Administration. Those first allotments will not be enough to cover the roughly 20 million health workers and 3 million long-term care residents, who have both suffered during the pandemic. But deliveries expected throughout December and January could come close to vaccinating this entire group.
“It would be nice if we have even more vaccine than we do now, but we have a vaccine,” said Romero. “And the point at this moment is to use it to get the maximum benefit from that vaccine.”
More than 243,000 health workers have been infected with Covid-19, and a database run by the Guardian and Kaiser Health News found more than 1,400 have died. More than 100,000 long-term care home residents have died of Covid-19. Though they represent less than 1% of the US population, long-term care residents represent more than 40% of deaths.
These deliberations reflect a concern echoed in nearly every corner of medicine right now: the need for equity in distribution of a Covid-19 vaccine. This is meant to be an antidote to the last pandemic-related vaccine distribution effort in the US, for H1N1 flu, which saw disproportionately low uptake among minority racial and ethnic groups.
Blacks in the US have died at a rate of 116 people per 100,00, or nearly double the rate of whites, who have been killed by Covid-19 at a rate of 59 people per 100,000.
The injustices that led to these disproportionate outcomes are dryly known as “social determinants of health,” and typically describe the effect of low wage, poor housing and discrimination on health.
The next groups to be considered by Acip for prioritization are much larger and more varied than those in phase 1a – they include essential workers, people with serious health conditions and people older than 65. Together, they encompass more than 100 million people whose health, job status and age may overlap.
“The decisions and recommendations that Acip makes are really grounded in science and epidemiology,” said Romero. “These decisions will be weighty, but they’ll be grounded in evidence we have at the moment.
“We foresee being very, very busy for the next few weeks.”
Source: The Guardian
Keyword: Justice must be guiding principle in US vaccine rollout, says top expert | Coronavirus