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Phase 1a, 1b or 1c? Understanding Coronavirus Vaccine Priority Groups

CDC panel recommends Americans 75 and older, frontline workers be second in line for shots

spinner image A medical provider receives a Pfizer-BioNTech COVID-19 vaccination. (Photo by Ethan Miller/Getty Images)
Ethan Miller/Getty Images

People age 75 and older and frontline essential workers, including police officers, firefighters, teachers, grocery store staff and U.S. Postal Service employees, should be next in line to get a COVID-19 vaccine, a federal advisory panel recommended on Dec. 20.

By a 13-1 vote, the Advisory Committee on Immunization Practices (ACIP) also recommended to the Centers for Disease Control and Prevention (CDC) that people ages 65 to 74, people ages 16 to 64 with high-risk conditions and other essential workers follow in what's being called Phase 1c, behind Americans 75-plus and frontline essential employees in Phase 1b. Whether or not to include all people 65 and older in Phase 1b consumed much of the debate during ACIP's five-hour meeting.

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The first priority group of 24 million Americans, designated as Phase 1a, began getting inoculated last week with the Pfizer-BioNTech vaccine. This category includes health care workers and residents and staff of nursing homes. Nearly 6 million doses of the Moderna vaccine, which received its emergency use authorization (EUA) from the U.S. Food and Drug Administration (FDA) on Dec. 18, have already begun to ship.

Vaccine Priority Groups

Phase 1a (24 million people):

  • Health care personnel
  • Long-term care facility residents

Phase 1b (49 million people):

  • Frontline essential workers
  • People 75 and older

Phase 1c (129 million people):

  • People ages 65-74
  • People ages 16-64 with high-risk conditions
  • Other essential workers

Phase 2:

  • People 16 and older not in Phase 1

Source: CDC

spinner image A nurse handles a vial of the the Pfizer-BioNTech Covid-19 vaccine, Kobi Wolf/Bloomberg via Getty Images
Kobi Wolf/Bloomberg via Getty Images

Under the ACIP recommendation, the second priority group, dubbed 1b, would include 19 million elderly people 75-plus and 30 million essential frontline workers. They would begin to get their shots after those in group 1a who wanted to be vaccinated were taken care of. Then after group 1b has been vaccinated, 129 million people in group 1c would come next. ACIP says that group should include 28 million Americans ages 65 to 74, 20 million other essential workers and 81 million people ages 16 to 64 who have high risk factors for the coronavirus.

"I voted no,” said ACIP member Henry Bernstein, a physician at Northwell Children's Medical Center on Long Island, New York, “because I feel that the science regarding COVID-19 morbidity and mortality” is similar among those between 65 years old and 74 years old and those over 75. Several other committee members questioned splitting the two older age groups. Pablo Sanchez, a doctor at the Research Institute at Nationwide Children's Hospital in Columbus, Ohio, said that although he voted yes, he also really felt “strongly that the elderly and those with high-risk medical conditions should be up front, over some essential workers who may be younger."

"We're are trying to thread the needle here,” said Peter Szilagyi, a doctor at UCLA. And Beth Bell, a physician at the University of Washington in Seattle, said she wished “we didn't have to be here making allocation recommendations. And that instead we had enough vaccine to provide it to everybody in the country who wants it."

Sanchez also joined several other committee members who agreed with some members of the public who asked the panel to include older Americans who are being cared for at home by family members among the next people to get the vaccine. These individuals are not eligible for vaccines at the same time as those in long-term care facilities. Several members of the public said especially in their communities — which included immigrants from Vietnam and Mexico — elderly parents are often cared for at home by family members, not placed in nursing homes or other long-term care facilities.

States have final say

ACIP's recommendations must be approved by CDC Director Robert Redfield before they become official CDC policy. But even then, the priority list will not be binding. It will be up to individual states to decide who gets the vaccine next. However, so far all the states appear to be abiding by CDC's suggestion on who should be in the first groups to get the vaccine.

ACIP members were told that according to the U.S. Department of Health and Human Services (HHS), there will be enough doses of the Pfizer-BioNTech and Moderna vaccines to inoculate 20 million people through the end of December, another 30 million by the end of January and another 50 million by the end of February. CDC officials said Sunday that they did not know at what point people in the 1b group would begin to get vaccinated and said the progression from vaccinated people in the 1a group to people in 1b and then to 1c would likely be different in every state.

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Essential workers get priority

The frontline essential workers in group 1b include first responders, such as firefighters and police; educators, including teachers, support staff and day care workers; food and agriculture workers; manufacturing employees; corrections workers; employees at the U.S. Postal Service; public transit workers; and grocery store workers.

Frontline Essential Workers in Phase 1b

  • First responders (firefighters, police)
  • Education (teachers, support staff, daycare)
  • Food and agriculture
  • Manufacturing
  • Corrections workers
  • U.S. Postal Service workers
  • Public transit workers
  • Grocery store workers

Source: CDC

In group 1c, the essential worker category is broadened to include food service employees, transportation and logistics workers, construction workers, finance employees, information technology and communications, energy workers, the media, the legal profession, public safety engineers, and water and wastewater employees. The high-risk health factors that ACIP says would qualify someone age 16 to 64 to be part of this group include: obesity, severe obesity, type 2 diabetes, COPD, a heart condition, chronic kidney disease, cancer, immunocompromised state as the result of a solid organ transplant, sickle cell disease, pregnancy and smoking (either currently a smoker or with a history of smoking).

Several members of the committee also pleaded with lawmakers in Washington, D.C., to provide adequate funding to state health departments that are charged with managing the delivery of COVID-19 vaccines.

"The fact that state and local health departments have not been funded for the vaccination program … is really appalling,” said Bell. “I hope that the government will address this discrepancy without which, I think, it's going to be very difficult for us to be successful."

Congressional leaders late Sunday announced they had allocated $30 billion for procurement and distribution of vaccines.

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