A somewhat obscure group of medical and public health professionals known as the Advisory Committee on Immunization Practices is debating the crucial question on the minds of millions of Americans: When can I get a COVID vaccine?
ACIP develops recommendations on the use of vaccines, and at least two big pharmaceutical firms could be just weeks away from funneling their products across the U.S. On Monday, the committee unveiled its ethical principles for an orderly distribution of the vaccines, beginning with an estimated 21 million health care workers.
Other groups at or near the front of the line include other essential workers such as first responders, teachers, farmworkers and energy industry workers; people with high-risk medical conditions; and people over 65.
The recommendations are designed to maximize benefits, minimize harm, promote justice and mitigate health inequities, the committee says.
"I know our nation looks to you all to give your thoughtful and wise recommendation," CDC Director Robert Redfield said at the start of the meeting. "I want to take a moment to underscore how important your work is."
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The ACIP recommendations provide public health guidance. The Centers for Disease Control and Prevention then uses that guidance to set the U.S. adult and childhood immunization schedules based on those recommendations.
The committee won't actually vote on allocation guidance until a vaccine is approved or authorized by the Food and Drug Administration. Monday's meeting was an informational meeting, one of more than 25 the group has held since April.
A recent Gallup poll showed only 58% of Americans were willing to get the COVID vaccine. Vaccine "hesitancy" normally accompanies a country’s efforts to contain an infectious disease, said Ogbonnaya Omenka, an associate professor and public health specialist at Butler University who is not directly involved with ACIP.
Part of the committee's charge is to instill confidence in the vaccines, Omenka said.
"The role of vaccines in population health is attested to by the containment of different infectious diseases such as polio, smallpox and measles," Omenka said. "The ACIP is an important part of the vaccine adoption process."
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Dr. Moncef Slaoui, chief science adviser for the federal government's Operation Warp Speed effort to quickly provide a vaccine, stressed this week that the final determination on the order of distribution will go to individual states.
"Each state will independently decide, taking into account the guidance, who to immunize," Slaoui said.
ACIP consists of 15 experts who are voting members primarily responsible for the vaccine recommendations. The secretary of the U.S. Department of Health and Human Services selects the committee through an application and nomination process.
Fourteen of them have expertise in vaccinology, immunology, pediatrics, internal medicine, nursing, family medicine, virology, public health, infectious diseases or preventive medicine. One member is a consumer advocate providing perspectives on the social and community aspects of vaccination.
In addition to the voting members, there are 30 non-voting representatives from professional organizations that are highly regarded in the health field. They comment on ACIP’s recommendations and offer the perspectives of groups that will implement the recommendations.
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Pfizer/BioNTech has already applied for U.S. Food and Drug Administration emergency authorization for a vaccine that could move forward by mid-December. Moderna says it will seek FDA authorization for its candidate soon. Other candidates are not far behind. Slaoui says 20 million Americans could be vaccinated next month.
ACIP develops vaccine recommendations for children and adults, including the ages when the vaccine should be given, the number of doses needed, the amount of time between doses and precautions and contraindications.
"The influence or role of ACIP in vaccine approval is sort of indirect," Omenka said. "Their recommendations are still weighed further before final decisions are made."
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