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COVID-19 COVID-19
VACCINES VACCINES

The Importance The Phases of COVID-19 ditional interim considerations for phased imple-
mentation of COVID-19 vaccines are available at
of COVID-19 Vaccine Administration https://www.cdc.gov/vaccines/ covid-19/initial-
populations.html and https://www.cdc.gov/vac-
Vaccination By Centers for Disease Control (CDC) cines/covid-19/phased-implementation.html.

for Healthcare The first vaccines for prevention of coronavirus disease 2019 (COVID-19) in the Phase 2
Personnel United States were authorized for emergency use by the Food and Drug Administra- not already recommended for vaccination in
Phase 2 includes all other persons aged ≥16 years
tion (FDA) (1) and recommended by the Advisory Committee on Immunization
Practices (ACIP) in December 2020.* However, demand for COVID-19 vaccines is
Updated Dec. 15, 2020 (CDC) Phases 1a, 1b, or 1c. Currently, in accordance with
expected to exceed supply during the first months of the national COVID-19 vacci- grocery store workers, public transit workers, and those who work in recommended age and conditions of use (1), any authorized COVID-
nation program. ACIP advises CDC on population groups and circumstances for the education sector (teachers and support staff members) as well as
Based on recommendations from the Advisory 19 vaccine may be used.
vaccine use.† child care workers.§§ A tiered approach for essential workers builds
Committee on Immunization Practices (ACIP), an
on the occupations identified by the National Academies of Science, References
independent panel of medical and public health ex- PHASES
perts, CDC recommends healthcare personnel be Engineering and Medicine for early vaccination (4). *65 years or greater in Texas
On December 1, ACIP recommended that 1) health care personnel§ and 2) resi- Persons aged ≥75 years are at high risk for COVID-19–associated 1. Food and Drug Administration. COVID-19 vaccines. Silver Spring, MD: US
among those offered the first doses of COVID19
dents of long-term care facilities be offered COVID-19 vaccination first, in Phase 1a morbidity and mortality. As of December 20, 2020, the cumulative Department of Health and Human Services, Food and Drug Administration;
vaccines. 2020. https://www.fda.gov/emergency-preparedness-and-response/coron-
of the vaccination program (2). incidence of COVID-19 among persons in this age group was 3,839
Healthcare personnel include all paid and unpaid avirus-disease-2019-covid-19/covid-19-vaccinesexternal icon
On December 20, 2020, ACIP recommended that in Phase 1b, vaccine should be per 100,000 persons, with a cumulative hospitalization rate of 1,211
persons serving in healthcare settings who have the 2. Dooling K, McClung N, Chamberland M, et al. The Advisory Committee on
offered to persons aged ≥75* years and frontline essential workers (non–health care per 100,000, and a mortality rate of 719 per 100,000 (7–9). The over- Immunization Practices’ interim recommendation for allocating initial supplies
potential for direct or indirect exposure to patients
workers), and, all proportion of persons aged ≥75 years who live in a multigenera- of COVID-19 vaccine—United States, 2020. MMWR Morb Mortal Wkly
or infectious materials. This recommendation per-
In Phase 1c, persons aged 65–74 years, persons aged 16–64 years with high-risk tional household is 6%; the proportion among non-Hispanic White Rep 2020;69:1857–9. CrossRefexternal icon PubMedexternal icon
tains to paid and unpaid healthcare personnel work- 3. Cybersecurity and Infrastructure Security Agency. Guidance on essential crit-
medical conditions, and essential workers not recommended for vaccination in Phase persons is 4%, and the proportion among racial or ethnic minority
ing in a variety of healthcare settings—for example, ical infrastructure workers: version 4.0. Washington, DC: US Department of
1b should be offered vaccine.** groups is higher (non-Hispanic Black persons, 10%; Hispanic or
acute care facilities, long-term acute care facilities, Homeland Security, Cybersecurity and Infrastructure Security Agency;
These recommendations for phased allocation provide guidance for federal, state, Latino persons, 18%; non-Hispanic persons of other races, 20%).*** 2020. https://www.cisa.gov/publication/guidance-essential-critical-infrastruc-
inpatient rehabilitation facilities, nursing homes and
and local jurisdictions while vaccine supply is limited. In its deliberations, ACIP con- ture-workforceexternal icon
assisted living facilities, home health care, mobile
sidered scientific evidence regarding COVID-19 epidemiology, ethical principles, and Phase 1c 4. National Academies of Sciences, Engineering, and Medicine. Framework for
clinics, and outpatient facilities, such as dialysis cen- equitable allocation of COVID-19 vaccine. Washington, DC: National Acad-
vaccination program implementation considerations. ACIP’s recommendations for In Phase 1c, vaccine should be offered to persons aged 65–74 years,
ters and physicians’ offices. emies of Sciences, Engineering, and Medicine; 2020. https://www.nationala-
COVID-19 vaccine allocation are interim and might be updated based on changes persons aged 16–64 years††† with medical conditions that increase
Examples of healthcare personnel include: cademies.org/our-work/a-framework-for-equitable-allocation-of-vaccine-for-th
in conditions of FDA Emergency Use Authorization, FDA authorization for new the risk for severe COVID-19, and essential workers not previously e-novel-coronavirus#sectionPublicationsexternal icon
Emergency medical service personnel, nurses and
COVID-19 vaccines, changes in vaccine supply, or changes in COVID-19 epidemi- included in Phase 1a or 1b. 5. Bui DP, McCaffrey K, Friedrichs M, et al. Racial and ethnic disparities among
nursing assistants, physicians, technicians, ther-
ology. Based on ongoing review of the literature, CDC has identified med- COVID-19 cases in workplace outbreaks by industry sector—Utah, March 6–
apists, dentists, dental hygienists, and assistants. June 5, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1133–8. CrossRefex-
Following ACIP’s interim recommendation for vaccine allocation in Phase 1a (2), ical conditions or risk behaviors that are associated with increased risk
Who is included under the broad term “health- ternal icon PubMedexternal icon
the Work Group proposed vaccine allocation for Phases 1b and 1c. A description of for severe COVID-19.§§§ The risk for COVID-19–associated hos-
care personnel”? Phlebotomists, pharmacists, stu- 6. Waltenburg MA, Victoroff T, Rose CE, et al.; COVID-19 Response Team.
the population groups in these phases, supporting scientific data, consideration of eth- pitalization increases with the number of high-risk medical condi- Update: COVID-19 among workers in meat and poultry processing facilities—
dents, and trainees, contractual staff, dietary and
ical principles, and considerations for vaccination program implementation are pre- tions, from 2.5 times the risk for hospitalization for persons with one United States, April–May 2020. MMWR Morb Mortal Wkly Rep
food services staff, environmental services staff, and
sented in this report, and supporting evidence is available condition to 5 times the risk for those with three or more conditions 2020;69:887–92. CrossRefexternal icon PubMedexternal icon
administrative staff. Healthcare personnel are at risk 7. CDC. Coronavirus disease 2019 (COVID-19): CDC COVID data tracker.
at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19/evidence- (10). According to a recent analysis of 2018 Behavioral Risk Factor
of exposure because they are on the front line of the Atlanta, GA: US Department of Health and Human Services, CDC;
table-phase-1b-1c.html. Surveillance System data, at least 56% of persons aged 18–64 years re-
nation’s fight against this deadly pandemic. Health- 2020. https://covid.cdc.gov/covid-data-tracker
port at least one high-risk medical condition (CDC COVID-19 Re- 8. CDC. COVID-NET: laboratory-confirmed COVID-19–associated hospital-
care personnel’s race and ethnicity, underlying health
conditions, occupation type, and job setting can Phase 1b sponse Team, Division of Population Health, personal izations. Atlanta, GA: US Department of Health and Human Services, CDC;
2020. https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html
contribute to their risk of acquiring COVID-19 and Approximately 49 million persons, including frontline essential workers (non– communication, December 2020). Essential worker sectors recom- 9. CDC. Weekly updates by select demographic and geographic characteristics:
experiencing severe outcomes, including death. health care workers) and persons aged ≥75* years are recommended to receive vaccine mended for vaccination in Phase 1c include those in transportation provisional death counts for coronavirus disease 2019 (COVID-19). Atlanta,
By providing critical care to those who are or in Phase 1b of the COVID-19 vaccination program (Table). Essential workers per- and logistics, water and wastewater, food service, shelter and housing GA: US Department of Health and Human Services, CDC;
might be infected with the virus that causes form duties across critical infrastructure sectors and maintain the services and func- (e.g., construction), finance (e.g., bank tellers), information technol- 2020. https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#Age-
AndSex
COVID-19, healthcare personnel have a high risk tions that U.S. residents depend on daily. The Cybersecurity and Infrastructure ogy and communications, energy, legal, media, public safety (e.g., en- 10. Ko J, Danielson M, Town M, et al. Risk factors for coronavirus disease 2019
of being exposed to and getting sick with COVID- Security Agency (CISA) of the U.S. Department of Homeland Security has developed gineers), and public health workers.**** (COVID-19)–associated hospitalization: COVID-19–Associated Hospital-
19. As of December 3, the day CDC published a list intended to guide jurisdictions in identifying essential critical infrastructure Implementing vaccination programs to reach essential workers will ization Surveillance Network and Behavioral Risk Factor Surveillance System.
these recommendations, there were more than workers, who may be exempted during stay-at-home-orders (3). ACIP used CISA pose challenges. Use of multiple strategies is recommended to reduce Clin Infect Dis 2020. E-pub September 18, 2020. CrossRefexternal icon Pub-
249,000 confirmed COVID-19 cases and 866 guidance to define frontline essential workers as the subset of essential workers likely barriers to vaccination,†††† such as providing vaccination opportuni- Medexternal icon
deaths among healthcare personnel. View more re- at highest risk for work-related exposure to SARS-CoV-2, the virus that causes ties at or close to the workplace. State and local health authorities will 11. McClung N, Chamberland M, Kinlaw K, et al. The Advisory Committee on
Immunization Practices’ ethical principles for allocating initial supplies of
cent numbers on the toll COVID-19 has taken on COVID-19, because their work-related duties must be performed on-site and involve need to take local COVID-19 epidemiology and demand for vaccine COVID-19 vaccine—United States, 2020. MMWR Morb Mortal Wkly Rep
healthcare personnel by visiting the CDC website. being in close proximity (<6 feet) to the public or to coworkers. into account when deciding to proceed to the next phase or to sub- 2020;69:1782–6. CrossRefexternal icon PubMedexternal icon
Vaccinating healthcare personnel protects ACIP has classified the following non–health care essential workers as frontline prioritize within an allocation phase if necessary. A flexible approach 12.CDC. COVIDView: a weekly surveillance summary of U.S. COVID-19 activity.
healthcare capacity. workers: first responders (e.g., firefighters and police officers), corrections officers, to allocation will facilitate efficient management and ensure that Atlanta, GA: US Department of Health and Human Services, CDC; 2020.
food and agricultural workers, U.S. Postal Service workers, manufacturing workers, COVID-19 vaccine is administered equitably and without delay. Ad- https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html

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