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Ought to frontline docs get the coronavirus vaccine first? Not essentially

Health workers treating patients with the coronavirus may be high on the list to get a vaccine once one is approved. But that's not necessarily the obvious step.

The National Vaccine Advisory Committee met on Wednesday for the first of a two-day public session on the Covid-19 pandemic, vaccine developments and a distribution plan whenever one is ready.

"The question is, how at risk are healthcare workers, especially in the US, especially during times of adequate PPE," said Dr. Ezekiel Emanuel, chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania attended the meeting. "Because at least in our hospital there is zero transmission from patient to doctor with PSA."

The National Academies of Science, Engineering, and Medicine released a draft distribution in the United States earlier this month that prioritizes healthcare workers and vulnerable Americans such as the elderly and those with underlying health conditions. The group formulated the draft application at the request of the Centers for Disease Control and Prevention, which are estimated to have between 17 and 20 million healthcare workers in the United States.

"Frontline health workers are especially important to contain the pandemic and prevent death and serious illness," the group wrote in a section of the report titled "Justification."

"Since the pandemic began, many employees have worked on the front lines in environments where they have been exposed to the virus, often without adequate PPE." PPE refers to personal protective equipment such as masks, gloves, and robes that are used to prevent the spread of infectious diseases.

Reports continue across the country of health workers suffering from the critical PPE shortages that plagued the U.S. response to the pandemic from the start. PPE refers to personal protective equipment such as masks, gloves, and robes that are used to prevent the spread of infectious diseases.

Emanuel added that prioritizing a potentially life-saving vaccine was "very, very complex", noting that placing all healthcare workers in the first prioritization group "is unlikely to be warranted at this point in the pandemic."

The panel presented to the NVAC set a possible framework for reflecting on the difficult ethical issues surrounding vaccine distribution. Vaccines will not be available to the entire population at once, so certain populations will likely need to take precedence over others.

Should health workers in the United States be vaccinated first, possibly before key employees in meat packers, schools, or grocery stores? Elderly people in nursing homes are another group that bioethicists would prioritize given the high mortality rate of those who contract the virus.

Emanuel noted that at this point in the pandemic, many of the medical workers in his hospital – and in other health systems – now have access to adequate PPE, reducing the risk of contracting the virus. However, more thought is needed to better determine which hospital workers are most at risk of infection, he said.

"What high-risk job should be a top priority," he asked. "How many of you think that firefighters are really at high risk, or are we just throwing them in? So it seems to me that we need a serious risk assessment here if that is our justification."

Dr. Emanuel pointed out the importance of modeling the potential risk before reaching any conclusion.

Other panel members noted that health workers may still be at high risk because not everyone has access to PPE. This can include home health workers, caregivers, hospital security, or staff delivering food to sick patients.

Dr. Sara Oliver, an epidemic intelligence officer with the CDC's Viral Diseases Division, admitted that proper PPE has reduced the spread of the coronavirus in the healthcare sector. However, she noted that the front line medical workers most at risk of infection are often not the doctors and nurses, but rather the security guards, caregivers, staff and others who may not have access to PPE.

"While we should do everything we can to ensure that people who need PPE get it, I don't know that doing so completely removes the importance of protecting health workers early on," she said at the meeting on Wednesday.

The panel also discussed that many frontline medical workers may experience "PPE fatigue" which could increase the risk for health care workers.

Emanuel noted that the distribution plan should give special priority to these risk groups when certain health workers are more at risk than others. But he added that it "does not seem justified to group them all".

"The goal is to reduce the harm and maximize the benefit. You have to look at how much vaccine will do how much good in a group," said Emanuel.

He added that who should be prioritized may very well depend on which vaccine is approved and what the study data say about immunization. He said if a vaccine reduces transmission of the virus but doesn't reduce the severity of the disease, or vice versa, it could have an impact on distribution.

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