CDC Adviser On COVID-19 Vaccine Priority Groups And Why Some Aren't Eager To Be First

Dec 2, 2020
Originally published on December 3, 2020 12:12 am

For those fighting the COVID-19 pandemic — and those hit hardest by it — a vaccine could be just weeks away, as the Food and Drug Administration weighs emergency approval for two vaccines. On Tuesday, a Centers for Disease Control and Prevention advisory panel recommended that the first vaccines should go to health care workers and residents and staff of long-term care facilities.

The companies behind the two vaccines, Pfizer and Moderna, say their vaccines have been shown to be 95% and 94% effective, respectively. But some people who could be at the front of the line aren't eager to go first, says Dr. Robert Atmar, a professor at Baylor College of Medicine in Houston and a member of the Advisory Committee on Immunization Practices that made the recommendations.

"We're hearing a lot of hesitation among health care personnel, and I think a lot of it has to do with the politicized nature of the vaccine development and the whole response to the pandemic," says Atmar, who also works in the Harris County hospital system in Texas.

"We're beginning to roll out education to our staff to explain exactly what the process has been and to reassure that there weren't any steps that were skipped" in the compressed testing and approval timeline, he tells All Things Considered.

"But because of the severity of the pandemic — one person a minute dying in the United States each day — it really is important to try and take steps that will be effective in preventing disease."

In excerpts from his interview, Atmar discusses hesitancy among front line medical workers and the decision to include the elderly in the first priority groups.

Let's start with the recommendations. It makes sense that health care workers should get first access. Do you have any concerns about that second group of elderly, possibly sick, people getting it? I'm wondering if there's enough data to show that it (a) works and (b) will be safe in that population?

I think that was the main concern that the ACIP considered. ... The problem is that this is a group that has not specifically been studied in the clinical trials that have been done to date. And we know from flu vaccine studies that residents in long-term care facilities tend to respond less well to the vaccine than other individuals. So there is some concern that it may not work, but it's reasonable to think that there will be at least some protection, and the burden of disease, and particularly that 40% of deaths in the U.S. have occurred in long-term care facilities, really argues that if there's any way we can protect them, to try and do so.

Do you still have outstanding questions about either of the leading vaccine candidates that you would want answers to before vaccinating your colleagues?

I will want to review the data, and particularly the safety data. We know that individuals will have some side effects. I think knowing exactly what the reactions are to be expected will reassure individuals who are going to receive the vaccine.

If you are hearing hesitation from health care workers, from front line people, how do you expect to persuade the rest of Texas, the wider population?

Many of the health care workers I've spoken to, who have expressed concern to me, don't necessarily want to be in the first group — even though they're prioritized for the first group — but want to see for themselves how their friends and colleagues respond to the vaccine. I understand that's human nature, but I certainly plan on being a model — if either vaccine becomes available and is recommended by the ACIP — to demonstrate my confidence in the vaccine and the whole review and approval process.

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MARY LOUISE KELLY, HOST:

For those fighting the COVID-19 pandemic and those hit hardest by it, a vaccine could be just weeks away. The FDA is weighing emergency approval for two vaccines. And yesterday, a CDC advisory panel recommended that health care workers and residents and staff of long-term care facilities be first in line to get it. Dr. Robert Atmar of Baylor College of Medicine is a member of that panel. He joins us now from Houston.

Welcome.

ROBERT ATMAR: Thank you for having me.

KELLY: So let's start with the recommendations from this panel yesterday. It makes total sense that health care workers should get first access. I do wonder, do you have any concerns about that second group of elderly, possibly sick people getting it? I'm wondering if there's enough data to show that it, A, works and, B, will be safe in that population.

ATMAR: Well, I think that was the main concern that the ACIP considered...

KELLY: ACIP - we should - that is the...

ATMAR: The advisory committee.

KELLY: That is the panel.

ATMAR: Yes. The problem is, is that this is a group that has not specifically been studied in the clinical trials that have been done to date. And we know from flu vaccine studies that residents in long-term care facilities tend to respond less well to the vaccine than other individuals. So there is some concern that it may not work, but it's reasonable to think that there will be at least some protection. And the burden of disease - and particularly that 40% of deaths in the U.S. have occurred in long-term care facilities - really argues that if there's any way we can protect them to try and do so.

KELLY: And then who next after those two groups? Is that something you're still trying to figure out?

ATMAR: That's something that we have had some preliminary discussions on but have not yet determined. The police, fire department, teachers and other people in essential positions might be in the next group, followed by persons with underlying diseases that put them at greater risk of complications or death, including persons over the age of 65.

KELLY: Do you still have outstanding questions about either of these two leading vaccine candidates that you would want answers to before vaccinating, say, your colleagues at Baylor Medicine?

ATMAR: I will want to review the data and particularly the safety data. We know that individuals will have some side effects. I think knowing exactly what the reactions are to be expected will reassure individuals who are going to receive the vaccine.

KELLY: May I ask, are you hearing any hesitation among staff, people saying, I'm not sure I want to be in the very first group? Let me see how it goes for a couple weeks.

ATMAR: We're hearing a lot of hesitation among health care personnel. And I think a lot of it has to do with the politicized nature of the vaccine development and the whole response to the pandemic. So we're beginning to roll out education to reassure that there weren't any steps that were skipped. But because of the severity of the pandemic - one person a minute dying in the United States each day - it really is important to try and take steps that will be effective in preventing disease.

KELLY: If you are hearing hesitation even from health care workers, from front-line people at Baylor, how do you expect to persuade the rest of Texas, the wider population?

ATMAR: Well, many of the health care workers I have spoken to who have expressed concern to me don't necessarily want to be in the first group (laughter), even though they're prioritized for the first group, but want to see for themselves how their friends and colleagues respond to the vaccine. I understand that's human nature. But I certainly plan on being a model if either vaccine becomes available and is recommended by the ACIP to demonstrate my confidence in the vaccine and the whole review and approval process.

KELLY: You'll be as close to the front of the line as you are able to get.

ATMAR: Correct.

KELLY: Dr. Robert Atmar. He is a professor at Baylor College of Medicine.

Thanks so much.

ATMAR: My pleasure. Transcript provided by NPR, Copyright NPR.

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