December 8th, 2020

This week we have reached a global milestone, not in deaths or new COVID-19 infections, but for a vaccine approved by Great Britain that has been administered to the first recipient outside of a clinical trial. As an infectious diseases pharmacist, this brings optimism - but not without trepidation as we approach the New Year. There is a lot we don’t know yet about the new vaccines, but the results we have seen give me reason to hope. I was invited to attend the ACIP meeting last Tuesday, December 1st and wanted to share my observations as SIDP President-elect.

ACIP expects both Pfizer/BioNTech and Moderna to each deliver on their pledge of 20 million vaccine doses by the end of the year following FDA authorization. They also anticipate another 5-10 million doses per week in 2021. I saw the headline recently that this was in contrast to the 300 million doses promised earlier in the year. That number always seemed out of reach to me and I’m pretty pleased with 20 million courses being available myself. ACIP voted to recommend these vaccines be allocated first to the 21 million healthcare personnel (HCP) and 3 million long-term care residents (LTCR) in the United States.

The recommendation to vaccinate healthcare personnel first includes not just professionals, but also lower wage earners such as food and environmental services staff. It is hoped that this will help break the chain of transmission in the community that is disproportionate in racial and ethnic minorities. It also protects our patients. Priority within HCPs should be given to those who interact with patients or enter their rooms. Asking personnel to disclose high-risk conditions may lead to inadvertent bias and is not recommended. Employees working from home may have to wait to receive their vaccine until supply is adequate for are still eligible. If uptake is similar to flu vaccines, that means over 90% of hospital-based personnel will eventually accept the vaccine, but I was alarmed to hear that only 65% of nursing home staff report being vaccinated for influenza annually. These are probably best case scenarios with a new technology and actual results will be harbingers of willingness for the public to be vaccinated.

Residents of long-term care were chosen because of the great morbidity and mortality they face from rapid spread of COVID-19 within facilities. The term LTCR includes those that reside in either a skilled or assisted living facility. There are 1.3 million residents of skilled nursing facilities (SNF). They have accounted for 6% of all cases but 40% of deaths from COVID-19 in the US. ACIP indicated there is implied priority given to residents of SNF. A Federal Strategy for Pharmacy Partnership with CVS and Walgreens covers over 90% of all LTCR. One challenge facilities will face is that residents on short-term post-acute stays might not be present for the second shot of vaccine to be administered in 3-4 weeks. This will require a coordinated effort to locate and vaccinate these individuals. It sounds like there are enough doses planned for distribution to immunize everyone that needs it, but the logistics of delivery and uptake will be difficult.

Scott Bergman, PharmD, FCCP, FIDSA, BCPS, BCIDP

SIDP President

Antimicrobial Stewardship Coordinator

Nebraska Medicine, Omaha, NE