National Academies Report Outlines Draft Priorities for COVID-19 Vaccine
Regulation | September 01, 2020 | by
Older adults in congregate settings and front-line health care workers among the top priority groups.
Older adults in congregate settings and front-line health care workers among the top priority groups.
On September 1, the National Academies of Sciences, Engineering, and Medicine (NASEM) published its Discussion Draft of the Preliminary Framework for Equitable Allocation of COVID-19 Vaccine.
What’s Most Important?
This draft framework includes recommendations for a tiered prioritization for a COVID-19 vaccine. The top priority group includes front-line health care workers, including those in nursing homes, assisted living and home-based care. It also includes older adults living in “congregate or overcrowded settings,” which the report defines broadly, from residential settings such as nursing homes to more community-based settings such as multigenerational households.
About the Report
This draft report is designed to provide recommendations as to how a COVID-19 vaccine should be distributed, which population groups should be prioritized and what factors should and should not be considered. The NASEM committee is comprised of physicians, researchers and scientists (see page 100 of the report for a full list). NASEM was not tasked with final decision making through this report but rather making recommendations to other entities, including the Advisory Committee on Immunization Practices (ACIP).
More on Priority Groups
A key part of the NASEM report is the recommendation of a four-tier prioritization of which groups should first have access to the vaccine. These are outlined below. Groups emphasized in bold are of most relevance to aging services providers.
Priority Groups and Aging Services
Tier 1 includes high-risk workers in health care facilities and older adults living in congregate or overcrowded settings.
For the workers, this tier includes “front line health care workers (in hospitals, nursing homes, or providing home care) who either: (1) work in situations where risk of SARS-CoV-2 transmission is high, or (2) are at an elevated risk of transmitting the infection to patients at high risk of mortality and severe morbidity.” Workers in this category include both clinical staff and nonclinical staff. In addition to the settings listed in the quote, the report section also mentions assisted living facilities as a high-risk setting. Staff in community-based settings such as adult day services and PACE organizations are not specifically written into this section but might be included if NASEM takes a broad definition of high-risk settings.
For older adults in living in congregate or overcrowded settings, NASEM includes nursing facility residents, residents of residential care facilities and older adults who live below the poverty line. The last category is a proxy for “overcrowded” settings such as multigenerational households. While HUD-assisted/affordable housing communities are not specifically written into the report, most would likely be included in this tier as part of the last category (below the poverty line).
Older adults who do not live in congregate or overcrowded settings are part of the second phase of the recommended framework, unless they have living in “comorbid and underlying conditions” that put them at high risk.
The NASEM report includes a review of the literature for each group to support their placement in the framework. The report takes into consideration the impact of the COVID-19 pandemic on each group to date, known transmission routes (e.g., asymptomatic staff going to nursing homes) and the data on race/ethnicity.
What’s Next?
The NASEM committee that developed the framework is holding a public meeting on September 2 to hear public comments. LeadingAge is scheduled to present our comments at this forum. Our priorities are listed below.
Written public comments will be accepted until September 4 at 11:59 PM EST. Comments can be submitted here: https://www.nap.edu/catalog/25914/discussion-draft-of-the-preliminary-framework-for-equitable-allocation-of-covid-19-vaccine