CDC announces priorities for vaccinations in Phase 1a, 1b and 1c

This information comes from the CDC ACIP recommendations updated on December 20, 2020. The suggested dates, in parenthesis, are my estimates based on best available information. See here for my original analysis and expectations on vaccine availability.

These are CDC recommendations – each state may set its own priorities and schedules so this could be different depending on where you live. In addition, vaccines are allocated to states by their percentage of the U.S. population. Because the “prioritized groups” in 1a, b and c are not distributed randomly across the states, some states will end up with more vaccine than is necessary to meet their 1a, 1b and 1c goals – while others will end up with too little. Thus, the date you become eligible can vary considerably based on the state you live in. 

 

See CDC ACIP PPT slide 10.

Vaccine Allocation Planning Model.

Phase 1a (24M) (Dec to Feb/Mar)

  • Health care workers and the institutionalized elderly.

Phase 1b (49M) (Feb/Mar to Spring)

  • 30 M “front line workers” in specific occupations – meat plants, food and agricultural jobs, grocery stores, prisons, transit/transport, manufacturing, teachers, USPS workers, police/fire/EMS.
  • 19M adults age 75 and older

Phase 1c (129M) (Spring to Summer)

  • Adults 65 and older
  • Adults 16 to 64 with high risk conditions
  • “Essential workers” including media, construction, non-teaching education staff, daycare, finance, IT, public safety engineers (assume this means government employed engineers only), “legal” sector, food service, energy and logistics (shipping). Oddly does not include general “retail” front line workers.

Total: Up to 202 million people

No recommendation yet for Phase 2 categories to reach the remaining 126 million people in the U.S. Additionally, no vaccine has yet been approved for children under age 16 (this is expected in the summer of 2021). 

As of December 20th, the U.S. had publicly disclosed contracts for delivery of vaccines to 150 M by June 30th. The news reports say the estimated numbers in each group have removed overlap between groups. 

Update December 23, 2020

The US announced it has reached an agreement with suppliers for doses for an additional 35 M by June 30th and 15M more by July 31st. This brings the total to 200M by end of July, enough doses for 2/3ds of the U.S. population. This tends to confirm the estimated times lines above – mid to late summer before we start giving vaccinations to the general public.

The US Secretary of Health and Human Services assumes that a very large percentage of the U.S. population does not want to get a vaccine

“This new federal purchase can give Americans even more confidence that we will have enough supply to vaccinate every American who wants it by June 2021,” Azar said in a statement Wednesday.

By June 30th, we now have doses available for 185 M for the 202 M in the Phase 1a, 1b and 1c groups.  Obviously, HHS is now hoping that fewer people want the vaccine while Fauci is simultaneously saying 75 to 85% need to take the vaccine. More inconsistencies in public health.

How Will You Know When it is Your Turn?

Or conversely, how can you “prove” to a provider that you fall into one of the groups 1a, 1b or 1c? This is not obvious.

The NY Times notes that Belgium will mail an “invitation” letter to residents when it is their turn. This of course assumes that the government can know your personal situation.

At this point, I doubt I will be vaccinated until the Fall of 2021. There are far too many inconsistencies in the statements and numbers for public health to meet their publicly stated delivery goals – and many of us will be among the last persons in the nation eligible to receive a vaccination.

They imply they hope to get doses for an additional 50M by June 30th, so that all 202M could be vaccinated up through roughly that time frame. Other news reports say the U.S. is negotiating with Pfizer to deliver doses for up to 50M more, by an unknown date. Another report suggests that Johnson and Johnson has not yet signed contracts with any country and has just begun to negotiate potential deals.

By “spring” I include “March” but note that vaccinating up to 129M people from March to June 30th, even if we had the vaccine, would be more than 1 million people per day, and up to 2 million shots per day (2 doses), 7 days per week.

General Availability

Possibly starting in late July/August..

Source: Front-line essential workers and adults 75 and over should be next to get the coronavirus vaccine, a CDC advisory group says – The Washington Post

Other Issues

Some racial and ethnic minority groups have been hit hard by Covid-19 and media reports imply that some states are seeking to prioritize access to these groups within each phase. The reports imply, if you are a member of a minority group, and you fall in Phase 1b, then members of your group would be prioritized within 1b, moving forwards in time.

This reporting, though, may be in error.

In my state, Oregon, the state uses the words “health equity”  frequently. As best I can tell, the state is ensuring ensuring a fair and timely delivery of vaccines to rural hospitals serving large migrant agricultural worker populations and tribal medical clinics. The reasonable concern is that such facilities would receive vaccine supplies after “big city” medical centers – a “business as usual” approach might put these smaller communities as last in line. 

Herd Immunity

“Experts” say herd immunity occurs when a certain percent of the population has immunity. For measles, this figure is estimated at 94%. For Covid-19, this is estimated at 70% (or may be 85% says Fauci). Coincidentally, 70% of the US population is about 200 M people – the phase 1a, 1b and 1c groups.

When this is reached, will the U.S. be under pressure to redistribute its vaccines to other nations?

WHO has redefined “herd immunity” to count only vaccinated individuals in the percent immune. This is not scientifically supportable. There are respectable scientists suggesting about 1/3 of the US may have antibodies by January 1, 2021, but WHO would not count this group.

When a disease is very bad, it is preferable to achieve immunity through vaccines – but it is wrong to suggest that herd immunity is the only way to reach herd immunity. In any case, the point here is that the US may be at 70% herd immunity sooner than expected, and it is possible that further vaccine availability could then be delayed, under pressure to redistribute US supplies to other countries.

Wild cards.

  • More vaccines could be delivered sooner than expected.
  • More vaccines could be approved from more manufacturers than expected.
  • More people choose not to be vaccinated, creating a surplus of vaccines.
  • The pandemic may go endemic on its own, and come to an end on its own, as all prior pandemics have done.
  • Developed nations, including the U.S. may come under pressure to divert some of their vaccine supply to other nations, delaying vaccinations for those who are already scheduled late in the queues.
  • Civil unrest. Public health and the media incorrectly set expectations about vaccine availability that will not be met. I have seen frustration expressed in news and social media comments about the reality being summer or fall of 2021.

CDC ACIP Slide 10

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