How COVID-19 Vaccination Effort Should Proceed

The United States is experiencing the worst coronavirus disease 2019 (COVID-19) surge since the beginning of the pandemic. We’re seeing a seven-day average of 209,000 new daily cases, over 119,000 people hospitalized, and over 2600 people a day dying from the disease. The past week has been busy with news of vaccine roll-outs. Not only is the Pfizer vaccine in distribution, but Moderna’s vaccine recently got approval for emergency use authorization (EUA).

Now though, comes the most challenging piece for many in infection prevention and healthcare—distribution of the vaccine. Most of the healthcare workers on the frontlines will be included in the first stages of. While the US Centers for Disease Control and Prevention has released interim recommendations for the use of COVID-19 vaccines through the Advisory Committee on Immunization Practices (ACIP), it’s ultimately up to local (state) authorities to determine roll-out. In addition to these recommendations, the National Academies of Sciences, Engineering, and Medicine has released a framework for equitable allocation. This allocation proposal includes four phases, which starts with those working in high-risk health settings and first responders, followed by those with underlying conditions and older adults living in congregate or overcrowded settings.

In Phase 2, the direction shifts to teachers and school staff, high-risk industrial settings, and people in prisons and jails. The authors also noted that “Current evidence shows that COVID-19 disproportionately affects particular racial and ethnic minority groups, including Black, Hispanic or Latinx, American Indian and Alaska Native, and Native Hawaiian and Pacific Islander communities. Many of these groups experience increased social risks and are impacted by structural inequalities that contribute to health inequities, along with pre-existing conditions that put them at higher risk of severe illness and death from COVID-19.”

Currently, US states and hospitals are working to identify their rollout plans. For many in healthcare though, the question will be—who goes first? Part of this will involve infection prevention efforts and insights—who are those most at risk and involved in exposures? One piece will be to involve those working on designated COVID-19 units and high-risk areas, like emergency departments and urgent care clinics.

For those in intensive care units and even oncology centers, this will be also be a critical decision regarding allocation for those working with vulnerable patient populations. In addition to those most at risk and working with at-risk patients, it’s important to consider ancillary staff. Employees in environmental services, lab, respiratory therapy, physical therapy, and food services, are all people who have been working in these high-risk areas as well.

This also includes infection preventionists, which means we must be advocates for not only those ancillary staff, but also our programs and people who have been educating and rounding in those high-risk units and areas. Fundamentally though, it will be critical that vaccine allocation efforts in hospitals not only integrate public health strategies, but also make the vaccine rollout accessible and efficient. Moreover, these efforts will need to counter vaccine misinformation and proactively focus on how to educate healthcare workers, and the public, regarding the vaccines, their side effects, and efficacy. This will be a critical time in US history, healthcare, and infection prevention, but through strategy and continued information sharing, we can start to rollout in an equitable and effective manner.