After months of discussion, state health leaders on Thursday unveiled a draft plan for who will be first in line for a coronavirus vaccine when one likely becomes available in scant quantities toward the end of this year or early next year.
Though several vaccine candidates have entered the final stage of clinical trials, there likely won’t be enough supply of any of them to vaccinate all Coloradans for months after they have been approved. So states, working with the federal government, must come up with plans for whom to prioritize.
Colorado’s plan attempts to balance the need to protect frontline health workers while also delivering vaccine doses to people most at risk for severe illness and to communities of color, which have been especially hard-hit by the virus. It is still a draft plan because everyone involved in making it acknowledges there is considerable uncertainty about how the next few months will proceed — no vaccines have yet completed their clinical trials or received official approval; the federal government has not yet announced its plan for a vaccine rollout; and it’s unknown how many doses of vaccine will be initially supplied or when more will become available.
“This is going to be modified over time as we learn about the individual vaccine — which groups it is most effective on, which groups it is least effective on,” said Dr. Anuj Mehta, a pulmonologist at National Jewish Health who helped create the prioritization plan.
The plan was presented Thursday during a meeting of the Governor’s Expert Emergency Epidemic Response Committee, a group made up of health leaders from across the state who advise Gov. Jared Polis on how to respond to the coronavirus pandemic. The state must next week submit a broader plan to federal health authorities detailing how it intends to distribute vaccines.
The draft prioritization plan suggests rolling out vaccine allocation in four phases. Phase 1 puts an emphasis on delivering vaccines to health care workers, first responders and the highest-risk patient groups, such as those living in nursing homes. Phase 2 focuses on essential workers who interact with the general public in situations where social distancing is difficult, such as in grocery stores, and on other high-risk patient groups, such as those over 65 or people with underlying medical conditions like diabetes or obesity.
All other essential workers will become eligible for vaccination in Phase 3. And Phase 4 opens up to everyone else in the general population.
The plan does not provide recommendations for which phase would include children or pregnant women. No clinical trials are currently enrolling children or pregnant women, meaning there will be no data on the vaccines’ safety or efficacy in those populations when they are approved. Mehta said he hopes more information will become available as the vaccines reach broader populations. The goal, he said, is for every Coloradan who wants a vaccine to be able to get one.
But when setting out to create the plan, Mehta and others working on it soon realized a problem. Added together, the first two phases, when vaccine availability will be most limited, include as many as 3 million people. That’s more than half the state’s population.
This led the group to create subcategories within the phases. Phase 1A, for instance, is limited to only inpatient and outpatient health care workers, including those at nursing homes and assisted living facilities. Phase 1B covers first responders.
But even that might not be narrow enough. Mehta said there are roughly 350,000 health care workers and first responders in the state. The first months’ delivery of vaccine to Colorado could be as little as 20,000 doses — enough to vaccinate only 10,000 people, since most of the vaccines under development would require two doses.
So, the plan recommends that the state prioritize inpatient health care workers over outpatient ones in Phase 1A and direct vaccine first to virus hot spots.
Mehta said the plan also takes into account the disproportionate impact coronavirus has had on communities of color, though it does not consider race when deciding how to allocate vaccine. He said the things that make people of color most vulnerable during the pandemic also place them higher on the priority scale, such as proportional overrepresentation among health care workers and other essential workers and systemic inequality that means Black and Hispanic Coloradans on average have worse health outcomes than white Coloradans.
“We decided to address the issue of racism, not race,” Mehta said. “…At every phase, we considered the impact on communities of color.”
The prioritization plan is only one hurdle the state will have to overcome in distributing coronavirus vaccines.
Diana Herrero, the state Health Department’s interim deputy director for the Division of Disease Control and Public Health Response, said the state expects the vaccine will be delivered by the massive pharmaceutical distribution company McKesson and the state will use other existing infrastructure to send doses to hospitals, clinics and other providers. She said more than 1,100 providers have already signaled an interest in offering coronavirus vaccine. (Because the U.S. government has invested heavily in development of the vaccines, they are expected to be available for free in this country.)
But at least one vaccine under development will require ultracold storage — on the order of minus 70 degrees Celsius — which most providers in the state have no ability to accomodate. So the state has been looking for sources of dry ice and freezers capable of reaching those temperatures.
Also, for almost all vaccines under development, patients will need two doses, spaced three to four weeks apart. This means the state will need to figure out a way to make sure patients are getting their follow-up doses and aren’t mixing and matching different vaccines.
“They are considered not interchangeable,” Herrero said during Thursday’s GEEERC meeting. “So whatever vaccine a person starts with, that is the second dose that they would need to receive.”