National Academy of Medicine Presents COVID-19 Vaccine Framework

The National Academies of Sciences, Engineering, and Medicine recently released a discussion draft of a preliminary framework to assist policymakers in planning for equitable allocation of a COVID-19 vaccine.

Back in July, a committee came together to develop the draft framework in response to a request to the National Academy of Medicine from the National Institutes of Health and the CDC. Now, the committee is asking the public for comments and suggestions regarding its draft advisement. 

“We are pleased to help inform the government’s decision-making process and provide our expert advice for priority-setting for the equitable allocation of potential COVID-19 vaccines,” Victor J. Dzau, president of National Academy of Medicine, said in a public statement.  

“Input from the public on this draft framework, especially from communities disproportionately affected by COVID-19, is essential to produce a final report that is objective, balanced, and inclusive.”

The draft mentions a summary of lessons learned from past allocation frameworks for mass vaccination campaigns, such as the 2009 H1N1 influenza, the 2013–2016 Ebola epidemic, and the current pandemic. The COVID-19 guidance included the allocation of scarce resources, such as medical resources and supplies.

Leveraging the past framework, the committee defined the foundational principles, primary goal, and criteria for determining fair allocation framework, including: 

·       Risk of acquiring infection

·       Risk of severe morbidity and mortality

·       Risk of negative societal impact

·       Risk of transmitting disease to others

A higher priority is given to individuals with a greater chance of being in settings where COVID-19 is circulating and exposure is more prominent, as well as individuals with a greater probability of severe disease or death following infection.

A higher priority is also given to individuals with societal functions and those upon whom other people’s health and livelihood depend directly, according to the draft. Additionally, individuals with a higher chance of transmitting the disease to others also have a higher priority. 

The committee also recommended a four-phased approach for the initial period when vaccine demand exceeds supply in order to prioritize each group included in each phase. 

Phase 1 includes high-risk workers in healthcare facilities, first responders, people of all ages with underlying conditions, and older adults living in congregate or overcrowded settings.

The decision is based on data from August 1, which found that nearly 80 percent of all COVID-19 deaths in the US have occurred in people over the age of 65 and a likewise large percentage of these deaths represent residents in long-term care facilities.  

Phase 2 includes critical risk workers, teachers and school staff, individuals of all ages with comorbid and underlying conditions, older adults not included in Phase 1, individuals in homeless shelters, group homes, or those with disabilities, individuals in prisons, detention centers, and similar facilities, and staff who work in those settings.

Phase 3 includes young adults, children, and workers in industries essential to the functioning of society or an increased risk of exposure not mentioned in the first two phases.

Finally, Phase 4 includes everyone in the US who did not receive the vaccine in previous phases.

The number and timing of available vaccine doses, number of available vaccine types, vaccine efficacy and safety, vaccine uptake, and vaccine distribution and administration are all uncertainties affecting COVID-19 vaccine allocation. 

“While major efforts are being made to have a significant supply of COVID-19 vaccine as soon as possible, the committee has been tasked with considering the tough choices that will need to be made for allocating the tightly constrained initial supplies,” said Helene Gayle, committee co-chair, president and CEO of the Chicago Community Trust.  

“We look forward to receiving and reviewing public feedback on our draft four-phased approach for allocation, to inform the committee’s work moving forward,” added committee co-chair William H. Foege, emeritus distinguished professor of international health at Emory University and former CDC director. 

The committee stated that it will release a final report this fall that will include a final recommended allocation framework informed by pubic comments.