Report: Access to COVID vaccine in 2020 won't expand beyond 'Phase 1' individuals

Posted at 11:26 AM, Sep 04, 2020

SAN DIEGO, Calif. - There could be as many as 78 million doses of COVID-19 vaccines available by the end of 2020, according to the most optimistic timeline in leaked documents from the Centers for Disease Control and Prevention.

But assuming that the vaccine will require two doses per individual, that figure would only be enough to inoculate the highest priority individuals, based on draft guidelines released this week from the National Academies of Sciences, Engineering, and Medicine.

“We’re not even going to get through Phase 1 people” in 2020, said Dr. Mary Barger, an epidemiologist at the University of San Diego.

There are an estimated 44 million people in NASEM’S Phase 1 group: frontline healthcare workers, first responders, people with multiple high-risk factors, and adults living in nursing homes and other group settings.

Based on leaked CDC guidance to states published by the New York Times, if two vaccine candidates become available in October, there would be enough doses for 39 million people by the end of 2020 -- not quite enough to cover the entire Phase 1 group.

If only one vaccine is available by October, the projections suggest there could be enough doses to cover 13 to 26 million people.

That might only be enough for frontline healthcare workers and first responders, of which there are an estimated 17 million.

Healthcare workers and first responders get the highest priority, which NASEM calls Phase 1a, so they can maintain the integrity of the healthcare system.

“When there’s a pandemic, you want to make sure you have enough people to take care of those that are sick,” said Dr. Abisola Olulade of Sharp Rees-Stealy Medical Group.

Phase 1b includes individuals with multiple underlying conditions, like cancer, chronic kidney disease, and serious heart conditions.

Approximately 75% of adults hospitalized for COVID-19 in the U.S. between March 1 and August 15 had at least two underlying conditions, according to data from the COVID-19 Associated Hospitalization Surveillance Network cited in the NASEM guidelines. More than 60% of hospitalized adults had three or more underlying conditions.

“It would make sense that you would include a segment of the population that’s at risk of doing the worst,” said Dr. Peter Chin-Hong, an infectious disease specialist at UC San Francisco.

There are an estimated 27 million people in the Phase 1b category.

Critical workers in high-risk industries like grocery store clerks, mail carriers, and bus drivers would be in Phase 2, along with teachers, homeless people, prisoners, people with moderately risky underlying conditions, and anyone over the age of 65.

“Even though people 65 and older make up less than 20% of the population, there have been 80% of COVID-19 deaths in this age,” Dr. Olulade said.

Risk factors including high blood pressure, liver disease, or moderate-to-severe asthma would qualify an individual for Phase 2.

There are an estimated 27 million people in this phase.

In Phase 3, NASEM recommends inoculating people who are at lower risk of a bad infection but may be vectors for the spread of disease, including young people and children.

NASEM noted that it will be “critical to conduct additional trials to gain a better understanding of safety and efficacy of COVID-19 vaccine among children before they receive the vaccine.” Currently, there are no COVID vaccine trials that include children.

Other essential workers at moderate risk of exposure would also be included in Phase 3, including employees in restaurants, hotels, hair salons, and exercise facilities.

Phase 4 includes everyone else.

This story was first reported by Derek Staahl at KGTV in San Diego, California.