COVID vaccines are expected in a few weeks. Who will get the first shots?

Written by Amy Ta, produced by Angie Perrin

A person holds a small bottle labeled with a "Coronavirus COVID-19 Vaccine" sticker and a medical syringe in front of the Pfizer logo in this illustration, October 30, 2020. Photo by REUTERS/Dado Ruvic/File Photo

Governor Gavin Newsom on Monday warned that he could impose stay-at-home orders for most of the state soon. COVID hospitalizations in California are at record highs, and hospitals may run out of ICU beds in a couple of weeks. 

Mid-December is also when the first round of vaccines could be available. California is expected to have about 327,000 doses of Pfizer's vaccine. Gov. Newsom assembled three teams to map out a plan for how the vaccines will be distributed and who gets them first.

KCRW talks with Dr. Oliver Brooks, who helped draft those guidelines. He’s also chief medical officer at Watts Healthcare Corporation. 

KCRW: Do you know exactly when the vaccine will be available in LA?

Dr. Oliver Brooks: “No, we don't. … The Pfizer vaccine will be going to the FDA officially for a ruling on December 10. After that, then it'll have to go to the CDC for determination of how the vaccine is recommended for use. Then it has to be distributed. We’re anticipating mid-December.”

Do you have a plan already in place as to who will get the first shots?

“We've been working on that. There's a task force called the Vaccine Development Workgroup. And we’ve presented information to another group. And by the two groups working together, we're looking at having the vaccine go first to health care personnel and those who support health care personnel.”

So how many people is that? 

“In this state, it's somewhere between 2 and 2.4 million. The number we're looking at is 2 million.”

There are some 327,000 for the first round of doses. And since they're two doses per person, that means about 163,000 people would be able to get the first shots.

“From our calculation, the 327,000 that the governor noted is people — and not vaccines. Because the feeling is that that first 327,000 will come, and then the second dose will come right behind it. So think of it as just 327,000 people and not divide it by two. 

… We have to prioritize among the health care personnel. And that has been the significant decision and debate. What we're looking at, and this [has to] be finalized by the governor … primarily looking at acute care hospitals and potentially those that work in long-term care facilities. And those of that ilk being in the first round.”

Do you already have those hospitals and long-term care facilities identified?

“The way it'll work is the vaccine will get distributed to the state, or we'll get an allocation. And then each local health department by county will get a certain amount of vaccine. And then they will determine which particular hospital or other site of allocation … how it will be delivered.

Also potentially will be residents of skilled nursing facilities or assisted living facilities. The Advisory Committee on Immunization Practices meeting today, they're looking at the same concept of how it will be allocated. And with their decision, we will more or less follow once we know for sure exactly what recommendations specifically they make.”

In the second round, essential workers (who are not health care workers) would be eligible to receive the vaccine. Who determines who is an essential worker?

“There is a determination from the state of who or what trade, if you will, is an essential worker. That is something that is being provided to us. And it's done in a scientific fashion. So it's not just what someone's opinion is. So what we've been working with are food and agriculture, government facilities, IT, nuclear reactors, transportation, water and wastewater systems, emergency services, critical manufacturing, communication, commercial facilities. That's about the majority of what are considered essential critical infrastructure workers.”

What about health care professionals who aren't working directly with COVID? Are they considered essential workers and would get early doses?

“Well, essential workers generally are — we're saying other than health care. Okay, so food and agriculture, public safety, education, child care. 

… So what will happen then for those in health care, there will be sub-prioritization of those also. So for example, those who have the greatest risk of exposure, let's say an ER nurse would be someone that would be high on the list. 

And then from there, let's say someone … their work is important, very important. Then other factors, such as are they at higher risk if they get it? Are there other underlying conditions that would allow them to be more susceptible and have more adverse outcomes? 

… It would be … probably a little lower on the priority for someone who was not directly exposed. However, let's say they're very important to the operation. So it's a myriad of factors that will be put together to make that determination, and how much vaccine we have.

Teachers are considered essential workers, and they would be eligible for the early round of vaccines. But what about the students/children? 

“Likely no. And the reason being that the studies that were done by Pfizer, Moderna, AstraZeneca and the other ones generally did not include children. Some had a few children. … As we see them in our mind, let's say, zero to 14 years of the high school age, they were not involved in the clinical trials. And so it would not be appropriate at this point to include them. 

An important concept also is that those that we're looking at — including in phase 1A, 1B, 2, 3, and out — are those right now that we need to prevent COVID-19 in them. Right now, we don't have clear evidence that the vaccine reduces transmission.”

If you have enough people vaccinated, there would be herd immunity at that point.

“It's going to take a while to get to herd immunity, in my opinion. Herd immunity is variable. I hear 50%, I hear 70%. My feeling is more like 70%. So to get 70% of the population vaccinated, we’ll need months and months. So herd immunity is not in the short or even intermediate term, something that I am looking at that will reduce the transmission. 

Actually it may be about a year off, maybe more, from now. Because you think about it, there are many that don't even want to get the vaccine. At this point, there is a lot of vaccine hesitancy and concern regarding the vaccine. 

So if you immunized, say, 100% of those who wanted it, you still may have a significant 20%, 30%, whatever the population that has chosen not to get it. So that'll slow us down in terms of getting to herd immunity.”

Would you take it if you were offered it in the first round?

“Yes, absolutely. Because I will be looking at — along with the state, along with other organizations — the data that is being presented to the FDA. And then after the FDA, it goes to the CDC, which is called the ACRP, they're a group that looks at it. And then it'll be published in another document. And so all of that information will be available. 

… The vaccine is, at this point from my review, safe and effective. I'll give it the final review once the FDA gives it the final review. But assuming it is safe and effective as stated, I will be getting that vaccine. I don't want COVID, okay?”

Credits

Guest:
Dr. Oliver T. Brooks - co-chair of California’s drafting guidelines workgroup, chief medical officer of Watts Healthcare Corporation

Host:
Madeleine Brand

Producers:
Sarah Sweeney, Michell Eloy, Amy Ta, Rosalie Atkinson, Brian Hardzinski, Angie Perrin, Nihar Patel