NEW YORK -- A federal advisory panel recommended Sunday that people 75 and older and essential workers such as firefighters, teachers and grocery store workers should be next in line for covid-19 shots, while a second vaccine began rolling out to hospitals as the nation works to get the coronavirus pandemic under control.
The two developments came amid a vaccination program that began only in the past week and has given initial shots to about 556,000 Americans, according to the Centers for Disease Control and Prevention.
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The covid-19 vaccine developed by Pfizer Inc. and Germany's BioNTech already is being distributed, and regulators last week gave approval to the one from Moderna Inc. that began shipping Sunday.
Earlier this month, the Advisory Committee on Immunization Practices said health care workers and nursing home residents -- about 24 million people -- should be at the very front of the line for the vaccines.
Sunday's vote by the panel was who should be next in line, and by a vote of 13-1, it decided that it should be people 75 and older, who number about 20 million, as well as certain front-line workers, who total about 30 million.
The essential workers include firefighters and police; teachers and school staff; those working in food, agricultural and manufacturing sectors; corrections workers; U.S. Postal Service employees; public transit workers; and grocery store workers. They are considered at very high risk of infection because their jobs are critical and require them to be in regular contact with other people.
It's not clear how long it will take to vaccinate those groups. Vaccine doses have come out slower than earlier projections. But at the same time, some experts noted that not everyone who is recommended to get vaccinated may choose to get a shot.
The committee also voted that behind those groups should be people aged 65 to 74, numbering about 30 million; those aged 16 to 64 with medical conditions like obesity and cancer who are at higher risk if they get covid-19, numbering as many as 110 million; and a tier of other essential workers. This group of as many as 57 million includes a wide category of food service and utility workers but also those in legal and financial jobs and the media.
The expert panel's recommendation next goes to the CDC director and to states as guidance to put together vaccination programs. CDC directors have almost always signed off on committee recommendations. No matter what the CDC says, there will be differences from state to state, because various health departments have different ideas about who should be closer to the front of the line.
"These are going to be imperfect," said Grace Lee, a committee member and professor of pediatrics at Stanford University's medical school, referring to the industries listed in the two groups of essential workers.
The 14 members of the panel have been wrestling with questions about balancing fairness and speed since the spring. They have held nearly a dozen public meetings to examine evidence to address how best to balance saving the lives of the most vulnerable against stopping the spread of the virus, and doing so in a way that will lessen health inequities.
Federal officials expect that vaccine doses will be limited for several months. CDC officials say up to 20 million are projected to start getting shots this month, another 30 million next month, and 50 million in February. That's 100 million out of a population of more than 330 million.
Pfizer's shots were first shipped out a week ago and started being used the next day, kicking off the nation's biggest vaccination drive.
Public health experts say the shots -- and others in the pipeline -- are the only way to stop a virus that has been spreading wildly. Nationwide, more than 219,000 people per day on average test positive for the virus, which has killed over 317,000 in the U.S. and nearly 1.7 million worldwide.
VACCINE SHIPS OUT
Earlier Sunday, trucks left the Olive Branch, Miss., factory, near Memphis, with the vaccine developed by Moderna and the National Institutes of Health. The much-needed shots are expected to be given starting today, just three days after the Food and Drug Administration authorized their emergency rollout.
Dr. Moncef Slaoui, the chief science adviser to the federal government's vaccine distribution effort, said on CNN's "State of the Union" that nearly 8 million doses will be distributed today, about 5.9 million of the Moderna vaccine and 2 million of the Pfizer vaccine.
Slaoui also predicted the U.S. will experience "a continuing surge," with larger numbers of coronavirus cases possible from gatherings for Christmas.
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"I think, unfortunately, it will get worse," he said.
There won't be enough shots for the general population until spring, so doses will be rationed at least for the next several months. President-elect Joe Biden pledged earlier this month to have 100 million doses distributed in his first 100 days in office, and his surgeon general nominee said Sunday that it's still a realistic goal.
But Vivek Murthy told NBC's "Meet the Press" it's more realistic to think it may be midsummer or early fall before vaccines are available to the general public, rather than late spring. Murthy said Biden's team is working toward having the shots available to lower-risk individuals by late spring but doing so requires "everything to go exactly on schedule."
SHOTS FOR THE INFECTED
Slaoui, speaking on "State of the Union," said that people who have been infected with the coronavirus -- a group that includes President Donald Trump -- should receive the vaccine.
Slaoui said Sunday that the vaccine is safe for those who have recovered and offers stronger and potentially longer protection than does the virus itself.
"We know that infection doesn't induce a very strong immune response and it wanes over time. So I think, as a clear precaution, it is appropriate to be vaccinated because it's safe," he said. "I think people should be vaccinated, indeed."
Trump is now one of the only senior-most U.S. officials who has not received the first of two vaccination shots. Vice President Mike Pence, House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Mitch McConnell, R-Ky., all were given doses Friday. President-elect Joe Biden was to receive his today.
All have chosen to publicize their injections as part of a campaign to convince a skeptical public that the vaccines are safe and effective.
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Trump, who in the past has spread misinformation about vaccine risks, tweeted earlier this month that he was "not scheduled" to take the vaccine, but looked "forward to doing so at the appropriate time." The White House says he is still discussing timing with his doctors.
Trump was hospitalized with covid-19 in October and given an experimental monoclonal antibody treatment that he credited for his swift recovery.
The CDC advisory board has said people who received that treatment should wait at least 90 days to be vaccinated to avoid any potential interference.
'UP AND DOWN'
Meanwhile, Trump's surgeon general, Jerome Adams, defended the administration's handling of the Pfizer vaccine Sunday, a day after the Army general in charge of getting covid-19 vaccines across the U.S. apologized Saturday for "miscommunication" with states over the number of doses to be delivered in the early stages of distribution. At least a dozen states reported they would receive a smaller second shipment of the Pfizer vaccine than they had been told previously.
Gen. Gustave Perna told reporters in a telephone briefing that he made mistakes by citing numbers of doses that he believed would be ready. Slaoui said the mistake was assuming vaccines that had been produced were ready for shipment when there was a two-day delay.
"And unless it's perfectly right, we will not release vaccine doses for usage," he said. "And, sometimes, there could be small hiccups. There have been none, actually, in manufacturing now. The hiccup was more into the planning."
But Adams told CBS' "Face the Nation" that "the numbers are going to go up and down."
"It absolutely was not poor planning," he said. "There's what we plan. There's what we actually allocate. There's what's delivered, and then there's what's actually put in people's arms."
Adams, who is Black, said he understands that mistrust of the medical community and the vaccine among Blacks "comes from a real place," the mistreatment of communities of color. He cited the decades-long Tuskegee experiment in Alabama, where Black men with syphilis were not treated so the disease could be studied.
CONTAGIOUS STRAIN
Additionally, officials in Britain on Saturday sounded an urgent alarm about what they called a highly contagious new variant of the coronavirus circulating in England.
In South Africa, a similar version of the virus has emerged that shares one of the mutations seen in the British variant, according to scientists who detected it. That virus has been found in up to 90% of the samples whose genetic sequences have been analyzed in South Africa since mid-November.
Scientists are worried about these variants but not surprised by them. Researchers have recorded thousands of tiny modifications in the genetic material of the coronavirus as it has hopscotched across the world.
Some variants become more common in a population simply by luck, not because the changes somehow supercharge the virus. But as it becomes more difficult for the pathogen to survive -- because of vaccinations and growing immunity in human populations -- researchers also expect the virus to gain useful mutations enabling it to spread more easily or to escape detection by the immune system.
"It's a real warning that we need to pay closer attention," said Jesse Bloom, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle. "Certainly, these mutations are going to spread, and definitely, the scientific community, we need to monitor these mutations, and we need to characterize which ones have effects."
The British announcement also prompted concern that the virus might evolve to become resistant to the vaccines just now rolling out. The worries are focused on a pair of alterations in the viral genetic code that may make it less vulnerable to certain antibodies.
But several experts urged caution, saying it would take years -- not months -- for the virus to evolve enough to render the current vaccines impotent.
"No one should worry that there is going to be a single catastrophic mutation that suddenly renders all immunity and antibodies useless," Bloom said. "It is going to be a process that occurs over the time scale of multiple years and requires the accumulation of multiple viral mutations. It's not going to be like an on-off switch."
Information for this article was contributed by John Hanna, Mike Stobbe, Jill Colvin and Julie Walker of The Associated Press; by Apoorva Mandavilli of The New York Times; and by Lena H. Sun and Isaac Stanley-Becker of The Washington Post.
