As chairman of the Advisory Committee on Immunization Practices, Romero is possibly the most influential person in deciding who – and when – will get a coronavirus vaccine in the coming months.
People know and have stood up for Romero and other members of the committee that runs the U.S. Centers for Disease Control and Prevention on vaccine distribution.
It was ACIP that decided that health care workers should be at the forefront and the frail, vulnerable residents of long-term care facilities should be at the forefront of the sparse first vaccines.
They meet on Sunday to decide who’s next.
In the mix: key workers, people over 65 and people with chronic illnesses who are at greater risk of developing serious illnesses if infected. There are tens of millions of people in any group and there won’t be enough vaccine to cover everyone right away. Decisions have to be made.
“We’re dealing with these decisions because we know there aren’t enough vaccines,” said Romero, a pediatric infectious disease specialist who is also the state health secretary for the state of Arkansas.
ACIP was mandated to provide a four-phase rollout of the vaccine, but there is still so little vaccine available that Phase 1 has been split into Phases 1a, 1b and 1c. Phase 2, said Romero, could not be discussed until February.
Phase 1b is likely to have a vital workforce – but that’s 87 million people. US Health Secretary Alex Azar estimates that the US will be able to vaccinate 50 million people by the end of January – including the roughly 20 million the US claimed to have vaccinated in December.
So who’s going next?
The CDC provided a list that included the food and agriculture sectors, transportation, energy, police, fire services, manufacturing, information technology and communications, water and sanitation.
But how about warehouse consultants?
“Childcare personnel in after-school educational and recreational areas such as camps and community centers are vital to providing continued support to the health system, first responders, the frontline and the country’s essential workforce, as well as helping our country continue to recover economically” the American Camp Association argued in its letter to Romero.
“Our workforce is a central and critical link in the country’s supply chain and will play a vital role in the upcoming COVID-19 vaccine distribution process. As the trucking industry is challenged to ship vaccines across the country, it is imperative that truck drivers have prioritized access to the vaccine to minimize the potential for delays and disruptions in the supply chain, “wrote Bill Sullivan, executive vice president of advocacy for the American Trucking Associations, in a letter to ACIP.
“We are not calling for aviation workers to be high on the list, but we do need governments to ensure that transport workers are seen as essential in developing vaccine roll-out plans,” said Alexandre de Juniac, CEO of International Air Transport Association.
Teachers don’t want to be left out.
“Our public schools are vital to California’s full recovery from this pandemic, and we cannot safely and fully return to face-to-face teaching without putting our public school staff high on the priority list,” the California Teachers Association said in an explanation.
“The vaccine rollout should include school-based vaccination sites where school staff and parents, guardians and household members of students who are key workers can get vaccinated to better protect our public school communities.”
But how can these people, including many young and healthy adults, be put in front of the elderly and sick, who are at much greater risk of serious illness if they become infected?
This includes people with obesity – more than 40% of the US population – diabetes, heart disease, lung disease, kidney disease, cancer, sickle cell disease, and other conditions.
Should rare disease patients come first because they are both at risk and in number? Should smokers have to wait because their lifestyle choice isn’t technically a disease?
“We understand that our decisions are being reviewed,” said Romero. “I assume that people will criticize me for my decision.”
In making the decision to include residents of long-term care facilities in Group 1a, the committee looked at data showing that these patients account for 40% of deaths from Covid-19. Romero said ACIP will similarly look for data to help decide who to recommend in Groups 1b and 1c.
“I’m going to these meetings openly. I just want to see the dates,” he said.
A team of cancer experts say they received this data. 28 different studies have shown that the risk of dying from Covid-19 is higher in cancer patients.
And then there is the problem of differences.
“The idea is that we want to minimize the harm from the vaccine and maximize its benefits. We want to eliminate the differences in health care. We want to make sure there is justice,” said Romero.
The committee has been given a specific mandate to reflect on these factors when making a decision.
“How do vaccine properties and logistical considerations affect fair access for all?” The committee was asked in a first document at the beginning of its session in November.
“Does the allocation plan include contributions from groups disproportionately affected by Covid-19 or exposed to health inequalities resulting from social determinants of health, such as income and access to health care?”
For Romero, it’s a good guide.
“It’s a complex decision. Yes, everything counts. You don’t consider any factor.”
And states have the flexibility to adapt the guidelines. Legally, you don’t have to follow this at all.
“States have the option not to use our recommendations,” said Romero. But he hopes they will.
“If we document that our decisions are based on current data on epidemiological diseases, they will be informed and allow governors to accept them.”