BISMARCK — Deciding who should get the first doses of the COVID-19 vaccine was easy. But for public health officials in North Dakota, the question of who comes second is more complicated.
The Department of Health's COVID-19 Vaccine Ethics Advisory Committee met on Monday, Dec. 14, to workshop their recommendations for the second group of vaccinations, going back and forth on how to best identify and vaccinate the most susceptible North Dakota populations.
At the end of the meeting, the five-person board voted unanimously to recommend vaccination of a large swath of older North Dakotans and residents with underlying conditions ahead of the state's essential workers.
According to the ethics committee's proposal, North Dakotans age 55 and older and all individuals age 16 and older with significant health risk factors will be eligible for the vaccine after the state completes the immunization of health care workers and nursing home residents.
The recommendation comes as the first doses of the newly authorized Pfizer vaccine arrived at some North Dakota hospitals Monday morning. Molly Howell, the state's immunization manager, said the health department hopes to have most of the first vaccination tier completed by the end of this year, with all nursing home residents and 60% of the state's health care staff receiving their first shots in December.
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The Pfizer vaccine, which received an emergency clearance from the federal Food and Drug Administration late last week, requires two shots three weeks apart for immunization. A separate vaccine developed by Moderna is expected to get similar emergency authorization this week. It requires two shots spaced four weeks apart.
The state expects to receive around 40,000 vaccine doses by the end of 2020, and Howell said she is planning for the second phase of vaccinations targeting older and health-compromised residents to begin sometime in January.
Prior to this week, the ethics committee established a broad categorization of people it hoped to target in the second phase of immunization, and Monday's meeting laid out their recommendations for how to prioritize individuals within this strata. According to the committee's latest recommendations, the second phase, called Phase 1B, will prioritize people 65 and older with multiple underlying conditions alongside anyone living in or staffing congregate facilities like prisons, jails or homeless shelters.
A second tier of Phase 1B would open up vaccination to people 65 and older with one underlying condition. The next tier would cover the remainder of the 65 and up population who do not have underlying conditions and open up vaccination to anyone with multiple underlying conditions, regardless of age.
Significantly, the committee also recommended a final tier of Phase 1B that would expand the vaccination of older adults to include anyone age 55 and up, regardless of underlying conditions. North Dakotans at severe risk of COVID-19 complications, according to a CDC list of high-risk factors , would also be eligible for the vaccine in this fourth tier.
The decision to prioritize this large group of older residents and individuals with high-risk underlying conditions in front of essential workers was based on "their increased risk for severe disease," Howell said.
The committee's recommendations will be reviewed by Unified Command, the multi-agency body directing North Dakota's pandemic response. Among the decision-makers on Unified Command are Gov. Doug Burgum, chief operating officer Tammy Miller, National Guard General Alan Dohrmann and interim State Health Officer Dirk Wilke.
Howell noted North Dakota's broad prioritization of high-risk populations ahead of essential workers may put the state out of step with the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.
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The federal body has so far only cemented its prioritization of health care workers and nursing home residents, but Howell said it has indicated a leaning toward putting essential workers next in line. Many other states have indicated they may also break with the ACIP recommendations, which are expected to be broad and leave the most granular decisions up to individual states.
Howell said she hopes to get a finalized Phase 1B plan out later this week, but added the state may hold out for the results of an ACIP meeting this weekend to gauge how the state aligns with federal guidelines.
Readers can reach reporter Adam Willis, a Report for America corps member, at awillis@forumcomm.com.
