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Police, firefighters, teachers and grocery workers will be among those next in line for a COVID-19 vaccine, a Centers for Disease Control and Prevention advisory panel decided Sunday. The committee voted 13-1 to recommend that Phase 1b include people 75 and older and front-line essential workers. Phase 1c will include people 65 to 74 and people 16 to 64 who have high-risk medical conditions, along with other essential workers. (Weise, 12/20)

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. (Hanna and Stobbe, 12/20)

The recommendations are nonbinding, since states make the final decisions over who to prioritize for vaccination. However, many states have been looking to ACIP recommendations to help them settle challenging ethical questions over how to fairly divvy up scarce supply of doses. “This isn’t black and white,” Amanda Cohn, ACIP’s executive secretary, said of the recommendations. “It will vary by local context.” (Ehley, 12/20)

The panel of doctors and public health experts had previously indicated it would recommend a much broader group of Americans defined as essential workers — about 90 million people with jobs designated by a division of the Department of Homeland Security as critical to keeping society functioning — as the next priority population, and that older people who live independently should come later. But in hours of discussion on Sunday, conducted remotely, the committee members concluded that given the limited initial supply of vaccine and the higher Covid-19 death rate among older Americans, it made more sense to allow the oldest among them to go next, along with workers whose jobs put them “at substantially higher risk of exposure” to the virus. (Goodnough and Hoffman, 12/20)

Jose Romero, chair of the ACIP and Secretary of Health in Arkansas, said deciding how to give priority to the groups was wrenching. “This is without doubt the hardest vote that I have taken in my six-and-a-half years on the committee,” he said. Henry Bernstein, a pediatrician at the Zucker School of Medicine at Hofstra/Northwell Cohen Children’s Medical Center in New Hyde Park, N.Y., gave the sole no vote, he said, because he believes the second priority group should include people starting at age 65. Their risks are similar to those 75 and older, he said. (McKay, 12/20)

The group's recommendation may not align with public expectations, warned Molly Howell, immunization program manager for the North Dakota Department of Health. "We will need some very clear communication and talking points as to why frontline essential workers, who may be younger and healthier, are being vaccinated over [people ages 65 to 74] and those with multiple underlying health conditions," she said during the meeting, citing a recent poll showing public support for prioritizing seniors and immunocompromised individuals. (Huang, 12/20)

Supermarkets have been hit hard by the unprecedented explosion of the coronavirus in Los Angeles County, further straining an essential service that needs to remain open despite the new stay-at-home order. L.A. County is investigating ongoing coronavirus outbreaks at 490 businesses, compared with 173 a month ago, according to county data. The increase in outbreaks drives home officials’ warnings that the only way to stay safe is to stay home, even as many businesses remain open. (Karlamangla, 12/20)

Workers at a leading commercial laundry firm that cleans sheets for some of New York City’s biggest hospitals say every day on the job places them at greater risk of Covid-19 infection. Industry CEOs from all over the U.S. voiced concern earlier this month about potential outbreaks, too. As a critical component of a healthcare system buckling under the strain of a nationwide surge, commercial laundry companies have become essential in the fight against the pandemic. But their employees’ unions contend that while some operators have taken adequate measures to protect workers, others have not. (Davalos, 12/21)

What is clear is that there won’t be enough doses to go around for months. Local officials in each state will have to make tough choices about which essential workers get their shots first. “It almost feels like a wrestling match out there, where many interests want to make it clear that the people they represent have a lot of essential workers,” said Jonathan Slotkin, chief medical officer of Contigo Health, which leads partnerships between large national employers and hospital systems. Companies are displaying a “voracious appetite” for vaccines for their workforces, he said. (Rowland, Stanley-Becker, Bogage, Bhattarai and Reiley, 12/20)