2021 BQ Journal Vol 42 - 23

Early Release

TABLE. Advisory Committee on Immunization Practices recommendations for allocation of COVID-19 vaccines to persons aged ≥16 years -
United States, December 2020
No. (millions)
Phase
1a
1b
1c

Groups recommended
to receive COVID-19 vaccine
Health care personnel
Long-term care facility residents
Frontline essential workers§
Persons aged ≥75 years
Persons aged 65-74 years
Persons aged 16-64 years¶ with high-risk
medical conditions
Essential workers§ not recommended for
vaccination in Phase 1b
All persons aged ≥16 years¶ not previously
recommended for vaccination

Total persons
in each group*

Unique persons
in each group†

Unique persons
in each phase

21
3
30
21
32
110

21
3
30
19
28
81

All remaining

49
129

All remaining

Abbreviation: COVID-19 = coronavirus disease 2019.
* Data sources for each group: health care personnel (American Community Survey, 2019; https://www.census.gov/programs-surveys/acs/data.html); long-term care
facility residents (Minimum Data Set. Centers for Medicare & Medicaid Services; https://data.cms.gov/); frontline and other essential workers (American Community
Survey, 2019; https://www.census.gov/programs-surveys/acs/data.html); age-specific groups (U.S. Census; https://data.census.gov/cedsci/); high-risk medical
conditions (Behavioral Risk Factors Surveillance System, 2018; https://www.cdc.gov/brfss/annual_data/annual_data.htm).
† Excludes persons who were recommended to receive vaccine in an earlier phase (e.g., persons aged 65-74 years who are living in long-term care facilities or who
are health care personnel, who would have been included in Phase 1a) and accounting for overlap between groups within the same phase (e.g., essential workers
with high risk medical conditions).
§ Estimates for frontline and other essential workers are approximate and derived from prepandemic survey data; relative proportions will vary by state.
¶ As of December 18, only the Pfizer-BioNTech COVID-19 vaccine is authorized for use in persons aged 16-17 years.

daily. The Cybersecurity and Infrastructure Security Agency
(CISA) of the U.S. Department of Homeland Security has
developed a list intended to guide jurisdictions in identifying
essential critical infrastructure workers, who may be exempted
during stay-at-home-orders (3). ACIP used CISA guidance
to define frontline essential workers as the subset of essential
workers likely at highest risk for work-related exposure to
SARS-CoV-2, the virus that causes COVID-19, because their
work-related duties must be performed on-site and involve
being in close proximity (<6 feet) to the public or to coworkers. ACIP has classified the following non-health care essential
workers as frontline workers: first responders (e.g., firefighters
and police officers), corrections officers, food and agricultural
workers, U.S. Postal Service workers, manufacturing workers, grocery store workers, public transit workers, and those
who work in the education sector (teachers and support staff
members) as well as child care workers.§§ A tiered approach
for essential workers builds on the occupations identified by
the National Academies of Science, Engineering and Medicine
for early vaccination (4).
Although there is no national surveillance for COVID-19
among frontline or other essential workers, reports of high incidence and outbreaks within multiple critical infrastructure sectors illustrate the COVID-19 risk in these populations and the
disproportionate impact of COVID-19 on workers who belong
to racial and ethnic minority groups. During March-June,
§§

for example, the Utah Department of Heath reported 1,389
COVID-19 cases associated with workplace outbreaks in 15
industry sectors, accounting for 12% of all COVID-19 cases in
Utah during the same period (5). In addition, despite representing 24% of Utah workers in all affected sectors, Hispanic and
non-White workers accounted for 73% of COVID-19 cases in
workplace-associated outbreaks (5). Among 23 states reporting
COVID-19 outbreaks in meat and poultry processing facilities
during April and May, 16,233 outbreak-associated cases were
reported from 239 facilities, including 86 COVID-19-related
deaths (6). The percentage of workers with COVID-19 ranged
from 3% to 25% per facility, and among cases with information
on race and ethnicity reported, 87% occurred among workers
from racial or ethnic minority groups (6).
Persons aged ≥75 years are at high risk for COVID-19-associated
morbidity and mortality. As of December 20, 2020, the
cumulative incidence¶¶ of COVID-19 among persons in this
age group was 3,839 per 100,000 persons, with a cumulative
hospitalization rate of 1,211 per 100,000, and a mortality rate
of 719 per 100,000 (7-9). The overall proportion of persons
aged ≥75 years who live in a multigenerational household is
6%; the proportion among non-Hispanic White persons is 4%,
and the proportion among racial or ethnic minority groups is
higher (non-Hispanic Black persons, 10%; Hispanic or Latino
persons, 18%; non-Hispanic persons of other races, 20%).***
¶¶

https://www.cdc.gov/vaccines/covid-19/categories-essential-workers.html.

Incidences were calculated using age-specific population denominators from
the U.S. Census. https://www.census.gov/data.html.
*** Data from the U.S. Census Bureau 2019 American Community Survey 1-Year
Public Use Microdata Samples [CSV file]. https://www2.census.gov/programssurveys/acs/data/pums/2019/1-Year/. Accessed December 16, 2020.

MMWR / December 22, 2020 / Vol. 69

Diagnostics I Pharmaceuticals I DxRx Solutions I Continuing Education I News
23

A Henry Schein Publication

https://www.census.gov/programs-surveys/acs/data.html https://data.cms.gov/ https://www.census.gov/programs-surveys/acs/data.html https://data.census.gov/cedsci/ https://www.cdc.gov/brfss/annual_data/annual_data.htm https://www.cdc.gov/vaccines/covid-19/categories-essential-workers.html https://www.census.gov/data.html https://www2.census.gov/programs-surveys/acs/data/pums/2019/1-Year/ https://www2.census.gov/programs-surveys/acs/data/pums/2019/1-Year/

2021 BQ Journal Vol 42

Table of Contents for the Digital Edition of 2021 BQ Journal Vol 42