2021 BQ Journal Vol 42 - 24

Early Release

Phase 1c

Summary
What is already known about this topic?

In Phase 1c, vaccine should be offered to persons aged
65-74 years, persons aged 16-64 years††† with medical
conditions that increase the risk for severe COVID-19, and
essential workers not previously included in Phase 1a or 1b.
Approximately 129 million persons are included in Phase 1c
(Table), accounting for the overlap between groups in Phase 1c
and earlier phases; for example, some adults aged 65-74 years
reside in long-term care facilities, and many essential workers
have high-risk medical conditions. Persons aged 65-74 years
are at high risk for COVID-19-associated morbidity and mortality. As of December 20, 2020, the cumulative COVID-19
incidence in this age group was 3,109 per 100,000 persons,
with a cumulative hospitalization rate of 642 per 100,000, and
a mortality rate of 188 per 100,000 (7-9).
Based on ongoing review of the literature, CDC has identified medical conditions or risk behaviors that are associated
with increased risk for severe COVID-19.§§§ The risk for
COVID-19-associated hospitalization increases with the number of high-risk medical conditions, from 2.5 times the risk for
hospitalization for persons with one condition to 5 times the
risk for those with three or more conditions (10). According to
a recent analysis of 2018 Behavioral Risk Factor Surveillance
System data,¶¶¶ at least 56% of persons aged 18-64 years report
at least one high-risk medical condition (CDC COVID-19
Response Team, Division of Population Health, personal
communication, December 2020). Essential worker sectors
recommended for vaccination in Phase 1c include those in
transportation and logistics, water and wastewater, food service, shelter and housing (e.g., construction), finance (e.g.,
bank tellers), information technology and communications,

On December 1, the Advisory Committee on Immunization
Practices (ACIP) recommended that health care personnel and
long-term care facility residents be offered COVID-19
vaccination first (Phase 1a).
What is added by this report?
On December 20, ACIP updated interim vaccine allocation
recommendations. In Phase 1b, COVID-19 vaccine should be
offered to persons aged ≥75 years and non-health care
frontline essential workers, and in Phase 1c, to persons aged
65-74 years, persons aged 16-64 years with high-risk medical
conditions, and essential workers not included in Phase 1b.
What are the implications for public health practice?
Federal, state, and local jurisdictions should use this guidance
for COVID-19 vaccination program planning and implementation.

energy, legal, media, public safety (e.g., engineers), and public
health workers.****
ACIP's ethical principles for allocating initial supplies
of COVID-19 vaccine, namely, to maximize benefits and
minimize harms, promote justice, and mitigate health inequities (11), support the allocation scheme for Phases 1b and
1c. Allocation of COVID-19 vaccine to essential workers
and persons at increased risk for severe COVID-19 disease
balances the vaccination program priorities of minimizing
societal disruption and preventing morbidity and mortality.
Essential workers constitute a large and heterogenous group.
Allocation of vaccine to frontline essential workers in Phase 1b
acknowledges their increased risk for occupational exposure
compared with other essential worker categories, as well as the
benefits to society of maintaining these essential functions.
Allocation to persons aged ≥75 years is supported by their
high risk for COVID-19-associated morbidity and mortality
and is anticipated to also reduce hospitalizations in this group,
easing the burden on strained health care systems. Populations
included in Phase 1c are either at an increased risk for severe
COVID-19 compared with the general population or support
ongoing critical infrastructure operations. In addition, certain
essential worker groups have high proportions of some racial
and ethnic minority groups who have experienced disproportionate COVID-19 incidence, morbidity, and mortality (12).
Implementing vaccination programs to reach essential workers will pose challenges. Use of multiple strategies is recommended to reduce barriers to vaccination,†††† such as providing

†††

As of December 18, 2020, two COVID-19 vaccines have been authorized
for use under an Emergency Use Authorization (EUA), but only the
Pfizer-BioNTech COVID-19 vaccine is authorized for use in persons aged
16-17 years.
§§§ Adults of any age with the following conditions are at increased risk for
severe COVID-19-associated illness: cancer; chronic kidney disease; chronic
obstructive pulmonary disease (COPD); heart conditions, such as heart
failure, coronary artery disease, or cardiomyopathies; immunocompromised
state (weakened immune system) from solid organ transplant; obesity
(body mass index [BMI] ≥30 kg/m2 but <40 kg/m2); severe obesity
(BMI ≥40 kg/m2); sickle cell disease; smoking; type 2 diabetes mellitus;
and pregnancy. No data are currently available on the safety of COVID-19
vaccines in pregnant persons. If pregnant persons are part of a group that
is recommended to receive a COVID-19 vaccine (e.g., health care personnel
or essential worker), they may choose to be vaccinated. A conversation
between the patient and the patient's clinical team might assist with
decisions regarding the use of vaccines approved under EUA for the
prevention of COVID-19. Guidance for pregnant persons will be updated
as new data becomes available at https://www.cdc.gov/vaccines/covid-19/
info-by-product/clinical-considerations.html. The list of high-risk medical
conditions is updated routinely as new data becomes available at https://
www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-withmedical-conditions.html.
¶¶¶ https://www.cdc.gov/brfss/annual_data/annual_data.htm.

**** Certain occupations in Phase 1b might be related to sectors listed in Phase 1c
(public transit [transportation and logistics], grocery store workers [food
services], and corrections workers [public safety]).
†††† COVID-19 Vaccination Communication Toolkit. https://www.cdc.gov/
vaccines/covid-19/health-systems-communication-toolkit.html.

MMWR / December 22, 2020 / Vol. 69

Diagnostics I Pharmaceuticals I DxRx Solutions I Continuing Education I News
A Henry Schein Publication

24

3

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html https://www.cdc.gov/vaccines/covid-19/health-systems-communication-toolkit.html https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html https://www.cdc.gov/vaccines/covid-19/health-systems-communication-toolkit.html https://www.cdc.gov/brfss/annual_data/annual_data.htm

2021 BQ Journal Vol 42

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