Older adults 75 and older, as well as frontline essential workers, are the next priority for COVID-19 vaccination, according to recommendations from a Centers for Disease Control and Prevention advisory committee.

The group voted 13-1 Sunday on interim guidance on priority groups 1b and 1c to be next in line for COVID-19 vaccines. Committee members said their recommendations reflect careful examination of the data and address the current lack of vaccine supply as well as individuals at highest risk for severe disease.

The vote comes after long-term care residents and staff, and healthcare personnel, began receiving the first vaccines last week. It also comes one day after the Food and Drug Administration granted emergency use authorization for Moderna’s coronavirus vaccine, following the advisory committee’s endorsement of the vaccine in adults aged 18 or more years. 

Phase 1b includes 19 million people aged 75 and older and about 30 million frontline essential workers such as first responders (firefighters, police officers) and workers in education (teachers, support staff, daycare staff), food and agriculture, manufacturing, corrections, the postal service, public transit and grocery stores.

Adults 75 and older account for 25% of coronavirus-associated hospitalizations, even though they represent only 8% of the population, according to Kathleen Dooling, M.D., MPH, a chief medical officer at the CDC.

Phase 1c includes about 28 million individuals aged 65 to 74, about 81 million people aged 16 to 64 with high-risk medical conditions, and approximately 20 million other essential workers. 

Conditions associated with severe COVID-19 disease include obesity, type 2 diabetes, cardiopulmonary disease, cardiovascular disease, chronic kidney disease, cancer, immunosuppression and sickle cell disease. Pregnancy and smoking also increase complication risks. 

Essential workers not included in Phase 1b include those working in the areas of transportation and logistics, food service, shelter and housing (construction), finance, IT and communication, energy, media, legal, public safety engineering, water and wastewater.

Several committee members expressed concerns about whether states were adequately funded to ensure equitable vaccine distribution to groups most at risk.

“Fund the vaccine infrastructure to get this vaccine out,” said Helen Keipp Talbot, M.D., of Vanderbilt University. “It needs to be done rapidly and it needs to take precedence.”

Although the advisory panel makes recommendations to the CDC, states ultimately determine and execute supply distribution.