Frontline healthcare workers, including home care nurses, would be among the first to receive any approved COVID-19 vaccine, according to a final report released Friday by the National Academies of Sciences, Engineering, and Medicine.

The consensus study recommends a four-phased allocation framework that the U.S. Department of Health and Human Services and state and local officials should use to prioritize distribution efforts. It recommends using existing systems and resources from all levels of government to ensure equitable allocation, distribution, and administration of a COVID-19 vaccine; launching a COVID-19 vaccine promotion campaign and risk communication and engagement program; and supporting equitable allocation globally.

Although long-term care pharmacies have indicated they will play a major role in providing vaccines to frontline workers in skilled nursing facilities, much remains to be determined about how home health workers will be inoculated.

“We will have some home care identification issues,” Bill Dombi, president of the National Association for Home Care and Hospice told McKnight’s Friday, noting that “hundreds of thousands” of home care workers may be affiliated with non-licensed or non-medical services and working in the homes of COVID-positive patients or those especially vulnerable to the disease. “The question is,’ Are they [the Department of Health and Human Services] going to be purposely looking at home care with a wide lens?’”

Dombi said he was hopeful that was the case after a recent HHS decision widened access to rapid COVID-19 testing kits to include availability for non-healthcare home workers. He said HHS has said it will work with state health departments to identify companies with individuals who need vaccinations, but the process has only started in a few states.

There are about 190 candidates in preclinical development or undergoing clinical trials in the United States, Europe and China. It is uncertain when any will be approved, and the Academies said in announcing its recommendations that it is “very unlikely that sufficient quantities will be immediately available to vaccinate large portions of the U.S. population.”

Phase 1a covers approximately 5% of the population and includes front-line health workers; workers who provide healthcare facility services such as transportation and environmental services who also risk exposure to bodily fluids or aerosols; and first responders.

“This group has a critical role in maintaining healthcare system functionality, high risk of exposure to patients exhibiting symptoms of COVID-19, and higher risk of then transmitting the virus to others, including family members,” the commission said in a press release accompanying the report.

Phase 1b covers another 10% of the population and includes people of all ages with comorbid and underlying conditions that put them at significantly higher risk of severe COVID-19 disease or death. It also includes adults aged 65 or more years living in congregate settings including assisted living facilities, residential care facilities and nursing homes.

For more on this issue, see this article from the McKnight’s Senior Living Daily Briefing e-newsletter.