DEPARTMENT OF HEALTH AND HUMAN SERVICES 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

Advisory Committee on 

Immunization Practices (ACIP)

Summary Report

November 23, 2020 

Atlanta, Georgia 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

2 

Table of Contents Page

Agenda 3 

Acronyms 4-6 

Welcome and Introductions 5-7 

Coronavirus Disease 2019 (COVID-19) Vaccines

 Introduction

 EtR Framework: Public Health Problem, Resource Use, and Equity Domains

 EtR Framework: Values, Acceptability, and Feasibility Domains

 Phased Allocation of COVID-19 Vaccines

8-28

Certification 29

Membership Roster 30-39
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

3 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

4 

Acronyms

ACIP Advisory Committee on Immunization Practices

AE Adverse Event

CDC Centers for Disease Control and Prevention

CISA Cybersecurity and Infrastructure Security Agency

COI Conflict of Interest 

COU Clinical Operations Unit 

COVID-19 Coronavirus Disease 2019 

CoVPN COVID-19 Prevention Network 

DHS Department of Homeland Security 

DSMB Data Safety Monitoring Board 

ED Emergency Department

EHR Electronic Health Record 

ET Eastern Time

EtR Evidence to Recommendation 

EUA Emergency Use Authorization 

FDA Food and Drug Administration

HCP Healthcare Personnel / Providers

HCW Healthcare Workers 

HHS (Department of) Health and Human Services

ICU Intensive Care Unit 

IDCRP Infectious Disease Clinical Research Program 

LTCF Long-Term Care Facilities 

MMWR Morbidity and Mortality Weekly Report 

mRNA Messenger Ribonucleic Acid 

NCIRD National Center for Immunization and Respiratory Diseases 

NIH National Institutes of Health

OWS Operation Warp Speed 

PI Principal Investigator

POD Point Of Dispensing 

PROGRESSPlus SystemPlace of Residence, Race/Ethnicity, Occupation, Gender/Sex, Religion, Education

QI Quality Improvement

SARS Severe Acute Respiratory Syndrome 

SARS-CoV-2 Severe Acute Respiratory Syndrome Coronavirus-2 

SDOH Social Determinants of Health 

SES Socioeconomic Status 

SLU Saint Louis University 

SNF Skilled Nursing Facilities

SUD Substance Use Disorder

UK United Kingdom

US United States

USG US Government 

VE Vaccine Efficacy

VE Vaccine Effectiveness

VRBPAC Vaccines and Related Biological Products Advisory Committee Meeting 

VTU Vaccine Treatment Evaluation Unit 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

5 

Welcoming Remarks

Robert R. Redfield, MD

Director, Centers for Disease Control and Prevention

Administrator, Agency for Toxic Substances and Disease Registry

Thank you very much and good afternoon. Thank you for giving me an opportunity to join you

for this introduction. I wanted to start by just reflecting on a quote that has been very important 

to me in my life. I mentioned it to a number of CDC staff. It is a quote of President Teddy 

Roosevelt’s that I think is appropriate at this point in time and it says, “It is not the critic who 

counts: not the man [and I’ll paraphrase or woman] who points out how the strong man 

stumbles or where the doer of deeds could have done better. The credit belongs to the man [or 

woman] who is actually in the arena, whose face is marred by dust and sweat and blood, who 

strives valiantly, who errs and comes up short again and again, because there is no effort 

without error or shortcoming, but who knows the great enthusiasms, the great devotions, who 

spends himself [or herself] for a worthy cause . . .” [23 April 1910, Sorbonne, France].

I say that because I believe each of you are devoted to a worthy cause as we are right now 

trying to get a safe and effective vaccine to the American public. As the case counts rise across 

the United States, the implementation of the COVID-19 Vaccine Program is really more crucial 

than it has ever been before. I know our nation looks to you all to give your thoughtful and wise 

advice and recommendations as we stand now and face growing cases across our nation, 

complicated more by cold weather, the holiday season, and the increased strain on our health 

system across this nation. 

So, I really just wanted to take a moment to thank you for your service and just underscore how 

important the thoughtful work that you are doing now to give the best guidance to these new 

vaccines, which really, it’s very exciting that we now will have I think soon two vaccines 

available to distribute to the American public. I just want to thank you for being in the arena and 

making the tough decisions based on the data and your best thoughtful advice that you will give 

to see how this vaccine can begin to be distributed and ultimately, I believe, will ameliorate this 

pandemic that we face in the months ahead. So, that’s what I really wanted to say, Amanda, 

and thank you for giving me the chance to make a comment to begin your meeting.

Dr. Redfield, this is Jose Romero, the Chair. I want to thank you on behalf of all the members

and myself for those words and those thoughts. I think we will carry those with us through the 

next weeks as we come to recommendations for this vaccine. We understand the importance of 

this and we welcome the opportunity to improve the health and well-being of the American 

public. So, thank you very much to those kind words with the introduction and encouragement. 

Dr. Redfield: Thank you. Thank you, Jose, and thank you for your leadership. God bless.

Opening Session 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

6 

Call to Order, Overview, & Introductions

José Romero, MD, FAAP

ACIP Chair

Amanda Cohn, MD

Executive Secretary, ACIP / CDC

Dr. Romero officially called to order the November 23, 2020 emergency meeting of the Advisory 

Committee on Immunization Practices (ACIP), the primary purpose of which was to discuss 

Coronavirus Disease 2019 (COVID-19) Vaccine in terms of the Evidence to Recommendations 

(EtR) Framework and phased allocation of COVID-19 vaccines.

Dr. Cohn welcomed everyone and indicated that copies of the slides being presented during this 

meeting would be available until late afternoon on the ACIP website and had been made 

available through a ShareFile link for ACIP Voting, Liaison, and Ex-Officio members. Videos of 

the live webcast will be posted on the ACIP website approximately 1 week after the meeting. 

Meeting minutes will be posted on the ACIP website, generally within 90-120 days of the 

meeting. 

In terms of meeting logistics, participants were instructed to raise their hands virtually when Dr. 

Romero opened the floor for discussion and to disable their video or mute their phone lines to 

reduce issues with the Zoom connection. Dr. Cohn explained that during the discussion period, 

the order in which Dr. Romero would take questions would be first from ACIP Voting Members, 

second from Ex Officio and Liaison member representatives, and then from the audience. The 

plan was to stay on schedule with the meeting agenda as much as possible. Participants on the 

Zoom platform were instructed to disable their videos for the duration of the meeting.

The ACIP is, at its heart, a public body. Engagement with the public and transparency in the 

processes are vital to the committee’s work. As part of this commitment, ACIP has strengthened 

and written public comment process to maximize opportunities for comment and make public 

comment more transparent and efficient. For this meeting, one oral public comment period was 

scheduled for approximately 4:45 PM Eastern Time (ET). People interested in making oral 

public comments submitted a request online in advance of the meeting. Priority is given to 

advanced requesters. When more people request to speak than can be accommodated, a blind 

lottery is conducted to determine who the speakers will be. Speakers selected in the lottery for 

this meeting were notified in advance of the meeting. Any members of the public can also 

submit written public comments via https://www.regulations.gov using docket number docket ID 

CDC-2020-0117. Information on the written public comment process, including information 

about how to make a comment, can be found on the ACIP meeting website.

Members of the ACIP agree to forgo participation in certain activities related to vaccines during 

their tenure on the committee. For certain other interests that potentially enhance a member’s 

expertise while serving on the committee, CDC has issued limited conflict of interest (COI) 

waivers. Members who conduct vaccine clinical trials or serve on data safety monitoring boards 

(DSMBs) may present to the committee on matters related to those vaccines, but are prohibited 

from participating in committee votes on issues related to that specific vaccine product. 

Regarding other vaccines of the concerned company, a member may participate in discussions 

with the provision that he/she abstains on all votes related to that company. At the beginning of 

each meeting, ACIP members state any COIs. 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

7 

Dr. Romero announced the publication of “The Advisory Committee on Immunization Practices’ 

Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020” in 

the Morbidity and Mortality Weekly Report (MMWR), which can be found at the following URL: 

https://www.cdc.gov/mmwr/volumes/69/wr/mm6947e3.htm. The primary author on this 

publication is Dr. McClung and includes multiple members of the ACIP COVID-19 Vaccine 

Workgroup (WG), as well as the Chair of the WG, Dr. Bell, and the two Co-Leads, Drs. Oliver 

and Dooling. This publication outlines the ethical principles that were used for identifying 4 

groups for initial vaccine allocation. These groups have not been stratified as of yet and will not 

be stratified until a final vote is taken. As pointed out by Dr. Bell, the COVID-19 Vaccine WG 

Chair, this will not be done until vaccines are authorized by the Food and Drug Administration 

(FDA). The groups identified at this time were selected based on the available scientific data, 

vaccine implementation considerations, and ethical principles. In no particular order, they are: 

Healthcare Personnel (HCP); Other Essential Workers; Adults with High-Risk Medical 

Conditions; and Adults ≥65 Years of Age, Including Residents of Long-Term Care Facilities 

(LTCFs). 

Dr. Romero conducted a roll call of ACIP members, during which the following COIs were 

declared:

 Dr. Robert Atmar is serving as the Co-Director of the Clinical Operations Unit (COU) of the 

National Institutes of Health (NIH)-funded Infectious Diseases Clinical Research Consortium

(IDCRC) that is working within the COVID-19 Prevention Network (CoVPN) to evaluate 

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) vaccine candidates in 

Phase 3 clinical trials, including those produced by Moderna, AstraZeneca, Janssen,

Novavax, and Sanofi. He also has served as a Co-Investigator on the Moderna vaccine trial.

 Dr. Sharon Frey is employed by Saint Louis University (SLU), which has a Vaccine 

Treatment Evaluation Unit (VTU) that is part of the IDCRC. She is currently serving as the 

Site Principal Investigator (PI) for the Moderna and Janssen COVID-19 vaccine clinical 

trials.

 Dr. Paul Hunter owns a small amount of stock in Pfizer and has received a small grant from 

Pfizer to conduct a quality improvement (QI) project on pneumococcal vaccines.

A list of Members, Ex Officio Members, and Liaison Representatives is included in the 

appendixes at the end of the full minutes for the November 23, 2020 ACIP meeting.
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

8 

Introduction

Beth Bell, MD, MPH 

ACIP, COVID-19 Vaccine WG Chair

Clinical Professor, Department of Global Health

School of Public Health, University of Washington 

Dr. Bell introduced the COVID-19 Vaccines session for the November 23, 2020 emergency 

ACIP meeting, which focused on ACIP’s continued response to the ongoing pandemic and 

accelerated vaccine development. She reminded everyone that during the October 30, 2020

emergency meeting, ACIP reviewed the following topics:

 Updates from Vaccines and Related Biological Products Advisory Committee Meeting 

(VRBPAC) Meeting 

 Development Programs from 2 COVID-19 Vaccine Manufacturers

 Updates on Vaccine Implementation and Communication Plans

 Post-Authorization Safety Monitoring 

 Ethical Principles and Modeling Strategies for Initial Allocation of COVID-19 Vaccines 

 Updates to Immunity and Epidemiology 

 WG Interpretation of Data

 Policy Questions, EtR Framework and Outcome

The COVID-19 Vaccine WG continues to meet on a weekly business. The topics this group has 

covered during November include the following:

 Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine 

 Current Evidence for Each Domain in EtR Framework 

 Further Discussions Around Initial Allocation Recommendations

Dr. Bell indicated that during this session, presentations would be provided in the following topic 

areas:

 EtR Framework: Public Health Problem, Resource Use, and Equity Domains

 EtR Framework: Values, Acceptability, and Feasibility Domains

 Phased Allocation of COVID-19 Vaccines 

Dr. Bell reminded everyone that over 200 COVID-19 vaccines are currently under development. 

Within the US, 4 vaccines are in active Phase III clinical trials and 6 are in active Phase I/II

clinical trials. Based on information provided from the manufacturers in their press releases, 

there is information about the efficacy of 2 messenger ribonucleic acid (mRNA) vaccines from 

the Phase III trials. The Pfizer/BioNTech BNT162b2 vaccine trial in a final analysis of 170 cases 

found 162 cases in the placebo group and 8 cases in the vaccine group, yielding a point 

estimate of 95% efficacy 7 days post-dose 2. The report and press release gave a 94% efficacy 

estimate in adults ≥65 years of age. There were 10 severe cases, 9 of which were in the 

placebo group. The DSMB found no serious safety concerns and an EUA was submitted to the 

Food and Drug Administration (FDA) by Pfizer/BioNTech on Friday November 20, 2020. The 

Coronavirus Disease 2019 (COVID-19) Vaccines
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

9 

data on the mRNA-1273 vaccine from Moderna reported an interim analysis of 95 cases of 

which 90 cases were in the placebo group and 5 cases were in the vaccine group, yielding a 

point estimate of 94.5% efficacy 2 weeks post-dose 2. There were 11 severe cases all of which 

were in the placebo group. The DSMB found no serious safety concerns and the manufacturer 

reports that they plan to submit an EUA soon. Also noteworthy is that AstraZeneca/University of 

Oxford put out a press release earlier in the morning reporting early results of their Phase III 

trials in the United Kingdom (UK) and Brazil.

In addition to these vaccines, there is a Janssen viral vector non-replicating vaccine with a 1-

dose schedule that is currently recruiting. Novavax has completed enrollment of their Phase I/II 

trial of a protein subunit vaccine, and Sanofi/GSK is still recruiting on their Phase I protein 

subunit vaccine. Merck has a replicating viral vector vaccine in Phase I/II trials and Vaxart has a 

non-replicating viral vector vaccine in Phase I, both of which are recruiting. Inovio has a DNA 

plasmid vaccine in Phase 1 and Aivita has an AuDentric cell vaccine in Phase I/II. Neither of 

these is recruiting yet. There are 4 inactivated vaccines, 1 protein subunit vaccine, and 3 nonreplicating viral vector vaccines in Phase III trials outside of the US that are actively recruiting. 

There is 1 non-replicating viral vector vaccine in Phase II/III, 7 non-replicating viral vector 

vaccine candidates in Phase I/II, 1 RNA vaccine in Phase II/III clinical trials, and 7 RNA vaccine 

candidates in Phase I/II outside of the US.

EtR Framework: Public Health Problem, Resource Use, and Equity Domains

Sara Oliver MD, MSPH 

Co-Lead ACIP COVID-19 Vaccine WG

National Center for Immunization and Respiratory Diseases

Centers for Disease Control and Prevention

Dr. Oliver presented on the EtR framework which she explained is a structure to describe 

information considered in moving from evidence to ACIP vaccine recommendations. It also 

provides transparency around the impact of additional factors on deliberations when considering 

a recommendation. As a reminder, ACIP will undergo deliberations for 2 separate policy 

questions: 

1) Should a specific COVID-19 vaccine be recommended? 

2) To whom should early allocation of COVID-19 vaccine be recommended? 

She noted that the EtR framework would be used for the first policy question regarding whether 

the vaccine should be recommended for the US population, and that there would further 

allocation discussions in afternoon after the EtR framework presentation.
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

10

These are the domains used for EtR, with each domain having either one or several questions

for which ACIP will provide judgment:

EtR Domain Question

Public Health Problem • Is the problem of public health importance?

Benefits and Harms

• How substantial are the desirable anticipated effects?

• How substantial are the undesirable anticipated effects?

• Do the desirable effects outweigh the undesirable effects?

Values

• Does the target population feel the desirable effects are large relative 

to the undesirable effects?

• Is there important variability in how patients value the outcomes?

Acceptability • Is the intervention acceptable to key stakeholders?

Feasibility • Is the intervention feasible to implement?

Resource Use • Is the intervention a reasonable and efficient allocation of resources?

Equity • What would be the impact of the intervention on health equity?

To help make these questions easier, “the vaccine” or “the intervention” in question will be 

changed to “COVID-19 vaccine X” to be replaced by a specific vaccine name later. “The 

problem” also will be replaced with “COVID-19 disease.”

For the Benefits and Harms domain, which specifically discusses data for safety and efficacy, 

the Phase III clinical trial data will be used to inform this domain so it was not discussed further 

during this session. A new addition to the EtR framework is the Equity domain. The 3 domains 

discussed during this presentation included: Public Health Problem, Resource Use, and Equity.

The Public Health Problem will not be impacted by individual vaccine characteristics. The 

overall Resource Use domain will have minimal impact currently by individual vaccine 

characteristics, although this will likely change over time. Additionally, the Equity domain will be 

impacted by individual vaccine characteristics. Dr. Oliver noted that her second presentation on 

the EtR Framework would focus on the Values, Acceptability, and Feasibility domains, all of 

which will be impacted by individual vaccine characteristics.

The presentations during this meeting focused on the current evidence and WG discussions 

around each EtR domain for future COVID-19 vaccines, and the identification of areas where 

the EtR judgment may vary by individual vaccine characteristics. While no vote was scheduled 

for this meeting, once the Phase III clinical trial data and an FDA decision are available, the EtR 

framework for a specific vaccine will be presented. It is expected that the information will 

continue to evolve, so the EtR framework and vaccine recommendations will be evaluated 

continually and updated as needed.
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

11

The main question associated with the Public Health Problem is, “Is COVID-19 disease of public 

health importance?” The additional questions to help inform this discussion include the 

following: 

 Are the consequences of COVID-19 serious?

 Is COVID-19 urgent?

 Are a large number of people affected by COVID-19?

 Are there disadvantaged groups or populations disproportionately affected by COVID19? 

For each domain, the WG will be reviewing the available evidence to help answer questions 

addressed by the domain. For the Public Health Problem, as of November 21, 2020, there have 

been over 12 million cases of COVID-19 in the US, with a cumulative incidence of 3670 per 

100,000 population. The cumulative hospitalization rate between March 1 and November 14, 

2020 was nearly 230 per 100,000 population. Among those hospitalized, nearly one-third 

required intensive care and 15% died. As of November 21, 2020, there have been 255,076

COVID-19 associated deaths reported in the US and estimates of the SARS-CoV-2 infections 

fatality ratio ranged from 0.5% to 1.4%. There are other biologic factors associated with 

increased incidents, including age and the presence of underlying medical conditions, which 

have been presented in earlier ACIP meetings. Based on the review of the epidemiology data 

presented here, as well as the epidemiology data that have been presented at prior ACIP 

meetings, the WG judgment was that “Yes” COVID-19 disease is of public health importance. 

The primary question for the Resource Use domain is, “Is COVID-19 vaccine X a reasonable 

and efficient allocation of resources?” The additional questions include:

 What is the cost-effectiveness of COVID-19 vaccine X?

 How does the cost-effectiveness change in response to changes in context, 

assumptions, et cetera?

The WG reviewed estimates of economic costs related to COVID-19 vaccinations, disease 

outcomes, and disease mitigation activities in coordination with National Center for 

Immunization and Respiratory Diseases (NCIRD) and ACIP’s lead economist. To summarize 

the available evidence, this involves the balance of the cost of COVID-19 disease and the cost 

of COVID-19 vaccines. For the cost of disease, it has been estimated that if 20% of the US 

population is infected with COVID, the direct medical costs could be $163 billion. Health-related 

costs of COVID-19 disease (including premature deaths, long-term health impairment, and 

mental health impairment) have been estimated at $8.5 trillion. In terms of the costs associated 

with COVID-19 vaccines, the US Government (USG) has committed at least $10 billion to 

Operation Warp Speed (OWS) for the provision of vaccines. In addition, vaccine doses 

purchased with US taxpayer dollars will be given to the American people at no cost.

The WG interpretation is that there are no published cost-effective analyses currently available. 

The precise cost-effective analysis and economic impact of vaccination depends on a number of 

factors that are currently unknown, including the duration of vaccine protection, vaccination 

coverage levels, and implementation costs associated with a large vaccination program. The 

WG concluded that cost-effectiveness may not be a primary driver for decision-making during a 

pandemic and for a vaccine used under EUA. However, this will need to be reassessed for 

future recommendations. At this time, the differences by individual vaccine characteristics is 

minimal relative to the overall scale of the pandemic. However, when cost-effectiveness is 

reassessed for routine implementation, individual vaccine characteristics will need to be taken 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

12

into account. Based on these discussions, the WG felt that “Yes” COVID-19 vaccine X is a 

reasonable and efficient allocation of resources. 

The primary question for the new Equity domain is, “What would be the impact of COVID-19 

vaccine X on health equity?” The additional questions include the following:

 Are there groups or settings that might be disadvantaged in relation to COVID-19 

disease burden for receipt of COVID-19 vaccine X?

 Are there other considerations that should be made when implementing the COVID-19 

vaccine X program to ensure that inequities are reduced whenever possible, and that 

they are not increased?

For a review of the available evidence on equity, the WG first worked to identify groups who

might be disadvantaged in relation to COVID-19 disease burden or receipt of a COVID-19 

vaccine X. This was done building upon other work that has been done in this area using a 

PROGRESS-Plus system, which is an acronym to identify factors associated with unfair 

differences in disease burden such as place of residence, race or ethnicity, occupation, gender 

or sex, religion, education,), social capital, disability, or other. A review of the scientific and gray 

literature was conducted in addition to reviewing CDC COVID-19 response data and resources.

Data from several specific populations were used to inform this discussion. While comprising

only 40% of the US population, racial and ethnic minorities comprise 50% of COVID cases and 

45% of COVID-19 deaths. Age-adjusted hospitalization rates are approximately 4 times higher 

among racial and ethnic minority groups compared to compared to non-Hispanic White persons. 

Inequities in social determinants of health (SDOH) put racial and ethnic minority groups at 

increased risk of COVID disease, including discrimination, lack of healthcare access, overrepresentation among essential workers, low-income, and crowded housing. Regarding people 

living in poverty or with high social vulnerability, COVID-19 cumulative case rates are 1.5 times 

higher in high versus low poverty counties and 1.3 times higher in counties with high versus low 

social vulnerability. Regarding essential workers, large outbreaks have been reported in multiple 

essential industries (food and agriculture, manufacturing, construction, wholesale trade). Racial 

and ethnic minority populations are disproportionately represented in subsets of essential 

workers. There are disadvantaged groups of note, including justice-involved persons, persons

experiencing homelessness, persons with disabilities, persons with substance use disorders

(SUDs), and sexual and gender minorities.

There were additional considerations for the equity domain. Although COVID-19 vaccines will 

be provided at no cost, personal investments in time and travel to obtain the vaccine may be a 

barrier for some groups. Importantly, characteristics of specific vaccines, including the storage 

and handling requirements, have the potential to greatly impact equitable distribution of COVID

vaccines. Ultimately, the WG felt that equity could not be adequately assessed apart from these 

characteristics and had different assessments for the impact of health equity for different 

vaccines. 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

13

There are additional considerations that should be made when implementing the COVID

vaccine X program to ensure that inequities are reduced whenever possible and that they are 

not increased. The WG discussed various considerations, including ways to identify groups 

disproportionately affected by COVID-19 or who face health inequities; undertake focused 

outreach and education; identify and address barriers to vaccination; and conduct active followup of disadvantaged groups to ensure completion of a 2-dose series or consider 1-dose COVID 

vaccines for group or follow-up may be difficult.

The WG felt that the successful implementation of a COVID-19 vaccination program and 

confidence in COVID-19 vaccines are pivotal to reducing health inequities. A quote that 

resonated with the WG representing the importance of an equitable implementation of the 

COVID-19 vaccine programs states, “...increasing the availability of an effective intervention 

within a country or region is not necessarily enough to reduce inequities. The intervention has to 

be accessible, acceptable, effective in, and used by the most disadvantaged groups within that 

population to be truly effective at reducing inequities in health” [O’Neill J, Tabish H, Welch V, et 

al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially 

stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014; 67: 56-64]. 

When reviewing available data on the equity of COVID-19 as well as characteristics associated 

with individual vaccines, the WG group discussed the impact of COVID-19 vaccine X on health 

equity. Specifically, for a vaccine with ultra-cold chain requirements limiting where a vaccine 

could be provided, there was concern that this particular vaccine when considered alone would 

probably reduce health equity. However, a vaccine that could be used in a broad range of 

vaccine providers for 1-dose vaccines could probably increase health equity.

The WG invited the ACIP to provide input on the 3 domains discussed in this presentation, with 

the discussion divided by individual domain. 

Discussion Points

Public Health Problem Domain 

 There was strong consensus from the committee that the data presented clearly 

demonstrates that COVID-19 disease is a serious public health problem and additional 

data/information on the public health problem is not needed before a vote.

Resource Use Domain

 There was strong consensus from the committee that sufficient information has been 

presented to date on resource use without the need at this time for a specific costeffectiveness analysis.

 The committee agreed that cost-effectiveness may not be a primary driver for decisionmaking in the setting of a pandemic. 

 The committee recognized that as additional vaccines become available for use with 

different levels of effectiveness for potentially different populations or subgroups, analysis of 

cost-effectiveness and economic impact will become more important and may be necessary

to pursue further. 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

14

Equity Domain 

 It behooves the nation to invest the necessary resources to make sure that if there are only 

one or two vaccine products, it will be possible to provide equitable access to all 

populations. 

 Local considerations about implementation will have a large impact on equity and the 

populations that are reached with vaccine: 

 Equity and implementation are intertwined. Local and state health authorities require 

adequate resources to distribute COVID-19 vaccines to the most affected 

communities and ensure equitable access.

 Local decisions about selection of initial administration venues and potential 

recipients will be critical for maximizing equity. 

 Although some vaccines have challenging handling and administration requirements 

such as cold-chain requirements, this should not preclude support, access, 

acceptability, and use of vaccine regardless of characteristics in order to help ensure 

equitable access. Additional guidance may be needed to make this clear to local 

jurisdictions as they begin to use vaccine.

 It is essential to ensure that the equity domain also includes age equity so that there are 

pediatric children of color and well as children of all ages.

 Focused outreach and education are critical:

 Several hundred years ago, a medical professional said that the amount of resources 

devoted to a health problem should be proportionate to the need. The need is not 

just a healthcare need, it is also a social need. Difficulty in access is a need, so more 

resources must be devoted to subgroups of the population who have greater 

difficulties with respect to access.

 There are studies showing that minority populations are less interested at this point 

in a future COVID vaccine.

 Providers are a trusted source of information.

 Information should be tailored to specific groups. 

 Low perceived acceptance should not result in reduced allocation to areas and 

populations, but rather in increased efforts and resources for focused outreach and 

education to improve vaccine acceptance. 

 To reach groups who normally do not seek information from public health’s usual 

means of transmission, it may be necessary to identify thought leaders or influencers 

in communities who have the ability to change the current perception of the vaccine.

 Willingness to receive vaccine is modifiable, especially in the setting of a pandemic. 

 Early experience with vaccine will be very important to increase interest and 

demand. It will be critical to collect information on everyone who is vaccinated in 

terms of the vaccination itself and any AEs.

 Transparency is essential to improve trust and acceptability. 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

15

EtR Framework: Values, Acceptability, and Feasibility Domains

Sara Oliver MD, MSPH 

Co-Lead ACIP COVID-19 Vaccine WG

National Center for Immunization and Respiratory Diseases

Centers for Disease Control and Prevention

Dr. Oliver presented the EtR framework for the Values, Acceptability, and Feasibility domains 

again acknowledging that all of these domains will be impacted by individual vaccine 

characteristics. 

The first question for the Values domain is, “Does the target population feel that the desirable 

effects are large relative to the undesirable effects?” Additional questions include the following: 

 How does the target population view the balance of desirable versus undesirable 

effects?

 Would patients feel that the benefits outweigh the harms and burden?

 Does the population appreciate and value COVID-19 vaccine X?

The second question in the Values domain is, “Is there important uncertainty about, or variability 

in, how much people value the main outcomes?” Addition question related to this primary 

question include:

 How much do individuals value each outcomes in relation to the other outcomes?

 Is there evidence to support those value judgments?

 Is there evidence that the variability is large enough to lead to different decisions?

For the Values domain, the WG conducted a review of the scientific literature focusing on 

vaccine intent, confidence, and attitude with these search terms: SARS-CoV-2/COVID-19 string; 

vaccine string; intent, confidence, hesitancy, attitude, belief, accept, choice, decision, refusal. 

The search included scientific articles, news media and reports, and preliminary findings from 

CDC work, including a vaccine intent survey and focus group discussions.

The overall acceptability of COVID-19 vaccine was moderate. The proportion intending to 

receive the COVID-19 vaccine ranged from 42% to 86%. While nearly all of these surveys were 

performed prior to news for any specific vaccine, one survey was conducted after Pfizer’s 90% 

efficacy announcement, after which a large proportion of people indicated their belief that the 

vaccine would be safe (68%) and effective (71%). Many surveys reported anticipated benefits to 

vaccinations to protect self, family, and community; prevent infection and severe illness; and 

return to normal life. Vaccine intensions varied by time, population, and vaccine characteristics 

with a decline from May to September. Acceptance was lowest among Black respondents and 

highest among Asian respondents. Acceptance was greater with higher SES, history of prior 

influenza vaccine or higher COVID-19 risk perception, higher VE, and strong healthcare 

provider recommendations. Based on a combination of 26 surveys, vaccine intent has declined 

since the initial surveys in the spring. However, surveys conducted in November appear to 

rebound slightly with higher acceptance. Based on 6 surveys that provided COVID-19 vaccine 

acceptance by race/ethnicity, vaccine acceptance was lowest among Black respondents. Some 

surveys showed lower acceptance in Hispanic respondents compared to White respondents, 

and Asian respondents reported the highest acceptability.
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

16

To summarize the available evidence for the Values domain, common reasons for not planning 

to receive a COVID-19 vaccine include concern for side effects, uncertainty of vaccine efficacy

(VE), and low risk perception of COVID-19 or severe disease. A high VE was preferred. For 

many focus groups, most were open to receiving the vaccine, but many preferred not to be first. 

Many reported concerns that the vaccine approval process was fast. Limitations for these 

surveys include that they were conducted prior to an available vaccine or any specific data 

about the vaccines. Also, convenience samples for surveys or focus groups may not be 

representative of the entire US population. Broadly across national surveys, many adults 

reported intentions to receive a COVID-19 vaccine with a desire to protect themselves and their 

community and return to normal. However, concerns were raised around side effects, unknown 

efficacy, and the speed of the process. Intentions varied substantially by race, ethnicity, and 

SES.

The WG also discussed several strategies to consider for overcoming barriers to vaccine 

acceptance. This included engaging trusted sources, developing communication materials that 

are culturally appropriate, ensuring that providers have information on vaccines and vaccine 

recommendations, educating throughout specific communities and jurisdictions, and educating 

non-clinical staff around the benefits of vaccine. In terms of the WG interpretation for the first 

question, the plurality of the group felt that the answer to that is “Probably Yes” but also that it 

varies by vaccine, population, and over time. Not surprisingly when asked the second question 

regarding whether there was important uncertainty about or variability in how much people value 

the outcomes, the WG felt that there was “Important Uncertainty or Variability” or “Probably 

Important Uncertainty or Variability.” 

In terms of the Acceptability domain, the main question is, “Is COVID-19 vaccine X acceptable 

to key stakeholders?” Additional questions include:

 Are there key stakeholders who would not accept the distribution of benefits and 

harms?

 Are there key stakeholders that would not accept the undesirable effects in the shortterm for the desirable effects (benefits) in the future? 

For this domain, the WG conducted a review of scientific literature and a review of preliminary 

findings from CDC evaluations of COVID-19 vaccine attitudes, including a survey with state 

health officers, focus groups with nurses, and online surveys of HCP. They also looked at 

broader stakeholders, including professional societies and workers unions and considered

stakeholder opinions regarding programmatic, financial, and ethical aspects. There are no 

published provider knowledge, attitudes, and practices surveys. State health officers voiced 

concerns with vaccine hesitancy, safety, and communications. Seven different focus groups 

with nurses demonstrated that most supported prioritizing nurses, but some were reluctant to 

get vaccinated, especially nurses belonging to racial or ethnic minority groups. Another vaccine 

survey among HCP showed that 63% reported that they would get the vaccine once available.

Information from the nurses survey demonstrates moderate acceptability of COVID-19 vaccine 

where 63% were confident that the vaccine would be safe and effective, but only 34% would 

voluntarily receive the vaccine.
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

17

To summarize the available evidence overall, all jurisdictions have submitted vaccine 

implementation plans, demonstrating at least some level of acceptance with the vaccine. Large 

and small pharmacy chains are participating in COVID-19 vaccine programs. State health 

officers had concerns around hesitancy, safety, and communications. Nurses reported a low 

percent to receive the vaccine. The WG overall felt that a COVID-19 vaccine X was “Probably

Yes” acceptable to key stakeholders, but that it varies among the stakeholders. 

The primary question associated with the Feasibility domain is, “Is COVID-19 vaccine X feasible 

to implement?” Additional questions include the following:

 Is the COVID-19 vaccine X program sustainable?

 Are there barriers that are likely to limit the feasibility of implementing COVID-19 vaccine

X or require consideration when implementing it?

 Is access to COVID-19 vaccine X an important concern?

The WG discussed several barriers to implementation including financial barriers, complexity of 

recommendations, access to healthcare or vaccine providers, and vaccine storage and handling 

requirements. For financial barriers, all COVID-19 vaccines will be provided to the US 

population free of charge. However, health systems or health departments could incur the cost 

for vaccine implementation in clinics. Multiple vaccines under EUAs could make overall COVID19 vaccine recommendations complex. Individual vaccine recommendations may contribute to 

complexity, including variations in the number of doses or the vaccine schedules. Population 

access to healthcare or vaccine providers could be limited in rural or other hard-to-reach areas.

The range of providers providing a vaccine could be impacted by cold-chain storage 

requirements, populations with proven safety or efficacy, and populations recommended to 

receive the vaccine. Vaccines with ultra-cold requirements will be unable to be integrated into 

individual provider practices. However, vaccines with refrigerator temperature requirements will 

be easier to integrate. A large minimum size of orders could be a barrier to implementation. In 

many populations, requirements for a 2-dose series will be difficult.

The WG discussed that while these barriers to implementation might be insurmountable in 

traditional circumstances, there are innovative solutions to overcome these barriers including 

expanding funding opportunities, pharmacy partnerships, technology that includes second dose 

reminders, unique packing containers to maintain ultra-cold temperatures without a freezer, and

detailed state micro-planning. Taking these barriers and the novel solutions into account, the 

WG felt that COVID-19 vaccine X is “Probably” feasible to implement.

This table shows all of the EtR domains discussed during this session. It is worth noting that 

many of the aspects where the WG did not reach a singular conclusion will be informed by 

specific vaccine characteristics or data in the weeks to follow: 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

18

Before beginning discussions around the specific EtR domains, the WG wanted to let ACIP 

know that the WG is working its way through various proposed clinical considerations before 

there any specific vaccine recommendations. As discussed during the last ACIP meeting, 

pregnancy and breastfeeding were not felt to be contraindications to receiving a COVID-19 

vaccine if individuals were otherwise recommended to receive a vaccine in early allocation 

phases. Given that prior mRNA vaccines have not been licensed, mRNA vaccines have not 

been studied in pregnant women. Regarding prior infection, again as was discussed during the 

last ACIP meeting, vaccination is recommended regardless of prior infection and testing for 

antibodies is not recommended prior to vaccination. However, while vaccine supplies are 

constrained, the WG discussed that vaccination of persons with recent prior infection may be 

delayed. However, the duration of protection after infection is unknown. Other topics have been 

or will be discussed by the WG for future presentations. These include co-administration with 

other vaccines, vaccine dosing schedules and intervals, and the impact of vaccine 

reactogenicity for HCP. These topics will not all require a specific ACIP vote, but would be 

included as interim clinical guidance.

ACIP was then invited to provide input individually on the domains of Value, Acceptability, and 

Feasibility. 

Discussion Points

Values Domain

 Declines in vaccine intent are relatively recent and are likely mutable or modifiable: 

 Concerns among the populations who appear hesitant about a COVID-19 vaccine 

were predominantly about safety and vaccine characteristics. 

 As more data become available about these factors, it may be possible to modify 

intent.

 There was agreement with strategies to overcome barriers and the notion that the 

barriers are modifiable.
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

19

 Patients need to know what to expect in terms of the potential for arm soreness, fatigue,

body aches, fever, having to stay home from work, et cetera (e.g., reactogenicity reflects 

immune response to the vaccine) which can improve the likelihood of completing a 2-dose 

series. Perhaps term could be utilized that are less frightening to people such as “response” 

instead of “reaction.”

 People who seek vaccine and value getting vaccine early will be important for messaging 

and increasing vaccine uptake by subsequent groups of recipients. 

Acceptability Domain

 Trust and transparency are critically important to acceptability:

 Some headway has been made on this by Moderna and Pfizer posting their 

protocols online and the FDA posting guidelines on what will be required to consider 

EUA.

 HCP should get vaccinated to set an example and practitioners should begin having 

conversations with their patients early. 

 In thinking about equity, it may be necessary to reconsider expanding the definition of 

“stakeholders” to include businesses and employers other than healthcare. 

 It is important to remember that communities do not see vaccine as a categorical program, 

so thought must be given to this in the context of the COVID-19 response overall: 

 There will be a need to continue other mitigation measures and to support 

communities that desperately need economic assistance now to comply with 

isolation and quarantine and to meet the needs of mitigation to businesses and 

employees who are losing income and their jobs.

 When talking to businesses and employees, they want to hear holistically how they 

are being supported in coping with COVID-19. To speak about vaccines without 

addressing other very pressing needs and not having the resources to do that is 

problematic in terms of acceptability.

Feasibility Domain

 Although COVID-19 vaccine will be provided at no cost, there are other costs that must be 

considered that have the potential to impact feasibility:

 Some clinics providing tests are charging administrative fees to patients, which has 

been a barrier to others getting tested. The same could be true with vaccines, so it is 

important to ascertain how people can access vaccines without having to pay for an 

office visit and administrative fees.

 Work is underway to address potential administrative costs associated with vaccine 

receipt which can be a deterrent (e.g., for uninsured patients, Prep ACT funding will 

allow for providers to be reimbursed for administrative costs).

 Personal investments in time and travel (e.g., time off from work to be vaccinated or 

vaccine-associated side effects) may be a barrier for some, particularly for hourly 

workers who are not paid if they do not work.

 There is a potential that an entire workforce could be impacted if everyone is 

vaccinated within a week and a significant portion experience fever. For instance, an 

entire Intensive Care Unit (ICU) could be incapacitated if the majority are vaccinated 

simultaneously and experience AEs. CDC does have a group working on this and 

this type of feasibility issue can be addressed in the clinical guidelines.
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

20

 While the focus should be on targeting people susceptible to COVID-19, screening of 

individuals for prior infection (i.e., presence of antibodies) should not be done:

 Delaying vaccination for people with documented prior infection could be considered, 

although information on the duration of protection following natural infection is 

limited. 

 All of the clinical trials being conducted are assessing baseline antibody for evidence 

of prior infection. Hence at some point, there will be information about whether 

persons who had evidence of prior infection developed disease and whether the 

vaccine protected them. 

 The committee emphasized that adequate funding must be available to deliver a vaccination

program that is feasible to implement, values equity, and addresses issues of accessibility 

and acceptability. ACIP urged the relevant authorities to allocate parallel investment in the 

vaccine distribution and implementation structure to ensure that the accomplishments of the 

significant $10 billion investment over the last 9 to 11 months in vaccine research and 

development are fully realized.

 Communication between healthcare providers/healthcare systems and local public health 

authorities is essential throughout the vaccination program.

 Public/private partnerships at the local, state, and federal levels can be extremely beneficial.

 It will be imperative to engage a variety of stakeholders early to anticipate potential 

feasibility issues that may arise and identify strategies to mitigate these.

 The need for provider and patient educational materials and guidance is crucial. CDC noted 

that a health care provider toolkit and other materials will be available in the near future. 

Phased Allocation of COVID-19 Vaccines

Kathleen Dooling, MD MPH

Co-Lead ACIP COVID-19 Vaccine WG

Medical Officer, National Center for Immunization and Respiratory Diseases

Centers for Disease Control and Prevention

Dr. Dooling presented on the phased allocation of COVID-19 vaccines. One there is a vaccine 

approved for use, there likely will be a period when there is insufficient vaccine to meet demand. 

Given that, the objective for this session was to select groups for COVID-19 vaccine allocation 

in Phase 1a,1b, and 1c. In the previous two presentations, Dr. Oliver led the group through the 

domains of the EtR. Those determinations will lead to a decision on recommendations for any 

given vaccine in order to answer Policy Question #2, “Which groups should be recommended to 

receive COVID-19 vaccine X during Phase 1?” Dr. Dooling modified the approach to focus on 

the pillars of science, implementation issues, and ethical considerations that inform this 

important question.

As for the science pillar, the WG examined COVID-19 disease burden and the balance of 

benefits and harms in each group. Of course, details of the Phase III data will further inform this 

area when they become available. For implementation, the WG took into consideration the 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

21

values of the target group and the feasibility of implementation in each of the groups. The 

ethical principles were presented to ACIP and supported by members during the last ACIP

meeting. The principles aim to maximize benefits and minimize harms, promote justice, mitigate 

health inequities, and promote transparency throughout the vaccine policy process. These three 

pillars will be used to evaluate the proposed groups for Phase I vaccination. These groups are 

HCP, essential workers outside of healthcare, adults with high-risk medical conditions, and 

adults who are 65 years and older. 

Recall that during the August emergency ACIP meeting, ACIP members expressed support for 

vaccinating HCP in Phase 1a. HCP are defined as “Essential workers, paid and unpaid, serving 

in healthcare settings who have the potential for direct or indirect exposure to patients or 

infectious materials.” There are approximately 21 million HCP working in settings such as 

hospitals, LTCFs, outpatient settings, home health care, et cetera. Essential workers are “Those

who work outside of healthcare, continue critical infrastructure, and maintain services and 

functions Americans depend on daily.” The Cybersecurity and Infrastructure Security Agency 

(CISA), within the Department of Homeland Security (DHS) is tasked with creating the list of 

critical and essential workers that includes the sectors listed here: 

The guidance acknowledges that workers who cannot perform duties remotely and must work in 

close proximities to others should be prioritized for mitigation measures. It also is important to 

recognize that sub-categories of essential workers may be prioritized differently in different 

jurisdictions, depending on local needs. The estimated population for this group is 87 million, but 

it should be noted that this is a very rough estimate and may be revised as workplaces evolve 

and find innovative ways to protect their workers and allow work at a distance. Next are adults 

with medical conditions at high-risk for severe COVID-19. The estimated population for this 

group is over 100 million adults. The conditions that put people at risk are being constantly 

refined according to the evidence and updated on the CDC website. Finally, adults 65 years of 

age and older number approximately 53 million. This group can be thought of as older adults 

living in the community and those who are living in congregate settings. About 3 million adults in 

the US live in congregate settings, such as skilled nursing facilities (SNF), assisted living, 

residential, and Housing and Urban Development (HUD) housing. The COVID-19 pandemic has 

taken a tremendous toll on this group, which will be examined in greater detail later on in the 

presentation.
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

22

To summarize the WG’s considerations supporting vaccination HCP in Phase 1a. With respect 

to science, as of November 21st, there have been more than 220,000 confirmed COVID-19 

cases among HCP with 822 deaths. COVID-19 exposure that occurs both inside and outside 

healthcare settings result in absenteeism either due to quarantine, infection, or illness. 

Vaccination has the potential to reduce HCP absenteeism. LTCF modeling demonstrates that

more cases and deaths can be averted at the facility by vaccinating staff compared to 

vaccinating residents. Implementation considerations support the selection of HCP as acute

care HCP routinely have high uptake of influenza vaccine and high vaccine acceptance. Many 

acute healthcare facilities have the equipment and expertise to carry out large-scale vaccination 

with a vaccine that requires ultra-cold storage. From an ethical perspective, vaccinating HCP 

with a safe and effective COVID-19 vaccine maximizes benefits by preserving health care 

services essential to the COVID-19 response and the overall health care system. Also, the HCP 

group is inclusive of all job types and health care settings and is racially and ethnically diverse. 

Given ACIP’s prior support of early allocation of vaccine to HCP, Dr. Dooling focused the 

remainder of the presentation on the remaining groups in Phase 1 by examining these groups 

through the lens of science, implementation, and ethics and highlighting the relevant 

differences. In terms of the science, national estimates of COVID-19 incidents of confirmed 

cases by age group show that COVID-19 incidents is highest in young adults. On the other 

hand, COVID mortality rates are highest in older adults. The national estimates of death per 

100,000 population rises steeply after age 55. In terms of data on the proportion of COVIDassociated hospitalized patients who were admitted from a LTCF, more than 30% of 

hospitalized patients aged 65 to 74 were admitting from a LTCF and more than half of 

hospitalized COVID-19 patients 75 years of age and older were admitted from a LTCF. 

A published paper featuring COVID-Net data shows that risk for COVID-19-associated 

hospitalization increased with the number of underlying medical conditions. Compared to people 

without underlying medical conditions, adults with one or more conditions were significantly 

more likely to be hospitalized with COVID-19. That risk increased if a person had multiple 

conditions. Older adults living in the community also were more likely to be hospitalized for 

COVID-19 compared to younger adults. However, in this adjusted analysis, the magnitude of 

association for older age was smaller compared to having multiple comorbidities. It should be 

noted that persons living in long-term care were excluded from this analysis1

. In contrast, among 

persons already hospitalized for COVID-19, risk of in-hospital death increased dramatically with 

age, with adjusted rate ratios ranging from 6 to 11 in age groups that were 65 years of age and 

older2 [

1

Ko, Sept 2020, doi: 10.1093/cid/ciaa1419; 2Kim et al, 2020, 

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1012/5872581].
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

23

These data together demonstrate that older adults in congregate settings are disproportionately 

affected by COVID-19. LTCF residents and staff accounted for 6% percent of cases and 39% of 

deaths in the US, despite the fact that LTCF residents account for less than 1% of the US 

population. The SNF population is approximately 1.3 million and as of November 8th had 

experienced approximately 470,000 confirmed and probable cases and more than 67,000 

deaths. Assisted living facilities are home to approximately 800,000 residents nationally. 

Although surveillance is less systematic for this setting, states have reported thousands of 

cases and deaths among these residents.

To review the modeling data that were presented to the ACIP in October, the question was

“What is the potential impact of preventing COVID-19 infections and deaths of initially allocating 

vaccine to one of the following groups after vaccinating HCP in Phase 1a?”. The analysis was 

updated with a vaccine effectiveness (VE) input of 90% in younger and older adults and to 

reflect the current epidemiology. Full methods can be reviewed at the ACIP website at this link:

https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-10/COVID-Biggerstaff.pdf 

In terms of the population-wide averted infections after 6 months from the beginning of the start 

of the vaccine program using an infection-blocking vaccine, assuming that there is no 

asymptomatic infection or transmission among vaccinated persons, initially vaccinating high-risk 

adults or essential workers in Phase 1b averts approximately 1% to 3% more infections 

compared to targeting persons 65 and older. Under the same timeline and assumptions of 

vaccine performance, but instead considering averted deaths, initially vaccinating adults 65 and 

older in Phase 1b averts approximately 0.5% to 2% more deaths compared to targeting highrisk adults or essential workers. If the extreme scenario is considered whereby the vaccine does 

not prevent asymptomatic infections or transmissions at all and only prevents disease, the 

overall percent of a population-wide averted deaths is much lower. Initially vaccinating adults 65 

and older in Phase 1b averts approximately 2% to 6.5% more deaths compared to targeting 

high-risk adults or essential workers.

The WG concluded that the differences between the three strategies is minimal. Ethical 

principles and implementation considerations may greatly contribute to the selection of the 

optimal sequence in Phase 1b and beyond. The largest impact in averting deaths and infections 

is the timing of vaccine introduction in relation to increases in COVID-19 cases. This 

emphasizes the need to continue non-pharmaceutical interventions, such as wearing masks 

and social distancing. This analysis will continue to be updated as more information is collected. 

The factors that will inform interpretation of modeling going forward include estimates of VE in

older adults and the vaccine’s ability to prevent asymptomatic infection and transmission. In 

summary, the WG felt that the COVID-19 burden is high throughout the population and that the 

differences between sequencing strategies in terms of infections and deaths prevented was 

small.

Looking at the pillar of implementation, Dr. Dooling shared results depicting survey responses of 

intent to receive a COVID-19 vaccine as of September. Note that this was prior to any 

information publicly available about VE. Overall, 62% of survey respondents indicated that they 

were either absolutely certain, very likely, or somewhat likely to get a COVID-19 vaccine when it 

became available if it was available at no cost. The proportion was slightly higher for adults with 

high-risk medical conditions compared to those without those medical conditions, and higher in 

adults 65 years and older compared to younger adults. In a Harris Poll conducted in August, 

survey respondents supported the early allocation of COVID-19 vaccine to the groups proposed 

for Phase 1, with the strongest support for healthcare workers and seniors. 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

24

The WG considered a number of feasibility issues. For essential workers, it will be challenging 

to reach workers in rural locations, shift workers, those with multiple jobs, or those working in 

small cohorts. Jurisdictional approaches to overcome those challenges include on-site 

occupational clinics, pharmacy delivery, and health department point-of-dispensing (POD) strike 

teams. Most jurisdictions have and allocation micro-plan, which includes prioritization among 

non-healthcare essential workers and they are prepared for the period during which vaccine 

supply is limited. For adults with high-risk medical conditions, one of the biggest challenges may 

be determining eligibility. Healthcare homes, such as provider offices or pharmacies, could be 

better suited to verify the underlying medical conditions. Unfortunately, minimum size of vaccine 

orders and storage and handling requirements may preclude involvement of small clinics. For 

many, including adults 65 years and older, long distances to travel to central clinics and the 

necessity of large high-throughput clinics may be challenging. It should be noted that a federal 

pharmacy program has already been established to reach LTCF residents. Values, considered 

to be a combination of intent to get the vaccine and the values of the population, increased from 

essential workers to adults with high-risk medical conditions to older adults. Feasibility was 

thought to be slightly higher for essential workers and older adults than those with high-risk 

conditions. Overall, the WG felt that implementation would be easiest among older adults. 

This is an application of the ethical principles to the three groups under discussion. The ACIP 

was introduced to this application during the October meeting. Additional details can be found in 

the MMWR publication that Dr. Romero announced during the opening session: 

The darker green color indicates stronger support for that ethical principle. For essential 

workers, the WG noted that early vaccination of this group would strongly support maximizing 

benefits and minimizing harms, promote justice, and mitigate health inequities. Vaccinating 

adults with high-risk medical conditions moderately supported maximizing benefits and 

promoting justice. There were concerns that diagnosis of medical conditions may favor those 

who already have access to healthcare. The WG felt that early vaccination of adults 65 and 

older would strongly support maximizing benefits and minimizing harms. There were concerns 

that the racial and ethnic groups that have been disproportionately affected by COVID so far are 

underrepresented in this group.
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

25

The WG took all of this into consideration and here is the Proposed Interim Phase 1 sequence, 

which represents the majority of WG opinion: 

As previously indicated, Phase 1a would include HCP. The WG also felt that given the burden of 

disease, likely benefits, implementation, and ethics supported the inclusion of LTCF residents in 

Phase 1a as well. The proposed Phase 1b includes essential workers, such as those who work 

in the education and childcare sector, food and agricultural, utilities, police, firefighters, 

corrections officers, and those who work in transportation. The proposed Phase 1c group

includes adults with high-risk medical conditions and adults 65 years of age and older. This is 

an example of a schema depicting how the Phase 1 sequence might roll out over time: 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

26

There are two important things to note here. First, the phases will likely overlap in time and it will 

not be necessary to vaccinate 100% of one group before moving on to the next. Second, as 

more vaccine supply is expected in later months, this will allow broader and faster coverage.

There are some additional important WG considerations. The schema presented here presents 

an interim phase one sequence allocation policy that will need to be dynamic and adapted as 

new information, such as vaccine performance and supply/demand, become clearer. To that 

end, gating criteria will be needed to move expeditiously from one phase to the next as demand 

saturates. The WG reinforced that reaching essential workers may be challenging and will 

require jurisdictions to identify critical sectors at risk and optimal strategies to reach them. It is

important to keep in mind that following vaccination, measures to stop the possible spread of 

SARS-CoV-2, such as masks and social distancing, will still be needed. Ultimately, this interim 

allocation is a short-term measure. The USG has stated its commitment to making COVID-19 

vaccines available to all residents who want them as soon as possible. At this time, the ACIP 

members were invited to provide specific feedback on Phases 1a, 1b, and 1c. 

Discussion Points

Phase 1a

Long-Term Care Facility Residents

 Because LTCF residents were not enrolled in COVID-19 vaccine trials, safety and efficacy 

data are not available to assess the benefits and harms of COVID-19 vaccines in this group. 

 Influenza VE is known to be reduced in older compared with younger adults and could be 

reduced for COVID-19 vaccines as well. However, even reduced VE could result in benefits, 

such as reduced COVID-19-related hospitalizations in this group and ease of the burden on 

strained healthcare systems. 

 Reactogenicity following receipt of COVID-19 vaccine could lead to medical evaluation and 

treatment in this group and the potential for unnecessary harm. 

 Baseline mortality among LTCF residents is high. Deaths temporally associated with receipt 

of COVID-19 vaccine during the early phases of vaccine distribution will be difficult to 

evaluate and could reduce overall public confidence in the safety of COVID-19 vaccines. 

Similar issues may arise following vaccination of people with high-risk medical conditions in 

phase 1c.

 Vaccinating both LTCF residents and staff on-site would offer efficiency in operations, likely 

would result in increased vaccine coverage, and likely would decrease intra-facility 

transmission between staff and residents. 

 If consideration is given to delaying vaccination for previously infected individuals, some 

LTCF residents and staff have been previously infected with SARS-CoV-2. 

 It was stated that 30% of LTCF residents turn over every 30 days. However, a subsequent 

written communication to the committee noted that “...many nursing homes have both shortstay residents that are there for post-acute care rehab, and longer-stay residents that reside 

there. Both populations would not be difficult to track in terms of second COVID-19 vaccine 

dose...hospitals in some states are still using nursing home post-acute care for COVID-19 

convalescent care.” 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

27

 Many LTCF staff and other HCP live in higher-risk communities. Vaccinating them can help 

to protect the health of others in their community. 

 Some committee members indicated that provision of information to LTCF staff as well as to 

residents and their family members about COVID-19 vaccines, including available safety 

data and the lack of vaccine trial data for LTCF residents, would help to address their 

concerns if it was accompanied by consent for vaccination.

Health Care Personnel 

 Given the limited amount of vaccine that will be available in the first few weeks based on 

estimates from OWS, all HCP cannot be vaccinated initially so subsets of HCP will need to 

be targeted. Possible examples noted by committee members included frontline HCP, HCP 

who cannot work remotely or who have inadequate PPE, and older HCPs and those with 

high-risk medical conditions.

 The need for clear guidance on prioritization of subsets of HCP was emphasized. The initial 

shipments of vaccine will likely go to tertiary care facilities due to the requirement for storage 

at ultra-cold temperatures. However, the risk for acquiring SARS-CoV-2 is higher for HCP 

working in the community at LTCFs. 

 Among state health officials there is strong support for vaccinating HCP due to increased 

opportunities for exposure and the important role they play in the response. 

Phase 1b

 There was strong agreement with inclusion of essential workers (non-healthcare) in Phase 

1b, given that they are fundamental in the response to COVID-19. 

 By nature of their jobs and often close proximity to one another, many essential workers are 

at increased risk and should be given the opportunity to be vaccinated early on. 

 Participants applauded the emphasis on equity and identifying that the racial, ethnic, and 

low-come disparities, and the impact of COVID-19 warrants prioritization of such workers.

 Racial and ethnic minority groups are disproportionally represented in many essential 

industries and live in communities that are disproportionally affected. This offers an 

opportunity to really impact equity.

Gating Criteria 

 This will be a dynamic process and they do not want to find themselves in a situation in 

which available vaccine is not being used as efficiently as possible:

 Given all of the discussions and data reviewed about hesitancy and the willingness 

to be vaccinated, especially early on, not everybody in any given group is going to 

want to be vaccinated.

 As demand is saturated in one group, it will be necessary to be ready to move onto 

the next group before 100% coverage is attained to ensure that vaccine is used as 

effectively as possible. 

 Clear guidance is going to be needed on gating criteria. 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

28

Overall Summary

 Of the 14 ACIP voting members, 12 expressed that they support Phases 1a, 1b, and 1c as 

presented.

 Overall, there was general agreement among the ACIP members with the proposed interim 

Phase 1 sequence, with 2 members expressing a desire for better data to inform 

recommendations about including LTCF residents in Phase 1a. 

 All 14 ACIP voting members indicated agreement with essential workers as Phase 1b.

 Multiple stakeholders also agreed with the proposed interim Phase 1 allocation sequence.
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

29

 

Upon reviewing the foregoing version of the November 23, 2020 ACIP meeting minutes, Dr. 

Jose Romero, ACIP Chair, certified that to the best of his knowledge, they are accurate and 

complete. His original, signed certification is on file with the Management Analysis and Services 

Office (MASO) of CDC.

Certification
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

30

Department of Health and Human Services 

Centers for Disease Control and Prevention 

Advisory Committee on Immunization Practices 

July 1, 2019 – December 31, 2020 

 

CHAIR 

ROMERO, José R., MD, FAAP 

Professor of Pediatrics 

Horace C. Cabe Endowed Chair in Infectious Diseases Director, 

Pediatric Infectious Diseases Section 

University of Arkansas for Medical Sciences and Arkansas Children's Hospital 

Director, Clinical Trials Research 

Arkansas Children's Hospital Research Institute 

Little Rock, AR 

Term: 10/30/2018-06/30/2021 

 

EXECUTIVE SECRETARY

COHN, Amanda, MD 

Senior Advisor for Vaccines 

National Center for Immunization and Respiratory Diseases 

Centers for Disease Control and Prevention 

Atlanta, GA 

 

MEMBERS 

ATMAR, Robert L., MD 

John S. Dunn Clinical Research Professor in Infectious Diseases 

Departments of Medicine and Molecular Virology & Microbiology 

Baylor College of Medicine 

Chief, Infectious Diseases Service 

Ben Taub General Hospital, Harris Health System

Houston, TX 

Term: 7/1/2016 – 6/30/2020 

AULT, Kevin A., MD, FACOG, FIDSA 

Professor and Division Director 

Department of Obstetrics and Gynecology 

University of Kansas Medical Center

Kansas City, KS 

Term: 10/26/2018 – 6/30/2022 

 

ACIP Membership Roster
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

31

BAHTA, Lynn, RN, MPH, CPH 

Immunization Program Clinical Consultant 

Infectious Disease, Epidemiology, Prevention & Control Division 

Minnesota Department of Health 

Saint Paul, Minnesota 

Term: 7/1/2019 – 6/30/2023 

 

BELL, Beth P., MD, MPH 

Clinical Professor 

Department of Global Health, School of Public Health 

University of Washington 

Seattle, WA 

Term: 7/1/2019 – 6/30/2023 

BERNSTEIN, Henry, DO, MHCM, FAAP 

Professor of Pediatrics 

Zucker School of Medicine at Hofstra/Northwell 

Cohen Children’s Medical Center 

New Hyde Park, NY 

Term: 11/27/2017-06/30/2021 

 

FREY, Sharon E., M.D. 

Professor and Associate Director of Clinical Research 

Clinical Director, Center for Vaccine Development 

Division of Infectious Diseases, Allergy and Immunology 

Saint Louis University Medical School 

Saint Louis, MO 

Term: 11/27/2017-06/30/2021 

 

HUNTER, Paul, MD 

Associate Professor of Family Medicine and Community Health 

University of Wisconsin School of Medicine and Public Health 

Associate Medical Director 

City of Milwaukee Health Department 

Milwaukee, WI 

Term: 7/1/2016 – 6/30/2020 

 

LEE, Grace M., MD, MPH 

Associate Chief Medical Officer for Practice Innovation 

Lucile Packard Children’s Hospital 

Professor of Pediatrics, Stanford University School of Medicine 

Stanford, CA 

Term: 7/1/2016 – 6/30/2020 

 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

32

MCNALLY, Veronica V., JD 

President and CEO 

Franny Strong Foundation 

West Bloomfield, Michigan 

Term: 10/31/2018 – 6/30/2022 

 

POEHLING, Katherine A., MD, MPH 

Professor of Pediatrics and Epidemiology and Prevention Director, 

Pediatric Population Health 

Department of Pediatrics 

Wake Forest School of Medicine 

Winston-Salem, NC 

Term: 7/1/2019 – 6/30/2023 

SÁNCHEZ, Pablo J., M.D.

Professor of Pediatrics 

The Ohio State University – Nationwide Children’s Hospital 

Divisions of Neonatal-Perinatal Medicine and Pediatric Infectious Diseases 

Director, Clinical & Translational Research (Neonatology) 

Center for Perinatal Research 

The Research Institute at Nationwide Children's Hospital 

Columbus, Ohio

Term: 7/1/2019 – 6/30/2023 

 

SZILAGYI, Peter, MD, MPH 

Professor of Pediatrics 

Executive Vice-Chair and Vice-Chair for Research 

Department of Pediatrics 

University of California, Los Angeles (UCLA) 

Los Angeles, California 

Term: 7/1/2016 – 6/30/2020 

 

TALBOT, Helen Keipp, MD 

Associate Professor of Medicine 

Vanderbilt University

Nashville, TN 

Term: 10/29/2018 – 6/30/2022 

 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

33

EX OFFICIO MEMBERS 

Centers for Medicare and Medicaid Services (CMS) 

HANCE, Mary Beth 

Senior Policy Advisor 

Division of Quality, Evaluations and Health Outcomes 

Children and Adults Health Programs Group 

Center for Medicaid, CHIP and Survey & Certification 

Centers for Medicare and Medicaid Services 

Baltimore, MD 

Food and Drug Administration (FDA) 

FINK, Doran, MD, PhD 

Deputy Director, Clinical, Division of Vaccines and Related Products Applications Office of 

Vaccines Research and Review 

Center for Biologics Evaluation and Research 

Food and Drug Administration 

Silver Spring, MD

 

Health Resources and Services Administration (HRSA) 

RUBIN, Mary, MD 

Chief Medical Officer 

Division of Injury Compensation Programs 

Rockville, MD 

Indian Health Service (IHS) 

WEISER, Thomas, MD, MPH 

Medical Epidemiologist 

Portland Area Indian Health Service 

Portland, OR 

 

Office of Infectious Disease and HIV/AIDS Policy (OIDP) 

KIM, David, MD CAPT, 

US Public Health Service Director Division of Vaccines 

Washington, DC 

National Institutes of Health (NIH) 

BEIGEL, John, M.D. 

Associate Director for Clinical Research 

Division of Microbiology and Infectious Diseases 

National Institute of Allergy and Infectious Diseases (NIAID) Bethesda, MD 

 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

34

LIAISON REPRESENTATIVES 

American Academy of Family Physicians (AAFP) 

ROCKWELL, Pamela G, DO 

Associate Professor, Department of Family Medicine, 

University of Michigan Medical School 

Medical Director, Dominos Farms Family Medicine Ann 

Arbor, MI 

 

American Academy of Pediatrics (AAP) 

MALDONADO, Yvonne, MD 

Senior Associate Dean for Faculty Development and Diversity 

Professor of Pediatrics and Health Research and Policy 

Chief, Division of Pediatric Infectious Diseases 

Stanford University School of Medicine 

Stanford, CA 

 

American Academy of Pediatrics (AAP) 

Red Book Editor 

KIMBERLIN, David, MD 

Professor of Pediatrics 

Division of Pediatric Infectious Diseases 

The University of Alabama at Birmingham School of Medicine

Birmingham, AL 

 

American Academy of Physician Assistants (AAPA) 

LÉGER, Marie-Michèle, MPH, PA-C Senior 

Director, Clinical and Health Affairs 

American Academy of Physician Assistants

Alexandria, VA 

American College Health Association (ACHA) 

CHAI, Thevy S, MD 

Director of Medical Services 

Campus Health Services 

University of North Carolina at Chapel Hill 

Chapel Hill, NC

American College Health Association (ACHA) (alternate) 

MCMULLEN, Sharon, RN, MPH, FACHA 

Assistant Vice President of Student & Campus Life for Health and Wellbeing 

Cornell Health 

Ithaca, NY 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

35

American College of Nurse Midwives (ACNM) 

HAYES, Carol E., CNM, MN, MPH Lead 

Clinician 

Clinical Quality Compliance and Management 

Planned Parenthood Southeast 

Atlanta, GA 

American College of Nurse Midwives (ACNM) (alternate) 

MEHARRY, Pamela M., PHD, CNM 

Midwifery Educator, Human Resources for Health 

In partnership with University of Rwanda and University of Illinois, Chicago 

American College of Obstetricians and Gynecologists (ACOG) 

ECKERT, Linda O., MD, FACOG 

Professor, Department of Obstetrics & Gynecology 

Adjunct Professor, Department of Global Health 

University of Washington 

Seattle, WA 

American College of Physicians (ACP) 

GOLDMAN, Jason M. MD, FACP 

Affiliate Assistant Professor of Clinical Biomedical Science, Florida Atlantic 

University, Boca Raton, Florida 

Private Practice 

Coral Springs, FL 

American Geriatrics Society (AGS) 

SCHMADER, Kenneth, MD 

Professor of Medicine-Geriatrics 

Geriatrics Division Chief 

Duke University and Durham VA Medical Centers

Durham, NC 

America’s Health Insurance Plans (AHIP) 

GLUCKMAN, Robert A., MD, MACP 

Chief Medical Officer, Providence Health Plans 

Beaverton, OR

American Immunization Registry Association (AIRA) 

COYLE, Rebecca, MSEd 

Executive Director, AIRA

Washington, DC 

American Medical Association (AMA) 

FRYHOFER, Sandra Adamson, MD 

Adjunct Associate Professor of Medicine 

Emory University School of Medicine

Atlanta, GA 

 

American Nurses Association (ANA) 

RITTLE, Charles (Chad), DNP, MPH, RN 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

36

 

Assistant Professor, Nursing Faculty 

Chatham University, School of Health Sciences

Pittsburgh, PA 

 

American Osteopathic Association (AOA) 

GROGG, Stanley E., DO 

Associate Dean/Professor of Pediatrics 

Oklahoma State University-Center for Health Sciences 

Tulsa, OK 

American Pharmacists Association (APhA) 

FOSTER, Stephan L., PharmD CAPT (Ret) 

U.S.P.H.S. 

Professor, College of Pharmacy 

University of Tennessee Health Sciences Center 

Memphis, TN 

Association of Immunization Managers (AIM) 

HOWELL, Molly, MPH Immunization Program Manager 

North Dakota Department of Health 

Bismarck, ND

 

Association for Prevention Teaching and Research (APTR) 

McKINNEY, W. Paul, MD 

Professor and Associate Dean 

University of Louisville School of Public Health and Information Sciences

Louisville, KY 

Association of State and Territorial Health Officials (ASTHO) 

SHAH, Nirav D, MD, JD

Director 

Maine Center for Disease Control and Prevention

Augusta, ME

Biotechnology Industry Organization (BIO) 

ARTHUR, Phyllis A., MBA 

Senior Director, Vaccines, Immunotherapeutics and Diagnostics Policy 

Washington, DC

Council of State and Territorial Epidemiologists (CSTE) 

HAHN, Christine, MD State 

Epidemiologist 

Office of Epidemiology, Food Protection and Immunization Idaho 

Department of Health and Welfare

Boise, ID 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

37

Council of State and Territorial Epidemiologists (CSTE) (alternate) 

LETT, Susan, MD, MPH 

Medical Director, Immunization Program 

Division of Epidemiology and Immunization 

Massachusetts Department of Public Health 

Boston, MA 

 

Canadian National Advisory Committee on Immunization (NACI) 

QUACH, Caroline, MD, MSc 

Pediatric Infectious Disease Specialist and Medical Microbiologist 

Medical Lead, Infection Prevention and Control Unit 

Medical Co-director – Laboratory Medicine, Optilab 

Montreal-CHUM 

Montreal, Québec, Canada 

 

Infectious Diseases Society of America (IDSA) 

BAKER, Carol J, MD 

Professor of Pediatrics 

Molecular Virology and Microbiology 

Baylor College of Medicine

Houston, TX 

International Society for Travel Medicine (ISTM)

BARNETT, Elizabeth D, MD

Professor of Pediatrics

Boston University School of Medicine

Boston, MA

National Association of County and City Health Officials (NACCHO) 

ZAHN, Matthew, MD 

Medical Director, Epidemiology 

Orange County Health Care Agency 

Santa Ana, CA 

 

National Association of County and City Health Officials (NACCHO) (alternate) 

DUCHIN, Jeffrey, MD 

Health Officer and Chief, Communicable Disease Epidemiology and Immunization Section 

Public Health - Seattle and King County 

Professor in Medicine, Division of Allergy and Infectious Diseases 

University of Washington School of Medicine and School of Public Health

Seattle, WA

National Association of Pediatric Nurse Practitioners (NAPNAP) 

STINCHFIELD, Patricia A., RN, MS, CPNP 

Director, Infectious Disease/Immunology/Infection Control 

Children's Hospitals and Clinics of Minnesota

St. Paul, MN 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

38

National Foundation for Infectious Diseases (NFID) 

SCHAFFNER, William, MD 

Chairman, Department of Preventive Medicine 

Vanderbilt University School of Medicine 

Nashville, TN 

National Foundation for Infectious Diseases (NFID) (alternate) 

DALTON, Marla, PE, CAE 

Executive Director & CEO 

National Foundation for Infectious Diseases (NFID) 

Bethesda, MD

National Medical Association (NMA) 

WHITLEY-WILLIAMS, Patricia, MD 

Professor and Chair 

University of Medicine and Dentistry of New Jersey 

Robert Wood Johnson Medical School 

New Brunswick, NJ 

 

Pediatric Infectious Diseases Society (PIDS) 

O’LEARY, Sean, MD, MPH 

Associate Professor of Pediatrics 

Pediatric Infectious Diseases 

General Academic Pediatrics 

Children’s Hospital Colorado 

University of Colorado School of Medicine 

 

Pediatric Infectious Diseases Society (PIDS) (alternate) 

SAWYER, Mark H, MD 

Professor of Clinical Pediatrics 

University of California, San Diego School of Medicine 

San Diego, CA 

 

Pharmaceutical Research and Manufacturers of America (PhRMA) 

ROBERTSON, Corey, MD, MPH 

Senior Director, US Medical, Sanofi Pasteur

Swiftwater, PA 

 

Society for Adolescent Health and Medicine (SAHM) 

MIDDLEMAN, Amy B., MD, MSEd, MPH 

Professor of Pediatrics 

Chief, Section of Adolescent Medicine 

University of Oklahoma Health Sciences Center 

Oklahoma City, OK 
Advisory Committee on Immunization Practices (ACIP) Summary Report November 23, 2020

39

Society for Healthcare Epidemiology of America (SHEA) 

DREES, Marci, MD, MS 

Chief Infection Prevention Officer & Hospital Epidemiologist 

ChristianaCare 

Wilmington, DE 

Associate Professor of Medicine Sidney Kimmel Medical College at Thomas Jefferson 

University 

Philadelphia, PA