Description and Rationale for Population Groups Targeted for Pandemic Vaccination
Guidance for targeting vaccination defines population groups in four broad categories that correspond with the objectives of a pandemic vaccination program – to protect people who: 1) maintain homeland and national security, 2) provide health care and community support services, 3) maintain critical functions of society, and 4) are in the general population. The population groups are to be vaccinated in “tiers”. Reflecting public values and the need to address multiple important objectives with the pandemic vaccination program, each of the top tiers includes populations from all four categories for a very severe pandemic. The table below provides further definition of population groups for pandemic vaccination by tier for a pandemic with a high or very high level of severity, the estimated size of the group, and a brief description of the working group’s rationale for prioritizing that group. For planning purposes, note that the estimated number of persons in occupational groups are only those who are critical to maintaining essential functions. This interim guidance and table are provided for planning purposes. The Advisory Committee on Immunization Practices (ACIP), a federal advisory committee that develops recommendations for the director of the Centers for Disease Control and Prevention (CDC) on use of vaccines to control diseases in the United States, would serve as the advisory committee for developing recommendations for use of pandemic vaccine. If needed during a future pandemic, more specific guidance will be provided by CDC; the tiered schema outlined in this document will be adapted to provide guidance on targeted vaccination during the pandemic.
|Tier (High/Very High Severity)
|Estimated Number in Group
|Deployed and mission critical personnel for national security
|Military forces and other mission critical personnel not limited to active duty military or U.S. government employees. Includes some diplomatic and intelligence service personnel, and public and private sector functions identified by federal agencies as unique and critical to national security
|Critical to protect national security, unable to tolerate projected pandemic personnel loss and fulfill mission, potential greater risk of infection due to geographic location and crowded living or working conditions.
|Public health personnel
|Public health responders at federal, state and local levels
|Essential to implementing the pandemic response, including the vaccination program and other pharmaceutical and non-pharmaceutical response measures; also provide care for low income and underserved populations; personnel at increased risk of exposure to persons with pandemic illness, and also increased work load to respond to the pandemic.
|Inpatient healthcare providers
|Includes two-thirds of personnel at acute care hospitals who would be identified by their institution as critical to provision of inpatient health care services; primarily will include persons providing care with direct patient exposure but also will include persons essential to maintaining hospital infrastructure.
|Maintaining quality inpatient health care is critical to reducing mortality from pandemic influenza and from other illnesses that will occur concurrently with the pandemic; inpatient healthcare burden will likely be markedly increased during a pandemic; studies show health outcomes are associated with staff-to-patient ratio; personnel have increased risk of exposure, including to infectious aerosols; infected healthcare personnel may transmit infection to vulnerable persons hospitalized for non-influenza illnesses.
|Outpatient and home health providers
|Includes two-thirds of personnel identified by their organization at outpatient facilities, including but not limited to physicians’ offices, primary care clinics, dialysis centers, urgent care centers, retail health clinics, and blood donation facilities; and skilled home health care personnel providing care with direct patient exposure.
|Maintaining outpatient and home health care is critical to reducing pandemic mortality and morbidity and reducing the burden on inpatient services; outpatient healthcare burden will be markedly increased during a pandemic; personnel have increased risk of exposure, possibly including to infectious aerosols; infected health care personnel may transmit infection to vulnerable persons receiving care for non-influenza illness.
|Health care providers in long term care facilities (LTCFs)
|Includes two-thirds of personnel at LTCFs identified by their organization as critical to the provision of care.
|Essential to provide care to more than 3 million persons in LTCFs who are particularly vulnerable to influenza illness and death; risk of pandemic outbreaks in LTCFs may best be reduced by vaccinating staff and limiting exposure of residents to infection; if outbreaks occur, personnel have increased risk of exposure, possibly including to infectious aerosols, and can spread pandemic influenza to their high-risk patients.
|Pharmacists and pharmacy technicians
|Includes pharmacists dispensing drugs at retail locations and pharmacy technicians who interact with the public and are essential for pharmacy operations (note that pharmacists in hospitals or outpatient centers may be targeted as part of those groups).
|Essential to dispense medications and administer vaccinations for pandemic influenza and other illnesses; demand for pharmacist services would be expected to increase during a pandemic. Pharmacists and pharmacy technicians may have increased exposure risk to persons with pandemic infection given their exposure to the public for provision of services.
|Emergency services and public safety sector personnel (e.g. emergency medical service, law enforcement and fire services)
|Includes groups supporting emergency response and public safety. Emergency medical service personnel include those who are fire department based, hospital-based, or private; firefighters include professional and volunteers; law enforcement local police, sheriff officers, state troopers; and corrections officers include those in prisons and jails.
|Provide critical public safety and emergency response services; contribute to pandemic response activities by maintaining public order and contributing to medical care services; increased occupational risk for emergency medical services due to exposure to persons with pandemic illness.
|Manufacturers of pandemic vaccine and antiviral drugs
|Includes critical personnel required for ongoing production of pandemic medical countermeasures to support a pandemic response.
|Reducing pandemic health impacts requires production of pandemic vaccine and anti-influenza drugs.
|Women at any stage of pregnancy
|Pregnant women are at high risk of severe complications or death from pandemic influenza due to immunological, circulatory, and respiratory changes that occur during pregnancy; vaccinating pregnant women also reduces the risk of influenza in infants up to 6 months of age.
|Infants and toddlers (6-35 months old)
|Infants and toddlers in the specified age group
|Persons in this age group are at high risk of severe complications or death from pandemic influenza; vaccination may require a lower dose than used to protect older children and adults; public values prioritize children highest among groups defined by age and disease status.
|Essential military support and sustainment personnel
|Military and other essential personnel needed to support and sustain deployed forces
|Maintaining function is essential to mission success for deployed personnel; risk of infection may be less based on geographical location and living conditions.
|Critical personnel in the intelligence community serving at domestic and international posts that are not included in tier 1
|Essential to homeland and national security; opportunities for social distancing limited because of inability to telework due to need for secure facilities; some personnel may be at increased risk based on geographical location.
|National Guard personnel
|National Guard Personnel not included in tier 1, but who are likely to be activated to maintain public order during a pandemic or to support pandemic response services or critical infrastructure
|Likely to be activated in a pandemic to support critical response or community functions; may be at increased risk of exposure and infection based on mission
|Other domestic national security personnel
|Includes other groups that are essential to national security such as guards at nuclear facilities and critical personnel providing border protection.
|Essential to national and homeland security and includes critical personnel in agencies providing U.S. border security
|Community support service personnel (emergency management and community and faith-based support and response organizations)
|Personnel from community organizations who will provide essential support and have direct contact with persons and families affected during community pandemic outbreaks, and emergency management personnel who coordinate pandemic response and support activities
|Community level support will be critical for persons who are ill and isolated in their homes or are complying with recommendations for voluntary household quarantine during community pandemic outbreaks, for elderly persons who live alone and cannot or may be afraid of leaving their home during a pandemic, for persons who are homeless, and for other vulnerable populations; support may include providing food and medications, as well as other social and mental health services; personnel will be at increased risk of exposure to ill persons and, if infected could transmit illness to a high risk population.
|Mortuary services personnel
|Includes funeral directors
|Increased burden likely during a pandemic; may have increased occupational exposure to ill family members of deceased persons.
|Communications, information technology (IT), electricity, nuclear, oil & gas, and water sector personnel, financial clearing and settlement personnel
|Personnel who are critical to support essential communications, information technology, utility, financial and other services provided by the defined sectors
|These sectors provide products and services that generally cannot be stored, are required for community health and safety, and are essential to the functioning of other critical infrastructure sectors.
|Critical government personnel – operational and regulatory functions
|Federal, state, tribal, and tribal government employees and contractors who perform critical regulatory or operational functions required for essential operations of other critical infrastructure sectors
|Government personnel are critical for implementing and monitoring components of the pandemic response and performing regulatory or operational functions essential to critical infrastructure that protect public health and safety and preserve security.
|Household contacts of infants under 6 months old.
|Household contacts of infants under 6 months old
|Infants under 6 months old cannot be directly protected by vaccination, and influenza antiviral drugs are not approved for infants < 2 weeks old; therefore, vaccinating contacts can protect infants. Public values prioritize protection of children highest among groups at increased age risk of influenza-related complications based on age or disease status.
|Children 3 – 18 years old with a high risk medical condition
|Children in the specified age group with a chronic medical condition that increases their risk of severe influenza disease, including heart and lung disease, metabolic disease, renal disease and neuromuscular diseases that may compromise respiratory function, as defined by ACIP recommendations for seasonal influenza vaccination.
|Children with these conditions are at increased risk of severe complications or death from influenza disease; public values prioritize children highest among groups defined by age and disease status.
|Remaining active duty military and essential support
|Active duty personnel not included in higher priority groups and essential support personnel
|Essential to national and homeland security
|Other health care personnel
|Includes groups that provide important health care services but are at less occupational risk, such as laboratory personnel
|Personnel provide important health care services but are not as likely to have close contact with ill persons and are therefore at less risk of occupational infection compared to other healthcare sectors.
|Banking & finance, chemical, food & agriculture, pharmaceutical, postal & shipping, & transportation sector personnel. (Critical infrastructure with greater redundancy)
|Personnel who are critical to support essential services provided by the defined sectors
|These sectors provide essential products and services; however, compared with Tier 2 sectors, products can more likely be stored, facilities and personnel are more fungible and better able to maintain essential functions with high absenteeism, and other strategies can be implemented to protect workers.
|Other critical government personnel
|Federal, state, tribal, and local government employees and contractors who perform important government functions included in agency continuity-of-operations plans
|Continuity of key government functions is important to support communities and critical infrastructures.
|Children 3 – 18 years old without a high risk medical condition
|Children in the specified age group who do not have a chronic medical condition that increases their risk of severe influenza disease.
|Public values prioritize protection of children highest among groups defined by age and disease status; vaccinating children may reduce transmission of pandemic influenza to household contacts and in communities; if a substantial number of children are protected by vaccine, schools can re-open mitigating secondary adverse consequences of closing schools.
|Adults 19 – 64 years with a high risk condition
|Adults in the specified age group with a chronic medical condition that increases their risk of severe influenza disease, including heart and lung diseases, metabolic diseases, renal disease, and neuromuscular diseases that may compromise respiratory function, as defined by ACIP recommendations for seasonal influenza vaccination
|Adults with these conditions are at high risk of severe complications or death from pandemic influenza.
|Adults 65 years and older
|Older adults in the specified age group
|Persons in the age group are at high risk of severe complications or death from pandemic influenza.
|Healthy adults, 19 – 64 years old2
|Adults in the specified age group not included above
|Persons in this group lack age, health condition, and occupational rationales for priority pandemic vaccination.
1 Estimates of group size from information provided by Department of Defense, Department of Homeland Security, Department of Health and Human Services, and U.S. Census Bureau
2 The target group “Healthy adults 19-64 years old” does not include persons defined by occupation and pregnant women who are included in other target groups.