Fighting for a place in vaccine line
States put in varying rules for those with medical conditions
NEW YORK — When states started vaccinating people with medical conditions that may raise their risk for a severe case of COVID19, each one set its own rules. Like millions of Americans, Megan Bauer, of Royal Oak, Michigan, has been waiting patiently for her turn.
Bauer, who lives with cystic fibrosis, a genetic disease that can cause serious lung infections, has followed a strict self-isolation regimen recommended by her doctors. She said that she is grateful that other people with heightened risks are getting vaccinated: health care workers, teachers, her 81-year-old grandmother. If Bauer lived in Montana, New Mexico, Virginia, or at least 14 other states or Washington, D.C., she could get the vaccine now too. But not in Michigan.
“The wait seems never-ending,” Bauer said. “With cystic fibrosis, every day is precious, so losing this time is difficult.”
In the initial months of the vaccine rollout, states sought to balance between prioritizing the elderly, who are most likely to die from the virus, and people in professions most likely to be exposed to it. Under recommendations from the Centers for Disease Control and Prevention, people with underlying medical conditions, like Type 2 diabetes or cancer, which have been associated with an increased risk for severe virus symptoms, were slated to come next.
But with demand still
outstripping the nation’s vaccine supply, a new skirmish has emerged over which health problems to prioritize. States, which are not bound by the CDC’s recommendations, have set varying rules amid a dearth of definitive evidence about how dozens of medical conditions may affect the severity of COVID-19. The confusing morass of rules has set off a free-for-all among people who may be among the most vulnerable to the virus as they seek to persuade health and political officials to add health conditions to an ever-evolving
vaccine priority list.
At least 37 states and Washington, D.C., are now allowing some residents with certain health problems to receive vaccines, according to a New York Times survey of all 50 states. But the health issues granted higher priority differ from state to state, and even county to county.
Some people with Down syndrome may get vaccines in at least 35 states, for instance, but some of those states are not offering shots to people with other developmental conditions. At least 30 states allow some
people with Type 2 diabetes to get vaccines, but only 23 states include people with Type 1 diabetes. At least 19 states are making the vaccine available to some people with cystic fibrosis; at least 14 have included some people with liver disease; and at least 15 have deemed some smokers eligible. At least 30 states have prioritized vaccines for people who are overweight or obese, according to the Times survey, though they vary even there, some setting the bar at a body mass index of 25, others at 30 or 40.
Some states require a person to prove they have a medical condition, although at least 16 states and Washington, D.C., do not. And at least 12 states allow a person to get a recommendation from a health professional to get a shot, even if their medical condition has not been given priority by the state.
In the absence of large, rigorous studies of the virus’s effect on people with other medical problems, medical ethicists said, there are few clear principles to apply to determine a priority sequence among many conditions. Many states are taking their cues from a list of 12 sorts of conditions that the CDC has deemed to have substantial evidence for elevated COVID risks, including obesity, Type 2 diabetes, smoking and Down syndrome. CDC officials have said that they regularly review the scientific literature and will expand the list as warranted.
But some medical ethicists argue that the list itself is misleading because it suggests that the risks for all diagnoses have been considered and ranked. Is a 50-year-old with Type 1 diabetes at greater risk from COVID-19 than a 25-yearold with sickle cell disease?
Across the country, the vaccine eligibility requirements are a moving target.
Ohio added bone marrow transplant patients to its list last week after initially offering the vaccine only to those who had received a solid organ transplant. Next week, California, where only some counties have previously offered vaccines to people with medical conditions, will allow shots statewide to millions of people with health problems. That reversed the state’s earlier plan to prioritize shots based solely on age.
In Michigan, Bauer, the woman who had hoped her cystic fibrosis would permit her to receive a vaccine soon, a recent announcement from the state was bittersweet.
This week, Michigan expanded vaccine eligibility to people with cystic fibrosis and other medical conditions, so long as they are older than 50. In 2019, the median age of death for people with cystic fibrosis in the United States was 32, according to the Cystic Fibrosis Foundation.
“Most people with CF,’’ said Bauer, who is 24, “may not be in that group.”