Why state changed vaccination plan
Eligibility of 1.5M shifted focus
When Gov. Ned Lamont announced a sudden shift Monday in the state’s vaccination plans, he and his administration stressed they were streamlining what they said was a complicated process.
Among the problems they faced were more accurate estimates of essential workers and those with medical conditions had quickly swelled to upwards of 1.5 million people, far exceeding the initial projections.
Josh Geballe, Lamont’s chief operating officer, said in recent weeks it became clear that the number was much higher than the initial 675,000 identified in that group.
“As we had been working over the last weeks, and really months, since the CDC put out that list of high-risk medical condi
tions and essential front-line workers, it had been increasingly clear there were going to be major problems with that approach,” Geballe said Tuesday in an interview with Hearst Connecticut Media.
So state officials scrapped a focus on those groups and launched a new plan: Vaccinate by age groups. Starting next Monday, people age 55 to 64 become eligible. The eligibility expands every several weeks until everyone age 16 and above can get vaccinated on May 3.
Expanded vaccination efforts come as Connecticut on Tuesday reported a positivity rate of 3.92 percent, an increase in overall hospitalizations to 511 and 10 additional fatalities, bringing the total to 7,572.
When discussing the new plan, Dr. Reginald Eadie, a key adviser on state vaccination plans, said the shift comes down to efficiency.
“This is the fastest way to get the most residents in the state of Connecticut vaccinated as possible,” he said.
Scope broadens
Chief among the problems with a plan centered on essential workers and those with medical conditions was where to draw the line.
As advisers considered who fit into these groups, they were weighed down with calls and questions. They were forced to consider questions like: If you include grocery workers, does that extend to convenience stores that sell food? Some guidance included U.S. Postal Service workers, but why not the UPS and FedEx drivers who delivered the vaccines in the first place?
For those at higher risk of COVID complications because of illness, another series of questions surfaced, state officials said. What if the individual was previously treated, or what if they had a dire condition that wasn’t listed?
Officials estimated that 370,000 Connecticut residents were eligible under the CDC’s list of essential workers and another 260,000 were identified by the state’s Vaccine Allocation Subcommittee.
Couple that with more than 800,000 people whose medical conditions were considered highrisk by the CDC, and others with conditions at a lesser risk, the number grew to encompass a majority of people in the state, Geballe said.
These new estimates far eclipsed numbers previously released by the state that estimated these two groups to be roughly 675,000 people — about double the number of those age 65 to 74 who were the most recent group to become eligible for the vaccine.
“The numbers had grown to the point where you were contemplating taking on an absolutely unmanageable number of people at once. That put you in a situation where you would have to cut it by age anyway,” Geballe said.
In announcing his plan, Lamont said they fell back on the old business saying: “KISS — Keep it simple, stupid.”
“A lot of complications resulted from states that tried to finely slice the salami and it got complicated to administer,” he said, speaking of efforts to define these groups.
Proving eligibility
As the scale of the essential workers and those with preexisting conditions became clear, there was another hurdle: How do those people identify themselves when they seek the vaccine?
Officials considered whether to ask people to provide information such as pay stubs, letters from doctors, notes from employers, or other documents to prove they were an essential worker or someone with a high-risk condition.
“Fewer people are getting vaccinated because they are making it so complicated. You have to bring a pay stub, or proof of employment or a doctor’s note. This is the first time we said, ‘we need to find a better way,’” Lamont said during a Monday news conference in reference to states with similar plans.
In neighboring New York, where these groups are prioritized for vaccines, people are required to provide proof of employment or letters from doctors, medical records or signed certifications when they validate their appointments.
“Different states will of course take different approaches, but we believe our prioritization —
which includes both the most vulnerable New Yorkers based on age and underlying health conditions and essential workers like health care heroes, police officers, firefighters, teachers, taxi drivers, and grocery and restaurant workers — is the right system for New York right now,” said Jonah Bruno, director of public information for the New York Department of Health. “Currently, over 10 million New Yorkers can get vaccinated, representing roughly two-thirds of all individuals who are potentially eligible.”
Jason Schwartz, an associate professor for the Yale School of Public Health and member of Connecticut’s vaccine advisory committee, said once these groups were defined, states have tried “all sorts of things on how to make appointments.”
“All of those things are wellintentioned, but ultimately delays that process,” Schwartz said.
As the state balances its two goals — speed and equity — officials considered how a complex process like this could favor those with resources, technology, connections and relationships, and push aside others.
“Then you say, ‘All right, maybe we won’t ask for proof . ... Does the process kind of implode at that point?” Geballe said.
Focus on age
As Lamont’s administration sought a solution, they examined what other states had done before launching into the next step of vaccine distribution. If they followed through with vaccinating essential workers and those with preexisting conditions, they knew it would be hard to change course.
The focus fell on age, which had defined the last two eligible groups under the state plans — those 75 and above and then those 65 to 74.
“We found a close correlation between age and risk, age and comorbidities, and age and fatalities,” Lamont said Monday. Lamont highlighted that a vast majority of Connecticut’s COVID-19 deaths were people age 55 and older.
“Age is a key determinant in terms of risk of fatalities, complications, hospitalizations, all the things we are desperately trying to avoid,” Lamont said. This formed the new strategy, he added.
While the age groups still represent significant numbers of people, they are clearly defined and easy to identify.
“Age is such an important marker — it’s easy to implement, it’s easy to educate,” Schwartz said.
The state’s plan rolls out eligibility starting with those age 55 to 64 on March 1, those 45 to 54 on March 22, those between 35 and 44 on April 12, and those 16 to 34 on May 3.
“We do understand that there are people with chronic conditions that want to get vaccinated, that’s why we are focusing on speed and simplicity. We want to be able to get to people as quickly as possible,” Deidre Gifford, the acting commissioner of the state Department of Public Health, said of the new schedule.
Each group represents hundreds of thousands of people, but state officials said the plan falls in line with a substantial increase in vaccine allotments.
This week, Connecticut officials expect more than 90,000 first doses, but that number is expected to continue to grow in the coming weeks as the federal government anticipates larger allocations to states.
“This strategy will help us make the most of the next few months when vaccine supply will be surging, but we still won’t have the doses we would like to vaccinate everyone who wants one,” Schwartz said.