State must decide who is next for vaccination
Teachers, grocery clerks, bus drivers, corrections officers, prisoners and elderly residents could be included in the next phase of Wisconsin’s effort to administer COVID-19 vaccinations statewide.
But which groups should get the shots first? Who can afford to wait?
Health care officials and experts leading the state’s vaccination rollout discussed these questions Tuesday and said part of the problem they face
as they make the decision of who will be included in the second phase of vaccinations, known as 1B, is the growing number of people who think they should be next in line.
Complicating the decision is a lack of clarity about how many doses of vaccine the state will receive each week, making planning difficult.
Health Services Secretary Andrea Palm in a media briefing Tuesday said the first phase could last through February, but noted it’s difficult to predict due to supply and demand. Gov. Tony Evers in the same briefing said he would likely receive his first vaccine dose during the summer, as part of a group of residents who are over the age of 65.
Members of the state’s vaccine distribution oversight panel, which is part of the Wisconsin State Disaster Medical Advisory Committee, said at a meeting Tuesday they plan to create a list of suggestions for the next phase of vaccinations by the end of the week.
The planning comes as Wisconsin lags some of its Midwestern neighbors in getting vaccines out to residents.
As of Tuesday, nationwide data collected by the CDC shows that Wisconsin ranks 10th out of 12 Midwestern states in terms of the percentage of the population that has received a dose of the vaccine. More than 67,300 people, or 1.2% of the state’s population, have received a shot, according to the CDC.
However, state Department of Health Services spokeswoman Jennifer Miller pointed out the CDC’s data lags behind the state’s figures, which are culled from the Wisconsin Immunization Registry.
The state health department’s data shows Wisconsin has administered 85,609 doses of the vaccine, about onethird of the 266,000 that the state has received so far. That would put Wisconsin at sixth out of the 12 Midwestern states.
According to the state health department, 420,200 doses of the vaccine have been allocated to Wisconsin, of which 56,800 have been set aside for skilled nursing facilities, which began vaccinating last week. More will be set aside for assisted living facilities.
“The rollout has not gone real smoothly, and for as many doses out there, we’re not vaccinating very quickly,” vaccine committee co-chairman Jonathan Temte, the Associate Dean for Public Health and Community Engagement for UW-Madison School of Medicine and Public Health, said Tuesday about deciding who is included in the next phase.
“And the larger we make any particular group, the much longer it’s going to take,” he said. “One of the questions is how long do we put off some of those high-risk individuals.”
Evers on Tuesday dismissed the idea of comparing Wisconsin’s rollout to other states because of the variance in each state’s plans. The Milwaukee Journal Sentinel first reported on the state’s lagging ranking compared to other Midwestern states.
“If you want to compare, fine, compare away,” Evers said. “I think it’s also really important to think about there are some things that can’t be compared.”
Evers said some states include all elderly people in their first phase, whereas Wisconsin doesn’t.
“While we’re worrying about comparing ourselves to Florida or to some other state, I’ve continued to encourage people, at the same time we’re worrying about making those comparisons, to think about how important it is to make sure we’re not spreading this virus.”
Doses set aside for assisted living
The state is setting aside doses of the COVID-19 vaccine for assisted living facilities several weeks in advance of when they will be administered, which is further limiting the number of doses the state can give immediately to hospital workers and other priority health care workers in the state.
As part of the federal program for vaccinating residents and staff at Wisconsin nursing homes and assisted living facilities, the state is required to set aside tens of thousands of doses in advance, Palm said Tuesday.
By the time vaccinations began at Wisconsin nursing homes on Dec. 28, the state had set aside nearly 57,000 doses of the Moderna vaccine to cover most residents and staff at Wisconsin’s roughly 350 nursing homes.
State officials have not authorized the program to move forward in Wisconsin’s more than 4,000 assisted living facilities, but the state has already begun setting aside doses that will be needed to vaccinate an estimated 140,000 residents and staff in assisted living, Palm said.
Palm said they wanted to gradually build up their reserve of vaccine needed to start the program in assisted living facilities while still distributing the vaccine to other health care providers prioritized for the vaccine in the state.
In all, the state has set aside nearly 107,000 doses for both nursing homes and assisted living facilities, Palm said Tuesday.
“They are not in the state of Wisconsin sitting on a shelf somewhere waiting to be administered,” Palm said. “The feds have us put them essentially in a bank, in a reserve so we are able to have enough sort of down payment to trigger the program and get it started.”
Pharmacy chains CVS and Walgreens began administering vaccines through the federal program in Wisconsin on Dec. 28. They have only been authorized to begin vaccinations at nursing homes.
Palm on Tuesday did not answer how many doses have been administered through the program so far. Last week, DHS spokeswoman Elizabeth Goodsitt said vaccinations were set to begin last week at 42 nursing homes.
Nationwide, the vaccine rollout in long-term care facilities has been slowgoing. About 13% of the 3.26 million doses distributed nationwide for use in long-term care facilities had been administered as of Tuesday, according to data from the Centers for Disease Control and Prevention.
Palm said she expects that by the end of January, all nursing home residents in Wisconsin will have received their first dose of the Moderna vaccine, which is administered in two doses, separated by about 28 days.
Vaccination efforts in assisted living facilities could begin later this month or in February.
Among the groups being considered for the next phase of vaccinations are first responders, food and agriculture workers, and people who live in group housing facilities.
‘Is it fair?’
Edward Belongia, director of the Center for Clinical Epidemiology & Population Health at Marshfield Clinic Research Institute, told members of the State Disaster Medical Advisory Committee’s vaccine distribution group on Tuesday that he supported a narrow group for the next phase.
“I’m in favor of trying to really keep Phase 1B really focused on essential frontline workers and not trying to expand that category very much,” he said.
Belongia added that people in their 60s and 70s with “high-risk conditions” will already be included in the third phase, known as 1C.
“Is it fair? Should we be vaccinating folks whose, you know, personal risk is quite low of having a severe complication before we vaccinate people who have a much higher risk of dying?” he said.
There was also discussion of which age groups — such as people 65 and older, or those ages 50-64 — should be included in the next phase, although vaccine subcommittee members raised concerns that making Phase 1B too broad by trying to vaccinate all Wisconsinites over 50 would hinder distribution efforts rather than helping.
There was also discussion of whether just K-12 teachers should be part of the next phase, or whether it should also include school staff such as custodians, or college and university professors.
Much of the discussion was focused on incarcerated and those living in group housing facilities, and whether they should be included in Wisconsin’s next phase of the rollout.
“There has been quite heavy lobbying and an understanding that for these populations, they are not able to social distance in a proper way, and it may seem more like a long term care facility, but their ages may be lower,” said vaccine subcommittee co-chairwoman Ann Lewandowski, who is also founder of the Wisconsin Immunization Neighborhood.
Daryl Daane, the pharmacy director for the state Department of Corrections, argued it would be wrong to provide COVID-19 vaccine to corrections workers and patients in group housing facilities and not those who are incarcerated.
“These are all very tight confined living spaces. It’s not a large group, we’re talking under 100,000 lives,” he said. “And it seems to me rather unfair if we’re looking at workers but not the incarcerated population. Is that fair or equitable?”
Lewandowski noted that vaccinating longer-term prisoners would be less complicated than those in county jails, saying there is a high turnover in jails that could make it “extremely difficult to do two doses of the vaccine.”
But Mary Muse, chief nursing officer and director of nursing for the state Department of Corrections, said she was “extremely concerned about incarcerated populations” in both prisons and jails.
“When I look at the issue of inequities and disparities, to not do this population — they don’t have a way of getting access to the vaccine, except that we provide it for them,” she said. “And these people are going back to the community. Not everybody stays in for life.”
But Rob Gundermann, president and CEO of the Coalition of Wisconsin Aging and Health Groups, warned there may be pushback if Wisconsin prioritizes people in prisons over other groups.
“We have to be prepared to say why we prioritized them ahead of somebody else. And remember, if somebody goes ahead, that means somebody’s going behind,” Gunderman said. “That’s really the way we have to frame it, because we are then saying that they’re going in front of people 60 to 74 and everybody else with chronic health conditions. And that’s a tough discussion.”
“The rollout has not gone real smoothly, and for as many doses out there, we’re not vaccinating very quickly. And the larger we make any particular group, the much longer it’s going to take. One of the questions is how long do we put off some of those high-risk individuals.”
Jonathan Temte, vaccine committee co-chairman, Associate Dean for Public Health and Community Engagement for UW-Madison School of Medicine and Public Health