Who will get the vaccine in California next?
The state will soon decide over who to include in the next round of COVID-19 inoculations
California is poised to make a hard and controversial choice amid limited supplies of the coronavirus vaccine: whether to prioritize essential workers for vaccination over the elderly.
Such a step, to be debated by a state advisory committee on Wednesday, would help return schools and many businesses to some semblance of normalcy.
But it would delay protection for those at greatest risk of dying.
The deliberation comes as the
state must decide how to divvy up the second round of vaccines, following the current campaign to protect 2.4 million health care workers as the first priority.
These next groups are much larger, which makes the prioritization much more difficult.
Only 2 million new vaccine doses are slated to arrive in January, although supplies will climb with each passing month.
California is home to 11.9 million essential workers, of which 5.9 million are considered highest priority, not including health care workers. About 6 million people are over the age of 65.
“These are tough decisions. And the best hope is that this phase of scarcity is as short as possible,” said Anthony Wright, executive director of Oaklandbased consumer advocacy organization Health Access and a member of the state’s Community Vaccine Advisory Committee, a group of 60 communitybased organizations that are helping guide the state’s policies.
As currently drafted, California’s guidelines say that the vaccine should go to workers in three groups: education and childcare workers (1.4 million), emergency services personnel
(1.1 million), and people who work in high-priority essential businesses (3.4 million), ranging from agriculture and grocery services to plant nurseries and sawmills.
Other criteria — such as age and underlying medical conditions — are “subpriorities” of these three main groups.
This differs from the U.S. Centers for Disease Control and Prevention’s recommendation on Sunday asserting that adults 75 and older, as well as frontline essential workers, both belong in the next vaccination group.
On Wednesday, the state will discuss whether to adjust its criteria to include elders too, reflecting the new CDC recommendation. Wright expects California to align itself with the CDC guidelines. Gov. Gavin Newsom’s administration will make the final call.
So far, a state work group has focused on essential workers, said Dr. Robert Schechter, chief of the Immunizations Branch of the California Department of Public Health and co- chair of the group. But over the next days and weeks, the committee will consider those with medical conditions, including advanced age, that put them at higher risk, he added.
If not included in this second stage, elders and people with high-risk medical conditions, as well as additional essential workers, will almost certainly be included in the third phase of vaccination.
The risk for severe illness with COVID-19 increases with age, with older adults at highest risk. Eight out of 10 COVID-19 deaths are reported in those over the age of 65. Older people also have more underlying medical conditions, which elevate their risk. But many elders are retired, so they can stay sheltered at home, some experts note.
Across the nation, there is near-universal consensus on who belonged in the first round, called “1a”: front-line health care workers and residents of nursing facilities. Only Florida included adults over age 65
in its first wave of vaccinations.
But states are divided over who belongs in this next phase, officially called “1b.”
A labama , Delawa re, Florida, Maryland, North Carolina and Tennessee each prioritize elders and those with high-risk medical conditions over nonhealth essential workers. North Carolina and Tennessee prioritize those with high-risk medical conditions over those ages 65 and older, according to an analysis by the Kaiser Family Foundation.
The trade- off depends on what a state is trying to achieve, according to Dr. Scott Gottlieb, the former Food and Drug Administration commissioner. To reduce deaths, he said, you’d prioritize the elderly. To reduce the rate of infection and bolster the economy, you’d prioritize essential workers.
In California, parents and educators celebrated the addition of teachers to the proposed “1b” list.
“It is necessary to move forward with school reopening plans,” said Santa Cruz teacher Stacy Newsom Kerr. “In my district, something like 97% of teachers feel returning to classrooms right now is unsafe.”
Members of the justice system also applauded their inclusion.
“It’s been treacherous. The whole time, we’ve never stopped going into court,” said Santa Clara County Public Defender Molly O’Neal. “The hallways were really crowded, with members of the public coming in, and nobody is doing any kind of mask enforcement.”
But others, including companies, unions and industry trade associations, were frustrated that they must wait.
“We’re everywhere. We come in contact with a tremendous number of people,” said David Chandler of the California Association of Licensed Security Agencies, Guards & Associates, which represents 600,000 security guards. “We’re
in every kind of business, whether it be a retail establishment, hospital, distribution centers, transportation centers or financial institutions.”
Amazon already has an agreement in place with a licensed health care provider to administer COVID-19 vaccines to its employees on-site at its facilities. It just needs clearance to get the vaccine.
Among those not on the list: the Space X scientists who care for the four astronauts currently on the space station; Lyft and Uber drivers; the people who collect and process municipal solid waste; longshoremen and other Pacific maritime workers and employees of the California Independent System Operator, responsible for maintaining the reliability of one of the largest and most modern power grids in the world.
And while public transit workers are on the CDC’s list, they’re not on the proposed state list. “Our frontline workers sit alongside other essential workers: grocery clerks, health care workers, caregivers and emergency services personnel and therefore deserve equal prioritization in receiving the COVID-19 vaccine,” argues Robert Lyles of AC Transit.
Wright argues this is a moment to think of the common good. Even if others are vaccinated before us, we all benefit, he said.
“It is my interest to have my kids educated. It is in my interest to have access to an ICU bed. It’s in my interest to have groceries delivered and to have emergency services,” he said.
“This should be a moment of social solidarity.”