SOME STATES SHELVE VACCINE GUIDANCE
Elderly prioritized over others in bid to ease hospital crush
Some of the most populous states are shelving federal recommendations and making coronavirus vaccines available to the elderly before providing access to grocery store employees, transit staffers and other front-line workers.
Officials are pursuing such strategies in Florida and Texas, where a combined 50 million people live. The divergence ref lects differing needs in a highly diverse country where the coronavirus has killed unevenly, but it also highlights an emerging patchwork that could pose obstacles for the nationwide immunization campaign to corral the pandemic.
The differences also carry political undertones that recall varying approaches to mask mandates and stay-athome orders. Republicancontrolled states are breaking most openly with the expert recommendations at a time when advisers to President-elect Joe Biden are calling for greater federal coordination.
“We are not going to put
young, healthy workers ahead of our elderly, vulnerable population,” Florida Gov. Ron DeSantis, a Republican, vowed last week in an address at The Villages, the nation’s largest retirement community. A top infectiousdiseases official in Texas, Imelda Garcia, said focusing on adults 65 and older and people with chronic conditions “will protect the most vulnerable populations.” In
Ohio, Republican Gov. Mike DeWine is adopting a similar approach but also including school staffers in the early phase, emphasizing the need to return to in-person learning.
Medical workers and residents and staffers at longterm care facilities constitute the first tier in virtually every instance, in line with guidance released in early December by the panel advising
the Centers for Disease Control and Prevention. The question now confronting state leaders: Who comes next?
The expert panel of federal advisers met again before Christmas, seeking to balance protecting workers whose jobs put them in harm’s way with shielding those most likely to suffer complications from the virus or die of COVID-19. The panel recommended putting people 75 and older and essential front-line workers in the next priority group.
Among those workers — who the Advisory Committee on Immunization Practices said were most critical to the functioning of society — are emergency workers, educators, manufacturing workers, corrections officers and transit staffers. Many could get access to the vaccine early in the new year, though timelines may differ considerably by state.
“It’s not ideal to have differences across the states, but in terms of getting the vaccine out and into arms as quickly as possible, it may not be such a bad thing,” said Claire Hannan, executive director of the Association of Immunization Managers. As long as states are putting vaccine doses into arms, they are on their way to meeting the ultimate goal, she said.
At the same time, the divergent approaches reflect the difficulty of policing access to the shots once immunization moves from health care systems and nursing homes into the wider community. States and local jurisdictions will decide what sort of screening process to use, Hannan said, as vaccinators verify people’s ages, employment or health histories.
There are costs to adhering to the priority groups too strictly, she warned. “Everybody’s going to get it at some point, so turning people away is not where we want to be,” she said. Doing so, she said, may discourage people from returning at a later date.
Trump administration officials stress that governors are in charge of setting priorities for their states, consistent with the administration’s decentralized approach to managing other phases of the pandemic. Vice President Mike Pence, in a November phone call with governors anticipating federal clearance of the first two vaccines, told state officials they would be the “ultimate arbiters” of how the shots were rolled out, according to a call summary released by the office of Washington Gov. Jay Inslee, a Democrat.
Members of Biden’s coronavirus advisory board have suggested the federal government should play a more active role in aspects of the immunization campaign, the most ambitious in the nation’s history. Marcella Nunez-Smith, a co-chair of Biden’s advisory board and an associate professor at the Yale School of Medicine, said in an interview this month that more-detailed guidance about reaching particular populations within priority groups would help bring clarity to the allocation of finite resources while respecting the “wisdom and realities that will vary locally.”
In Florida, DeSantis made a point of setting his state on a different path. He traveled last week to The Villages, in Central Florida, to mark the state’s first two vaccinations of community members, as immunization quickly broadened beyond medical workers and nursing home residents.
“As we get into the general community, the vaccines are going to be targeted where the risk is the greatest, and that is in our elderly population,” DeSantis said.
Nationally, 80.7 percent of deaths have been among people 65 and older, according to the CDC, while people in front-line jobs who cannot work from home or keep a safe distance from others are at highest risk of work-related exposure. People of color, who have been disproportionately affected by the virus, are overrepresented in such jobs.
Jared Moskowitz, director of the Florida Division of Emergency Management, said people older than 65 with chronic conditions are among the state’s most vulnerable residents, along with medical and emergency workers and residents of long-term care facilities. Vaccinating those most likely to wind up in the hospital alleviates burdens on the state’s health care system, said Moskowitz, a Democrat.
While Florida and Texas have diverged perhaps most starkly from the recommendations of the CDC advisory group, draft plans in other states, which are still being revised in response to the latest federal guidance, exhibit differences, too.
Arizona’s plan puts all essential workers — not just those in front-line industries identified by the expert panel — in the second phase. Colorado’s strategy keeps frontline workers in the next priority group, unlike plans in Florida and Texas, but also widens the group of older residents who are prioritized to people 65 and older. Some members of the CDC advisory panel had favored that approach, foreshadowing the differences now appearing in some states.