With Covid vaccines expected to remain scarce into early spring, Connecticut has ditched its complicated vaccination prioritization plans for those under 65 with certain chronic conditions and front-line workers. Instead, the state will primarily base eligibility on age.
Governor Ned Lamont pointed to statistics showing that the risk of death and hospitalization from Covid-19 increases significantly with age.
However, the move to an age-based priority system – after offering vaccines to healthcare workers, nursing home patients, and those 65 and over – has frustrated people with health problems like cancer or diabetes who thought it would be their turn next. It could also compound the difficulty of vaccinating people in underserved communities and people in ethnic and racial minorities, health experts said.
While it is reasonable for states to want to vaccinate people in their fifties and sixties before those in their teens and twenties, there are no easy answers to deciding who to vaccinate first. Is a 40-year-old with diabetes at higher risk than a 64-year-old without any serious health problems? How about an older person who works at home or a younger person whose work puts them at higher risk of infection?
Gini Fischer, 57, a portrait artist based in Wilton, Connecticut, has mixed feelings about people their old age standing before those with chronic illness. She also teaches aqua aerobics to seniors in her local YMCA and sees vaccination as a way to protect others. So she plans to make an appointment for the vaccine.
“I think people with chronic diseases are more susceptible than I am,” said Fischer, a breast cancer survivor. But given her teaching responsibilities, “I definitely don’t want to pose a risk to anyone in the class,” she said. “I think the more people are vaccinated, the safer it will be for others who haven’t been vaccinated.”
“There is no such thing as a magic bullet,” said Claire Hannan, executive director of the Association of Immunization Managers, referring to the various priority lists.
Under Connecticut’s new plan, the state will be the first to vaccinate people aged 55 to 64 and over on Monday. Later this spring, the state plans to vaccinate younger adults. The only exception are educators and child carers, who can also be vaccinated from Monday.
Last month, Nebraska Governor Pete Ricketts also said the state would pass a plan to stop vaccinating people with chronic diseases as a priority. But on Friday, he said Nebraska would issue plans in March to give priority to certain people, such as dialysis patients and those with compromised immune systems, once the state finishes vaccinating those over 65.
Rhode Island has also put in place an age-based plan, and the state estimates that vaccination of people under 65 by age group will begin from mid-March. Between vaccinating residents aged 60 to 64 and those aged 50 to 59, Rhode Island will also offer vaccinations for people with certain chronic diseases. The state expects vaccination of people aged 16 to 39 to begin in June.
In addition, Indiana has established a largely age-based vaccine priority system for adults between the ages of 60 and 64. It is planned to continue vaccination according to age, but also to include people with chronic diseases.
Cathy Wilcox, 59, of Stamford, Connecticut, has made an appointment for Monday when the new eligibility kicks in. “I’m really glad I can get it,” she said.
Wilcox, who wears a KN95 mask when working at the reception of a tennis hall, expects it won’t be eligible until April or later but is upset because she’s worried about her risk of getting Covid-19 . “What worries me about Covid is that you can’t have symptoms, but you are carriers and are fine or can die or anything in between,” she said.
More than 40 states have passed plans to give priority to adults with certain chronic conditions. This strategy generally uses the “honor system”, according to the KFF, to confirm that people have conditions ranging from a history of smoking to asthma. (KHN is an editorially independent program of the KFF.)
“There is no obvious right or wrong way to do this,” said Dr. Amesh Adalja, an infectious disease expert at the Johns Hopkins Center for Health Security in Baltimore. He said the goal of the vaccination program – at least initially – is to protect the most vulnerable so they don’t overwhelm hospital capacity. However, it is difficult to determine who is most at risk.
A simpler age-based system could speed up vaccination efforts, which some say have been complicated in states with covid priority phases with numerous tiers based on job and health status, Adalja said. “There is a clear argument for making it as simple and seamless as possible,” he added.
The big benefit of dispensing vaccines by age is that people may stop playing in the system (or lying that they have a health condition) because vaccines can easily verify a person’s age identification, said Dr. Richard Zimmerman, Professor at the University of Pittsburgh, works with his Center for Vaccine Research.
“It can prevent some people from skipping the line,” he said.
States and the District of Columbia are defending their systems of early access for people with chronic disease, saying they are following the recommendations of the CDC.
Upon completion of seniors vaccination, Maryland will include all adults between the ages of 16 and 64 who work on the front lines, as well as adults with certain health issues. A spokesman for the Maryland Health Department said vaccines should be large enough in a few months that they don’t require age prioritization.
Washington, DC is pursuing a similar strategy. “Age is not a good measure of disease severity or disease progression,” the city health department said in a statement when asked why it plans to give people ages 18 to 64 equal access Grant vaccine.
Age doesn’t necessarily reflect overall risk either, said Dr. Ana Núñez, Internist and Vice Dean for Diversity, Justice, and Inclusion, University of Minnesota School of Medicine. Housing, employment, and other social determinants can all increase a healthy person’s chance of contracting the virus.
In fact, experts said these factors explain why people with Black, Hispanic, and Native American backgrounds die disproportionately often.
The age distribution, without targeting the most severely affected population groups, also favors white residents, as in many states they are more than racial and ethnic minorities.
“If only you get older,” said Núñez, “who do you prefer to immunize?”
Michelle Cantu, who oversees infectious disease and vaccination programs for the National Association of County and City Health Officials, said it was important that jurisdictions use data to determine who and how they immunize.
She contacted several large minority sites last month to learn that an age-based system wasn’t working for them, she said. “I think there are many critical considerations for states and local health departments to consider,” she said.
Identifying the order with the best priority for vaccines will be important in the short term as the number of vaccine doses is expected to increase exponentially by the end of April. But the question of vaccine hesitation could then become more of a challenge, said. Dr. Sonja Rasmussen, Professor in the Departments of Pediatrics and Epidemiology at the University of Florida.
“I have concerns that we will soon reach a point where we have more vaccines than people who want to get it.”
Correction: This story was updated on March 1 at 11 a.m. ET to report that Indiana also has a vaccination schedule that is largely based on age eligibility. However, the state plan also states that people with chronic illnesses may be included.
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