In America, eligibility for Covid vaccines is a “crazy quilt” of state rules

In North Carolina, the country’s leading tobacco producer, any adult who has smoked more than 100 cigarettes in their lifetime can now be vaccinated against Covid.

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In Florida, people under the age of 50 with underlying health conditions can only be vaccinated with the written approval of their doctor.

Mississippi had more than 30,000 covid vaccine appointments open on Friday – days after the state became the first in the neighboring United States to make the recordings available to all adults.

In California – along with about 30 other states – people are only eligible if they are 65 years of age or older, have certain health problems, or work in high-risk jobs.

How does it all make sense?

“There is no rationale for the system we have,” said Graham Allison, a professor of government at Harvard University. “We have a crazy quilting system.”

Jody Gan, a professional lecturer in the Department of Health Studies at American University in Washington, DC, said the lack of a national licensing system reflects how each state also has its own public health rules. “This wasn’t a great system for getting the contained virus,” she said.

The federal government bought hundreds of millions of doses of Covid vaccines from Pfizer, Moderna, and Johnson & Johnson – as well as other vaccines that are still being tested – but largely left distribution to the states. In some states, local communities can choose when to move on to major phases of eligibility.

When the first emergency vaccines were released in December, almost all states followed orders from the federal government’s Centers for Disease Control and Prevention, restricting use to frontline health workers, as well as caregivers and residents.

But since then the states have gone their own way. Some states have given priority to people age 75 and older, while others have been listed as senior citizens in specific jobs that were at risk of infection or who had health problems that put them at risk. Even then, the categories of jobs and illnesses across the country have changed.

As the supply of vaccines increased last month, states expanded the approval criteria. President Joe Biden pledged that by May 1, all adults will be eligible for vaccinations, and at least a dozen states say they will be past, or, as in the case of Mississippi and Alaska, will have that date.

But the different rules between the states – and sometimes also the different rules within the states – have led to a mishmash. This has sparked “vaccination jealousy” as people see friends and family members in other states qualify before them, even if they are the same age or have the same job. And it has raised concerns that decisions about who is eligible are made based on policy rather than public health.

The Hodgepodge reflects the overall response of states to the pandemic, including wide variations in mask mandates and restrictions on indoor gatherings.

“It’s created a lot of confusion, and the last thing we want is confusion,” said Harald Schmidt, assistant professor of medical ethics and health policy at the University of Pennsylvania.

As a result, some Americans are desperately looking online for an open vaccine appointment every day while vaccines are lacking in other states.

The various guidelines have also prompted thousands of people to drive across state lines – sometimes across state lines – to an open vaccine appointment. Some states have set residency requirements, although enforcement has been inconsistent and those seeking vaccines are often in the honor system.

Todd Jones, assistant professor of economics at Mississippi State University near Starkville, said the confusion signals a need for a change in the government’s handling of the vaccine. “The Biden administration should definitely think about how they intend to change state allocations based on demand,” Jones said. “If it becomes clear that some states are actually not using many of their cans, then I think it makes sense to take some dates from those states and give them to other states with higher demand.”

Jagdish Khubchandani, professor of public health at New Mexico State University, said no one should be surprised to see 50 different eligibility systems as states opposed a single federal eligibility system.

“A lot of governors don’t want to be seen as someone who goes to the federal government or the CDC for advice,” he said. Florida Republican Ron DeSantis has boasted of ignoring the CDC council when he decided to start questioning people 65 and over from December.

“There is a lot of political stance in the eligibility decision,” said Khubchandani.

Of course, the governors also wanted the flexibility to respond to specific needs in their states, such as: B. the vaccination of farm workers or those in large food processing plants.

Jones said the decision to open vaccines to all adults in the state may sound good, but Mississippi has one of the lowest vaccination rates in the country. Part of this is due to the reluctance of some minorities and conservatives. “It’s good news that anyone can get it, but there doesn’t seem to be much demand for it.”

Jones, 34, got online on Tuesday and was vaccinated Thursday morning in a large church a short drive from his home. “I was very happy,” he said.

KHN (Kaiser Health News) is a national newsroom that produces extensive journalism on health issues. Alongside Policy Analysis and Polling, KHN is one of the three most important operational programs of the KFF (Kaiser Family Foundation). KFF is a foundation that provides health information to the nation.


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