Why some states have opened vaccine eligibility faster than others

WASHINGTON – When Alaska When the nation offered COVID-19 vaccinations to all adults earlier this month, officials were able to point out the state’s vaccination pace – the best in the country.

But when increasing number States have canceled the approval requirements for vaccination. It has become less clear why some states act faster than others.

Mississippi, which removed the requirements in mid-March, ranks low in the proportion of vaccinated adult residents.

In fact, of the 28 states that are either open to all or will open in the next two weeks, seventeen have below-average adult vaccination rates, according to figures released on Sunday of the Centers for Disease Control and Prevention. Eleven are behind other states when it comes to fully vaccinating those over 65, one of the risk groups.

Governors have often cited increases in vaccine supplies as the driver behind the decision to lift licensing restrictions. As the number of doses available across the country grows, there is still wide variation in who can get a vaccine, even in most states are expected to meet President Joe Biden’s goal to question every adult by May 1.

“Where you stand in line depends on where you live,” said Jennifer Tolbert, director of government health reform at the Kaiser Family Foundation. “There doesn’t seem to be a uniform justification.”

Various explanations for pace, suitability for vaccines

Experts say the reasons for the differences are how confident governors are about the increased dose projections, demographic differences between states, and whether states have struggled to staff time slots for vaccination appointments. The latter could be a reflection of how easy states have made it to get vaccinated. It could also mean that residents were less interested in taking pictures.

“Some states may be reluctant to vaccinate earlier than other states,” said James Blumenstock, senior vice president of pandemic response and recovery for the Association of State and Territorial Health Officials. “And that means they have to open the gate to allow other categories so that precious time is not lost.”

Officials are particularly concerned about avoiding unclaimed appointments as more contagious COVID-19 variants spread.

“We really want to achieve the goal of getting as many people as possible vaccinated, especially with variants, as soon as possible,” said Hemi Tewarson, an expert at the Duke Margolis Center for Health Policy who has been following the states closely. Efforts.

Concerned about a “possible trend” of increasing infection and hospitalization rates, Illinois Governor JB Pritzker on Friday gave local health officials permission to make the vaccine available to anyone who wants it if demand in an area subsides .

“Every county is different and local health authorities know better how to vaccinate people in their communities as quickly and fairly as possible,” said Dr. Ngozi Ezike, director of the Illinois Department of Public Health, in one Explanation.

Some states have continued to focus on systematically going through the CDC recommended vaccination priority levels.

“With respect to other states, we are taking the approach we are taking,” said Phil Murphy, governor of New Jersey said last week. Garden State residents under 65 are still not eligible unless they have certain high-risk medical conditions or hold certain jobs. “We try to get to a good place as methodically and persistently as possible.”

Trish Riley, executive director of the National Academy of Public Health Policy, said some states have been focusing more on ensuring vaccines go to those who are most urgent and at risk.

“And other states think that you, you know, open the doors and bring everyone in and get as many shots as you can,” Riley said. “They’re just different approaches to the same problem.”

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Patricia Warnock, 76, of San Rafael, Calif., Receives a COVID vaccine from Moderna at a mass vaccination site in City College in San Francisco on Friday, January 22, 2021.

Justice should not lag behind

But Riley and other experts say there is concern that fast-moving states are not giving up on ensuring that the most vulnerable people are vaccinated.

“The story of justice is not over with vaccines for everyone,” said bioethicist Harald Schmidt of the University of Pennsylvania. “By just saying, ‘Oh, you know, we’re open to everyone and now come and get it,’ that can’t be good enough for either justice or public health.”

Different approaches were a hallmark of the vaccination rollout that began under the Trump administration and left many decisions to the states.

The CDC guidelines on population prioritization are helpful, Riley said, but still pose challenging questions for states, such as how to define an essential worker. Should clerks be given the same priority as nurses and doctors in the hospital? Is a waiter less important than a hotel employee?

Some decided that it would be easier to vaccinate strictly by age after vaccinating health workers and nursing home residents.

That includes Connecticut, which switched to an age-based approach in March and plans to open vaccinations to all adults by April 5.

When Alaska made vaccines available to everyone ages 16 and older, they knew they didn’t have enough vaccines for everyone, Tewarson said. However, the simplification of the authorization made the transmission and distribution of messages easier.

“It took some of the process and effort they put into classifying and prioritizing the different populations,” Tewarson said.

Almost three in ten adult Alaskans were fully vaccinated, one of the highest rates in the nation. About six in ten Alaskans age 65 and over are vaccinated, which is also one of the best rates for this high-priority group.

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Medical assistant Keona Shepard prepares a dose of Johnson & Johnson's COVID-19 vaccine at a mass vaccination clinic in the Ernest N. Morial Convention Center in New Orleans Thursday.

No final rules

The federal guidelines do not specify what proportion of a priority level should be vaccinated before moving on to the next level. Suggested factors to consider include when appointments are less than 80% busy for several days, when vaccine doses increase significantly, when a state’s target vaccination rate has been reached for a group, and when there is a risk of doses cannot be used in certain areas.

The measure of priority progression that is easiest to compare using public data is vaccination rates for seniors. Seniors are responsible for 80% of COVID-19 deaths.

If states are already vaccinating this group at a lower rate, it suggests that there may be barriers – like ease of scheduling and reaching vaccination appointments – that should be addressed first, Tolbert said. These barriers can also exist for other high-risk or hard-to-reach populations, including the poor, minorities and people in rural areas.

“We could see some of these justice problems worsen if a concerted effort is not made to continue to ensure that as states begin to vaccinate more and more people, they also focus on outreach and other efforts to ensure that there is more equitable administration of the vaccine, ”she said.

Missouri, which has one of the lowest vaccination rates for both seniors and all adults, has lagged over cities both because of poor public health infrastructure and the disproportionate allocation of vaccines to rural areas, said Dr. Sarah George, an infectious disease specialist at Saint Louis University.

With infections ascendingGeorge wants everyone to be vaccinated as soon as possible. However, she hopes the state’s decision to question all adults on April 9 will not result in high priority groups rescheduling vaccination.

“I want us to do both,” she said.

When asked if it is a mistake for states lagging behind in vaccinating seniors to extend eligibility to all adults, Jeff Zients, the White House’s coronavirus task force coordinator, reiterated Biden’s goal of keeping the vaccinations up Open to the general public at the end of April.

“But we must continue to prioritize the most vulnerable populations,” he said. “And if there are states that are lagging behind, we work with those states.”

Featuring: Scott Fallon of The Record in Bergen County, New Jersey.

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