Several red states are eschewing federal recommendations for vaccine distribution and prioritizing the elderly and vulnerable over essential workers, in the hopes of saving more lives.
Texas, Florida, South Dakota, and Tennessee have decided to focus on groups that are the most at risk of death, including those with chronic conditions and elderly people who are 65 and up. That is a different distribution plan than the one recommended in mid-December by the federal Advisory Committee on Immunization Practices, which said that certain essential workers and those age 75 and older be the next in line for coronavirus vaccinations after healthcare workers and long-term care facility residents.
The ACIP is the committee under the Centers for Disease Control and Prevention charged with recommending how vaccines should be used. While the ACIP’s suggestions do not have the force of law, they have long influenced which vaccines private insurers and the federal government will pay for.
Most states are following its direction. Nevada, for instance, changed its vaccine distribution plan to match the committee’s recommendations.
But Texas has decided to break with the ACIP, instead prioritizing those age 65 and older and people age 16 and older who have chronic conditions that put them at increased risk for severe illness from COVID-19.
“The focus on people who are age 65 and older or who have comorbidities will protect the most vulnerable populations,” Imelda Garcia, chairwoman of Texas’s Vaccine Advisory Panel, said in a statement. “This approach ensures that Texans at the most severe risk from COVID-19 can be protected across races and ethnicities and regardless of where they work.”
On Wednesday, Florida Gov. Ron DeSantis signed an executive order that gave priority for vaccination to healthcare workers, residents and staff of long-term care facilities, and those age 65 and older. Essential workers were not mentioned.
“There were discussions among the CDC that actually had a proposal to place ‘younger essential workers’ ahead of elderly individuals. Now, that was met with, deservedly, a lot of backlash,” DeSantis said at the time. “If you’re 22 years old and working at a grocery store, you take preference over a 74-year-old grandma? I don’t think that’s the direction we want to go in Florida. We’ve got to put our grandparents first.”
The ACIP had initially proposed that only essential workers be prioritized after healthcare workers and long-term care residents and staff. It based that proposal on the fact that significantly more essential workers are racial and ethnic minorities. The ACIP argued that vaccinating them first would help address “health inequity.” The proposal received considerable backlash, especially from critics who alleged that it put lives at risk out of racial considerations.
“I’d rather save lives than satisfy racial criteria,” said Linda Gorman, director of the Health Care Policy Center at the conservative Independence Institute. “I’m glad there are some states that have decided to save lives.”
Ultimately, the ACIP decided to prioritize those age 75 and older and a subset of essential workers, including firefighters, police officers, corrections officers, food and agricultural workers, Postal Service workers, manufacturing workers, grocery store workers, public transit workers, and teachers.
“It’s a difficult question who to prioritize since essential workers are younger and at a lower risk of dying if they develop COVID,” said Dr. Monaj Jain, an infectious disease physician at the Rollins School of Public Health. “However, they are at a higher risk of contracting the disease. But in my opinion, the risks and benefits of vaccinating essential workers versus the elderly balance out.”
About 80% of the deaths from COVID-19 occurred among those age 65 and up. According to a CDC report, the rate of death is 12 times higher for patients with chronic illnesses who become infected.
“If your goal is to save lives, then you vaccinate those most likely to die,” said Gorman. “And those most likely to die are those with chronic conditions and the elderly.”
South Dakota will be prioritizing some essential workers, such as law enforcement and correctional officers, before those with chronic conditions and the elderly. But those latter two groups will take priority over other essential workers such as manufacturing, food service, and transportation workers.
“Since the start of the pandemic, Governor Kristi Noem and her administration have focused on caring for the vulnerable population,” said Ian Fury, Noem’s communications director.
Tennessee will prioritize those with high-risk chronic conditions after all healthcare workers are vaccinated. Those age 65 and over will be vaccinated in the next phase, along with workers involved on critical infrastructure and teachers.
“Tennessee’s plan for allocation of COVID-19 vaccines has been thoughtfully developed with a focus on how best to serve our diverse populations and communities,” said a spokesperson for the Tennessee Department of Health.
