By Rachel Bluth, Kaiser Health News and Phil Galewitz, Kaiser Health News
Given that frontline health workers, as well as residents and nursing home workers, are about to receive their first doses of COVID vaccines, the tougher question is who’s next.
The answer likely depends on where you live.
While an influential federal advisory board is expected to make its recommendations later this month, state health departments and governors will be calling out who will get access to a limited number of vaccines this winter.
As a result, it’s been a jack-of-all-trades in recent weeks as manufacturers, grocers, bankers, dentists, and drive-shares scramble to get a spot near the front.
The Centers for Disease Control and Prevention (ACIP) Advisory Committee on Immunization Practices (ACIP) this month voted 13-1 this month for healthcare workers and residents of long-term care facilities to be given the first vaccination priority once the Food and Drug Administration picks up or down has approved several COVID-. 19 vaccines for emergencies. The Advisory Committee is expected to provide further details on its list of prioritized recipients before the end of the year.
The next recommendations will likely focus on prioritizing people who keep society going, such as workers in food and agriculture, public safety, and education. The elderly and people with chronic diseases are also high on the list.
However, with early vaccine supplies limited, difficult decisions lie ahead: is it more important to prioritize teachers who come in daily contact with large numbers of people or farm workers who cannot work remotely and provide the country’s food?
“We need to be aware of equity, comorbidities and the likelihood of death versus survival, even within this essential workforce,” said Mitch Steiger, a legislative attorney for the California Labor Federation. There will be “a lot of really tough talk and a lot of different competing principles”.
Initially, states will not receive enough vaccine doses to cover even their high-level groups.
In California, a state of 40 million people, the first shipments of around 1 million cans won’t cover nearly all at the top of the line. More than 2 million people fall into the phase 1a vaccine distribution category, which only covers those at risk of getting sick in healthcare or long-term care.
Even within this category of health workers, there are jockeys to get to the top, with pharmacists and dentists vying for priority.
Dr. Laurie Forlano, assistant commissioner for public health for the Virginia Department of Health, said the state had heard through letters, phone calls, and virtual meetings from numerous parties to decide which “critical workers” will follow the first pile in vaccination. “It’s complex “she said about the company. “But it is not new to public health to make these decisions.”
States have already signaled different priorities.
Florida Governor Ron DeSantis said that after vaccinating nursing home residents and health workers on the front lines, the state will seek to vaccinate people 65 and older and residents with serious illnesses.
Kentucky governor Andy Beshear said elementary school teachers should come in turn after health workers and nursing home residents, as well as first responders and adults with serious illnesses.
State Health Department spokeswoman Rachel Kostelac said “critical workers” and people at risk will be high on the list of priorities in Pennsylvania, as will health workers, nursing home residents and employees, and first responders.
At the national level, disease advocacy groups are advising that people with pre-existing medical conditions are at higher risk of death if they contract the coronavirus. The American Diabetes Association released a statement advocating for their patients. The National Renal Administrators Association wrote to federal regulators that renal patients should be given priority.
Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, said he expected states to largely follow the committee’s list of priorities. However, it is unclear how many details the CDC committee will provide in its next round of recommendations – for example, which “people at high risk” and which critical employees should be included.
It is good to leave flexibility to states, said Plescia, as they could differ from people in terms of ways to vaccinate efficiently. For example, some states have large factories where people are at higher risk and could be vaccinated locally.
This is where lobbying comes into play.
“Priority 1a for us is to put our employees in this priority 1b group,” said Bryan Zumwalt, executive vice president of public affairs for the Consumer Brands Association, which represents companies that make thousands of household products, from toilet paper to Soda Of the membership’s 2.3 million employees, 1.7 million are considered material, he said.
“Our company’s employees make life-support products,” said Zumwalt. The association reaches out to state health departments with letters, but Zumwalt said the process would be easier if instead there was a unified national order of priority for the vaccine giving states the final say.
These companies are struggling with absenteeism averaging 10%, which could lead to delays in the production of food and other key products.
“If one worker tests positive, another five to ten workers must be taken off the line,” he said.
In Idaho, a COVID-19 advisory board ruled this month that first responders such as police and fire departments, as well as elementary school teachers and staff after health workers and residents of nursing homes, and elementary school teachers and staff should receive the shots, followed by prison staff and then food processing workers , Food workers and the Idaho National Guard.
Dr. Elizabeth Wakeman, associate professor of philosophy at the College of Idaho and a board member, had told colleagues that vaccinating to slow the transmission of viruses was more beneficial than classifying groups according to their value to society.
That would put the food processing workers in front of the grocery store clerks because there is more space in a grocery store for clearance and better ventilation, Wakeman said.
There is also pressure to quickly protect the food service and farm workers. Diana Tellefson Torres, executive director of the United Farm Workers Foundation, said farm workers are both important and at great risk. They can work outdoors where the risk of transmission is lower, but they often live and drive to work with many people outside of their immediate families, she said.
Most farm workers are undocumented immigrants with no health insurance and “may not even know they have health conditions,” said Tellefson Torres, who sits on California’s Community Vaccine Advisory Committee. “There are a lot of weak points.”
It is almost time for the winter citrus fruits to be harvested in California and for the lettuce to be picked in Arizona.
“It is important to ensure that the community of people providing food for this country, the food at each of our tables, is also a top priority,” said Tellefson Torres.
In the opening week of the California legislature, one of the first laws passed argued that the food workforce should be the first for vaccines and rapid testing.
The International Association of Fire Fighters, a union that represents 322,000 firefighters and rescue workers, urges its members to be among the first to gain access to the vaccine, arguing that firefighters provide emergency services that take them to people’s homes and homes other closed people bring rooms.
Airline employees also want to be vaccinated quickly.
Pharmacists have also advocated this. While ACIP included pharmacists in its Phase 1a health worker category, each state interpreted the recommendations differently based on its vaccine supply, noted Mitchel Rothholz, head of government and state affiliates of the American Pharmacists Association, which urges states to keep their members informed keep the list. “It’s a race to see who gets the vaccine first,” he said. “Everyone wishes there was enough care for everyone, but that’s not the situation.”
This story was produced by KHN publishing the California Healthline, an editorially independent service of the California Health Care Foundation.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.