States are choosing who gets the COVID-19 vaccine and in what order, sparking a behind-the-scenes battle among interest groups hoping to slide into line ahead of others.
Advocates for older adults, teachers, restaurant workers, agricultural workers and others are pleading their cases to governors and state health advisers. Some groups already have notched successes, particularly interest groups representing Americans over 65.
The federal Centers for Disease Control and Prevention initially issued broad vaccine recommendations that had people over 65 going after frontline health care workers, nursing home residents and staff, and people over 75.
But this week, in response to the slow vaccine rollout, Secretary of Health and Human Services Alex Azar said states should immediately start giving the shot to everyone over 65. States are not bound to follow the federal recommendations.
Even before this week’s shift, AARP and other advocates for older people had succeeded in getting states, including Alaska, Florida and Texas, to move all residents over 65 to the “Phase 1B” slot, just behind health care workers and congregate care residents and staff. In some places, that led to long lines and chaos.
The lobbying to be in the 1B category has been intense in many states.
California, for example, heard from 131 groups, the Associated Press reported. The petitioners included the state’s chief justice seeking protections for court workers, public defenders wanting vaccines for themselves and their jailed clients, multiple groups representing older adults, cemetery workers, public transit workers, nonemergency health care workers such as dentists and podiatrists, NASA employees, dock workers, Amazon employees, solid waste workers, cleaning services, retailers, pharmacists and power grid workers. Officials also were lobbied by ride-hailing drivers and news reporters.
The United Farm Workers helped convince California, home to about half a million agricultural workers, to put them near the front of the line in group 1B.
The state also prioritized education and child care providers, emergency service providers and food workers, including servers at restaurants.
Washington state took a different tack, announcing last week that in phase 1B, in addition to those over 70, it will prioritize people 50 and older who live in multigenerational households. The multigenerational household residents were placed ahead of workers 50 years or older in congregate settings, including teachers and food processors, who are in the next tier.
That news upset the United Farm Workers, as well as organizations representing other industries.
“Not placing farm workers at the top of the list is unacceptable and incredibly irresponsible,” Diana Tellefson Torres, executive director of the UFW Foundation, wrote in an email to Stateline. “States must act to protect the men and women feeding us all by making the vaccines available in their communities under Phase 1B.”
Florida prioritized all people over 65 even before the HHS’s new guidance. Speaking last month at a news conference in The Villages Retirement Community in Tallahassee, Republican Gov. Ron DeSantis said, “We are not going to put young, healthy workers ahead of our elderly, vulnerable populations.” That prompted many Florida seniors to line up for the vaccine, sometimes sitting in cars or lawn chairs overnight.
Dave Bruns, a communications manager for AARP in Florida, which advocates for older adults, said his organization had been pushing DeSantis, his aides and state regulators to inoculate older adults first. Florida is home to nearly 5 million people over 65.
“I don’t think there’s any question that elected leaders in Florida understand that the brunt of the pandemic has fallen most heavily on older people. Thirty-eight percent of the deaths in Florida are among the elderly,” Bruns said in a phone interview.
The CDC reported that older Americans are disproportionately dying from COVID-19, with about 79% of recorded deaths in people 65 and older and about a third of the deaths among those over 85.
Asked if it was fair for older adults to jump ahead of workers such as grocery store personnel, who interact with hundreds of people a day, Bruns said he thought the state should “walk and chew gum at the same time. Advocating for our group means we also have to advocate for the frontline workers, especially in long-term elder care facilities.”
After the HHS secretary’s latest announcement, AARP called on the federal government to streamline the availability of the vaccine for older people, publish statistics detailing how many have been vaccinated and set up websites for them to sign up.
Indiana also opted to prioritize older adults before the new HHS guidance. Republican Gov. Eric Holcomb announced Jan. 6 that his state would distribute the vaccine by age groups—over 80 first, followed by over 70s, then over 60s—immediately after paramedics and medical workers.
Indiana Health Commissioner Kristina Box said the state decided to modify the vaccine priorities because of the number of older Indianans dying from COVID-19. "Distributing vaccine is not a one-size-fits-all process," she told the Indianapolis Star.
Texas also opted to prioritize those over 65 ahead of people in public-facing occupations.
“Our goal is to get people in our priority populations vaccinated quickly and reduce the number of hospitalizations and deaths from COVID-19,” said Lara Anton, press officer for the Texas Department of State Health Services, in an email. “Phase 1B includes both people over 65 and people with medical conditions that put them at higher risk of severe disease or death regardless of their occupation.”
Maryland Gov. Larry Hogan, a Republican, announced the state is moving up eligibility for adults in special needs group homes, putting them in the same group as people over 75, teachers and child care workers. The Jewish Foundation for Group Homes, a nonprofit supportive of individuals with disabilities in the Washington, D.C., metro area, was exultant. The group had been lobbying for the inclusion of special needs group home residents in a high tier of the distribution plan.
“Many of you have taken the time to write letters and e-mails and make phone calls to Governor Hogan and members of his administration,” David Ervin, the group’s CEO, wrote in an online statement. “For that effort and for its outcome, thank you so very much! Grassroots advocacy works … .”
After the HHS announcement, Hogan said he was considering following the new recommendations but was reluctant to upset the ongoing rollout.
The amount of pressure state health leaders and governors face is evidenced by the fight in Maine, where vaccines currently are being given only to the highest priority recipients—medical workers and convalescent care residences. The state still hasn’t decided who will be next.
“We are receiving input from different groups to help us answer the question of when, how and where they should be vaccinated,” Dr. Nirav Shah, director of the Maine CDC said in a remote video news conference with reporters. “Though this process will take time, we pledge to make sure vaccine is available. We ask you to bear with us.”
Robert Long, a spokesperson for the Maine CDC, said that Shah and the agency have heard from “many advocacy groups and constituents who wish to share input,” including real estate agents, grocery story workers, truck drivers, restaurant and hotel workers.
Maine Gov. Janet Mills, a Democrat, will make the final decision on the order of vaccines. Following the HHS advisory statement, Mills said she will take the advice into account, but noted that the state is getting a limited and “inconsistent” amount of vaccine. Even before this week’s HHS announcement, some states were adjusting their rules on the fly.
In New York, Democratic Gov. Andrew Cuomo twice altered the rules in two days. On Jan. 8, Cuomo said teachers and a large group of other “essential” workers would get the vaccine beginning this week, including licensed practical nurses, pharmacists, dentists and podiatrists. On Jan. 11, the state said it would allow medical providers to administer any leftover vaccines to pharmacy store clerks or other store employees who interact with the public.