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COVID vaccine eligibility for “crazy quilt” by state regulations

COVID vaccine eligibility for “crazy quilt” by state regulations

By Phil Galewitz, Kaiser Health News

Monday, March 22, 2021 (Kaiser News) – In North Carolina, the nation’s leading tobacco producer, any adult who smokes more than 100 cigarettes in their lifetime can now be vaccinated against cobalt.

In Florida, people under the age of 50 with underlying health conditions can only be vaccinated if they have written permission from a doctor.

In Mississippi, more than 30,000 secret vaccination appointments were opened on Friday – the state became the first in the neighboring United States to make the shots available to all adults.

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

How does that make sense?

“There’s no logical reason we have a system,” said Graham Allison, a government professor at Harvard University. “We have a crazy quilt system.”

Jody Gan, a professional professor in the health studies department at the University of Washington, DC, said the lack of a national eligibility system also reflects how each state makes its own public health rules. “This hasn’t been a great system, you know to have the virus,” he said.


The federal government bought hundreds of millions of hidden doses of vaccines from Pfizer, Moderna and Johnson & Johnson, as well as other vaccines being tested, but largely left the distribution to the states. Some states decide when to go to broader eligibility stages for local communities.

When the first emergency vaccinations were cleared in December, nearly all states followed the guidelines of the federal government Centers for Disease Control and Prevention and restricted their use to primary border health care workers and nursing home workers and residents.

But since then the states have made their way. Some states have given priority to people over the age of 75, while others have allowed people who meet certain jobs that are at risk of being infected or endangered by health conditions. Even then, the categories of jobs and health conditions have changed across the country.


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


But different rules between states – and sometimes even different rules within states – created mishmash. This has unleashed a “jealousy of vaccines,” as people see friends and relatives in other states pre-qualified, even if they are the same age or in the same profession. And it has raised concerns that decisions about who is entitled are made based on policy rather than public health.

Hodgepodge reflects the state’s overall response to the pandemic, with large differences in internal mask orders and restrictions on internal meetings.

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

As a result, some Americans frantically seek an open vaccination appointment every day, while vaccines in other states want them.

A variety of policies have encouraged thousands of people to drive along state lines (sometimes across multiple state lines) to get an open vaccine appointment. Some states have established residency requirements, although enforcement is different and those seeking vaccines tend to remain in the honor system.


Todd Jones, an assistant professor of economics at Mississippi State University near Starkville, said the disorder indicates the need for a change in how the government handles the vaccine. “The Biden administration should certainly think about how it can seek to change state allocations,” Jones said. “If it becomes clear that some states don’t use a lot of their doses, then I think it would make sense to make some appointments in those states to give to other states that have a higher demand.”

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


“A lot of governors don’t want it the way they hear the federal government or the CDC asking for guidance,” he said. Florida Gov. Republican Ron DeSantis is proud to ignore the CDC’s advice when he chose the right to be anyone over the age of 65 in December.


“There is a political stance when it comes to deciding eligibility,” Khubchandani said.

Certainly, the governors also wanted flexibility to meet the special needs of their states, such as vaccines for agricultural workers or large food manufacturing plants.

Jones said the decision to open vaccines to all adults in the state may be a good one, but Mississippi has one of the lowest vaccination rates in the nation. Part of that is the hesitation between some minority communities and conservatives. “It’s good news that everyone can get, but there doesn’t seem to be much demand.”

Jones, 34, was able to be shot Tuesday and was vaccinated in a large church from his home on a pram Thursday morning. “I was very happy,” he said.

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