Vaccine Eligibility: States Race to Deliver on Promised Shots

As states broaden Covid-19 vaccine eligibility, it could take months for distribution to catch up — creating a race to limit new cases and lock in vaccination progress. 

People line up outside of the Delco Activity Center in Austin, Texas, waiting to receive a Covid-19 vaccine on Feb. 3. (Courthouse News photo/Madison Venza)

(CN) — The past few days have brought clear signs that the United States is making strides through vaccination to the goal of herd immunity, with big states like California announcing that all adults will soon be eligible to get a coronavirus vaccine. 

But public health experts say there’s a difference between what governors can promise, and how quickly the health system can keep up, pressing a weary public to remain patient and vigilant. 

“It really is going to be a race between the virus and a potential surge,” said Dr. Anthony Fauci during a recent interview on “Today“. 

Signaling that we’re not there yet, Covid-19 cases were on the rise in 19 states over the past week, although the national average remains around the same, at about 53,000 new cases each day. 

Arizona, one of a handful of states already offering a Covid-19 vaccine to all adults, saw new cases drop by about 45%, according to data from Johns Hopkins University. But the opposite happened in Michigan, where cases rose by 50%, the largest leap in the wrong direction. 

As it stands, more than a quarter of Americans are now at least partially vaccinated. Nearly every state has confirmed they are either on track, or ahead of schedule, to meet President Joe Biden’s target of making all adults eligible by May 1. 

One notable exception is New York state. Reporting by Courthouse News found that New York is the only state that has not either set a date by which all adults will be eligible or confirmed that the state is on track to meet Biden’s demand. 

Picking a date could prompt some good press for Governor Andrew Cuomo, facing dual investigations over his handling of nursing home data on Covid-19 deaths and his multiple sexual harassment allegations, but the governor has declined to do so. 

During public remarks on Wednesday, Cuomo said he prefers to wait until the picture is more clear. 

“I’d rather get the specific allocation number and then tell the people of the state so we don’t have to change advice, and we don’t create pandemonium for the scheduling operation,” Cuomo said. 

He noted that other states have made their projections based on doses they expect from the federal government, but that hiccups in the distribution chain could alter the actual doses received. 

There’s also the issue of just how many shots each state’s health system can dole out on a daily basis. 

“It’s easy for a politician to declare access open, and a much harder thing for public health and health care to deliver on that promise,” said Dr. Rebecca Wurtz, an infectious disease specialist and associate professor at the University of Minnesota School of Public Health. 

Most decisions about opening up eligibility for vaccination are political, Wurtz noted. 

The Centers for Disease Control and Prevention handed states a playbook for vaccine distribution last year, but state governments have made their own decisions, leading to significant disparities in how states have handled vaccinating some populations most vulnerable to Covid-19, like prisoners

In some states, elected officials have overruled the advice of health officials to broaden vaccine access, Wurtz said. 

“Each state’s approach to the vaccination rollout has been influenced as much by politics as by public health, much like the overall response to the pandemic has been,” she said.

That has led to “chaos and frustration” among public health and health care leaders across the country.

Wurtz echoed what health experts have been saying since the country began its decentralized vaccine distribution: More national guidelines, or even rules, would have helped to cut down on confusion. 

That point was made back in January by Dr. Bob Hopkins, a professor at the University of Arkansas for Medical Sciences, who also chairs the National Vaccine Advisory Committee of the U.S. Department of Health & Human Services. 

“We can’t forget: pandemics, viruses, do not respect state borders,” Hopkins said at the time. “What’s happening in Arkansas is happening in Tennessee.” 

Three months after U.S. regulators first approved a coronavirus vaccine for emergency use, some opportunities for clear federal guidance, or even rules, have already passed. 

“At this point, it’s too late to put that horse back in the barn,” Wurtz said.

“The best thing the federal government can do is to insure a steady and increasing vaccine supply,” which she said is already happening, “and for state and local health officials to make sure that no populations are missed.”

Wurtz said she thinks capacity to distribute vaccines — in terms of both supply and the ability to administer shots — is “expanding by the day.” She expects states will be able to catch up with politicians’ promises within six to eight weeks. 

In the meantime, for better or worse, state governors are making headlines with expanded eligibility. 

California’s news came with a warning from Health and Human Services Secretary Mark Ghaly, saying it could still take months for everyone to get vaccinated if supplies run short again. 

“We are even closer to putting this pandemic behind us with today’s announcement and with vaccine supplies expected to increase dramatically in the months ahead,” Ghaly said Thursday. “However, we are not there yet. It will take time to vaccinate all eligible Californians. During this time, we must not let our guard down.”

As vaccine distribution rolls on, the general population can look to residents of nursing homes, the earliest group to be vaccinated, as a case study of what may be. 

Deaths in nursing homes rapidly declined post-vaccination, dropping by 60% during the first month and a half of vaccination. 

But truly putting an end to the public health emergency caused by Covid-19 means quelling the pandemic quickly enough that vaccines are still doing their job. In other words, the goal is to stop enough spread that a vaccine-resistant strain cannot emerge, undoing the vaccination work already behind us. 

Framing the fight against the coronavirus as a “race,” as Dr. Fauci has done, is a fair assessment, Wurtz said. The more opportunities for the coronavirus to spread, the greater chance of a potentially dangerous variant emerging. More people getting vaccinated, then, cuts down those chances.

“We are drawing a noose around Covid,” Wurtz said, “and we need to draw it tighter and tighter by vaccinating as many people — from all segments of society — as fast as possible.”

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