States are breaking off CDC in rationing pictures

Texas Governor Greg Abbott speaks during an Operation Warp Speed ​​Vaccination Summit at the White House in Washington, DC, the United States, on Tuesday, December 8, 2020.

Al Drago | Bloomberg | Getty Images

People aged 65 and over and people with certain medical conditions can get the Covid-19 vaccine in Texas earlier than recommended by the federal government.

In Massachusetts, prisoners and correction officers are in the first round of vaccine recipients, as well as first responders such as police officers and firefighters, although the federal government has recommended that only healthcare professionals and long-term care residents be included.

The limited supply of vaccine doses has forced officials to ration the shots on a select group of people, especially in hospitals battling the pandemic or the most vulnerable populations in society. The Centers for Disease Control and Prevention has given priority to health workers and nursing home residents in the first round of vaccination.

Most states followed the CDC’s draft for what’s called the Phase 1a group, but some deviate a little from the agency’s recommendations for the Phase 1b group, which the agency outlined on Sunday to include everyone over 74 as well The key frontline workers involve workers such as farm workers, police and teachers.

This decision was the result of months of discussion and analysis by members of the CDC’s Advisory Committee on Immunization Practices. The group wanted to make sure that the US distributes the few million first doses in a fair and equitable manner, which also brings the greatest benefit to society – for example, so that the people who care for Covid-19 patients stay healthy enough to continue to do so. However, their recommendations are not binding, so states have the final say on who will be shot and when.

Texas was one of the first states to break away from the CDC guidelines. The state announced on Monday that it is prioritizing its Phase 1b vaccination schedule for those 65-year-olds and older, and those with certain medical conditions, so key frontline workers will have to wait a little longer.

“A focus on people 65 years of age and older or with comorbidities will protect the most vulnerable populations,” said Imelda Garcia, Chair of Texas’ Panel of Experts on Vaccine Allocation and Deputy Commissioner for Laboratory and Infectious Diseases at the Texas Department of State Health services. “This approach ensures that Texans at the highest risk of Covid-19 can be protected across races and ethnicities and regardless of where they work.”

Texas’s departure from federal guidelines is not unreasonable, said Dr. Jen Kates, senior vice president and director of global health and HIV policy at the Kaiser Family Foundation. The question of how to prioritize people for a potentially life-saving shot is not an easy one, and there are no right answers. But the state’s deviation is pretty big, Kates noted, adding that she expects even more states to deviate from the CDC recommendation when the plans are put in place.

Florida Governor Ron DeSantis followed Texas on Tuesday, saying he intends to prioritize people over the age of 70 to be the first to receive the vaccine, not essential workers.

“The vaccines are targeted where the risk is greatest, including our older population,” DeSantis said at a press conference. “We will not put young, healthy workers in front of our older, vulnerable population.”

‘State values’

“It’s not really about right or wrong, it’s about state values,” said Kates, who closely monitors state vaccine prioritization plans as they are released.

One of the key questions in deciding whether to prioritize those who are most at risk of dying from Covid, the elderly, or those who are most at risk of becoming infected and spreading the virus, the essential ones Workforce, she said.

“Texas is clearly on its side:” We will focus on those at greatest risk for disease and death, “she added, noting that other states are likely to have different values ​​in their plans.” Basically, it creates a different order for management and, in relative terms, people will have different access depending on where they live. “

Texas’ prioritization plan excludes key frontline workers from the next batch of shots, including the state’s nearly 2 million food and farm workers, according to trade group Feeding the Economy. Teachers and school staff, police officers, manufacturing workers, U.S. Postal Service employees, and public transportation employees are also among those prioritized under the CDC’s Phase 1b recommendation, but not in Texas.

“Farm workers have little protection and have suffered disproportionately, but in this scheme that Texas uses [they] won’t be at the top of the line, “said Kates.” It sends a signal. “

The CDC manual came “late”

Dr. Bill Schaffner, an epidemiologist at Vanderbilt University and liaison to the CDC Advisory Board, said that he, too, expects more states to part ways with the CDC guidelines in the coming weeks. At this point, state officials have been working on their prioritization plans for months, Schaffner noted, and they are unlikely to revise their plans following the CDC recommendation.

“The ACIP recommendation was serious, careful, thoughtful, egalitarian, sincere, honest, all these good things and a little late,” Schaffner said in a telephone interview. “I was pretty sure that in our diverse country of 50 states and I can never remember how many areas there would be some, say, harmonics – variations on a theme.”

ACIP members, when voting on their recommendations for phases 1b and 1c at their Sunday meeting, noted that local officials should follow federal guidelines and adapt them to local situations. However, Schaffner noted that the Texas plan is more than an interpretation of federal guidelines. It’s a remarkable departure.

He also reiterated Kates’ argument that there is no right or wrong answer here and that the Texas plan appears to be well worked out. Not everyone on the CDC’s vaccines committee supported the plan, which was passed on Tuesday. Dr. Henry Bernstein of Northwell Cohen Children’s Medical Center voted against the plan because he wanted to cover all 65-year-olds and older like Texas in the next round of shooting, Schaffner said.


The implementation of the plans is a great challenge. Of the 4.6 million doses of vaccine that were shipped to the US, only 614,117 were given by Tuesday morning, according to the CDC. Delivering the vaccine successfully to all critical populations will require time and money that local health officials currently do not have, he said. The recently passed Covid Relief Act provides more than $ 8 billion for vaccine distribution.

“It is implementation where justice really matters. What will the different states do to really reach the underserved populations?” he said. “If additional resources have not been made available to the health departments, the intentions can stand at the door.”

And tougher questions are likely to arise as states try to expand their vaccine allocation programs, said Kates of the Kaiser Family Foundation. For example, she noted that there could be a situation where neighboring states have different prioritization plans, encouraging some residents to travel across borders to get the vaccine.

“There are all these kinds of problems that are going to come up and really, they need to be managed and they can only be dealt with at the national level,” she said. “Otherwise the inequalities will arise.”

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