Vermont says it will not prioritize frontline workers for the next stage of vaccination, bucking federal guidelines and frustrating workers who hoped to get the vaccine soon.
The state will instead focus on vaccinating elderly residents, after Health Commissioner Mark Levine said the federal guidance was overly ambitious and doomed to fall short. He described the state’s alternative as a more realistic and simpler approach that will ultimately prevent the most vulnerable Vermonters from dying of Covid.
The state is “trying to balance the science and the data … about who’s been most adversely impacted by this virus, and a clear priority from the top down to save lives,” Levine said.
Providing vaccines by age is both ethical and easier to implement, Levine said. It brings an “element of simplicity and not wanting to disappoint everyone from the get-go.”
The shift from the state’s earlier plan has raised questions about who the state chooses to protect, and why.
“I worry about our likelihood of contracting Covid,” said Angela Burke Kunkel, a teacher at Vergennes Union High School whose partner is a nurse. The situation is complicated, she said. She wants to protect the most vulnerable, elderly Vermonters, but “I don’t understand how the state can prioritize keeping schools open, yet not prioritize vaccinating teachers.”
After the Food and Drug Administration granted emergency approval to a Pfizer-BioNTech vaccine, and soon after, to Moderna, the feds recommended that the first doses go to older Americans in elder care facilities and to health care workers.
Vermont followed suit, offering the first doses on Dec. 15. Hospitals and pharmacies have administered about 14,000 doses, about half the vaccine they’ve been allocated. Levine said he expects the state will be able to provide doses to 60,000 health care workers and elder care residents by the end of January.
The controversy comes in deciding who’s next. The federal vaccine advisory group voted on Dec. 20 to provide the next doses to both essential workers and elderly Americans.
The problem? According to Levine, it’s not realistic.
“What the [Advisory Committee on Immunization Practices] came out with, is trying to do everybody at the same time, which we looked at as not only complex, but almost a formula for failure,” Levine said.
“Essential workers” could cover as much as 85% of the state’s workforce, he said. Even frontline workers comprise a “huge number of people.” Texas and Florida have also rejected the Centers for Disease Control recommendations to focus on vaccinating elderly people.
Levine worried that if the state had to decide which essential workers were at the highest risk, it would breed a “tremendous amount of divisiveness.”
But he acknowledged it’s a difficult balance.
“We want our economy to thrive, we want people to be able to work, we want our schools to be in person. And we want our teachers to be able to be in front of the class with their class. All of that’s true,” Levine said.
Thorny subject
Essential workers who reached out to VTDigger were often conflicted about the news. Many asked to remain anonymous, fearing retribution from their jobs or public backlash.
One 29-year-old Vermonter, a school social worker, didn’t want her name used because her clients don’t know she is a cancer survivor. She was worried about being called “selfish” for asking for a vaccine before others. But she also thinks she and her peers need this help to keep going.
“How about instead of it being like, ‘You’re taking something away from someone else,’ being like, ‘We want to give you something so that you can continue to give?’” she said.
Such debates — whether to vaccinate essential workers or the very elderly — are going on nationwide, said Anne Sosin, program director at the Dartmouth Center for Global Health Equity.
The underlying ethical question centers on whether to vaccinate people who are most likely to die (the very old) or those most likely to catch and pass along the virus (essential workers).
Part of what makes this debate so difficult, Sosin said, is that it is not yet known how vaccination affects transmission.
If it could be determined that those who receive the vaccine couldn’t then act as vectors for the virus, “that would shift the balance,” she said, in favor of putting frontline, essential workers at the very start of the line.
“Absent that data, there’s still reason for ongoing debate around that question,” Sosin said.
Uncertainty over chronic conditions
Vermont still has to work out the details.
As a cancer survivor, the social worker may be able to skip the line. Gov. Phil Scott said qualifying chronic health conditions will get priority.
But the state hasn’t yet defined what those conditions are, and that may be a complicated process. Twelve conditions are listed as “risk factors” under Centers for Disease Control guidance, but 11 others are listed under “might be under increased risk.”
“Covid-19 is a new disease,” the CDC guidance said. “Currently there are limited data and information about the impact of many underlying medical conditions on the risk for severe illness.”
Cancer is one example: Having current cancer is a known risk factor for severe Covid, but it’s not known whether a history of cancer increases your risk, according to the CDC.
Levine said the issue of chronic conditions is an important one, since loosening the definition of conditions could “open up the floodgates” compared to being more stringent. “We don’t want to make cavalier and quick decisions,” he said.
Levine said roughly 400,000 Vermonters could be included in this phase of the plan, including 125,000 Vermonters over 65 and 275,000 people with chronic health conditions, although it’s not clear if every one of those will qualify.
That’s more than two-thirds of the state. If everyone on that list qualifies, other Vermonters may have a while to wait.
The long view
It’s reasonable for Vermont to prioritize the elderly and sick over essential workers in the next, most immediate phase of vaccine distribution, Sosin said. But the state shouldn’t stick strictly to age and health, she said, when it decides who gets the batch after that.
“It will be really important to ensure that that population that’s most exposed is prioritized in the next phases of vaccination,” Sosin said.
And Vermont will have to think carefully about not only who is prioritized for vaccination, but also how the medicine gets to them, Sosin said. The logistics of delivering the coronavirus vaccines, which require two doses several weeks apart, will be complicated. And more vulnerable Vermonters — like essential workers in low-wage work — may also be the hardest to track down.
“There’s some desire for expediency. And equity sometimes loses out when that happens,” she said.
Doctors are thinking about those issues as well.
Patients calling to ask about when they can get a vaccine have inundated the phone system at Community Health Centers of Burlington, said spokesperson Kim Anderson. Staff at the health center, which provides care for many New Americans and homeless patients in Chittenden County, are brainstorming ways to partner with other organizations or use its van to meet people where they live.
For now, staff members are thinking of reprogramming the phone system to stem the tide of calls. “When it’s your turn, you’ll know,” Anderson promised.