Vermont, with more relaxed Covid vaccine requirements than neighboring states, is vaccinating some out-of-staters. But some state health officials don’t see this as a problem.
So far, 94,949 people have been vaccinated in Vermont, and about 6% — almost 6,400 — are nonresidents, according to the state’s Covid dashboard as of Thursday evening.
With states getting limited doses that are based on their populations, the asymmetry in state policies has raised concerns about how fair the system is. Vermont officials say that fear is unwarranted, and some hospital workers agree.
“Our supply and allocation is anticipated to be enough to meet our vaccination plans,” Ben Truman, a spokesperson for the Vermont Department of Health, said in a written statement.
Vermont isn’t the only state drawing out-of-state people in search of a vaccine. Across the country, thousands of people are crossing state lines to get vaccinated, stirring up debates about what is ethical when there’s high demand and a very limited supply of Covid vaccines.
More than 50,000 people from out of state have been vaccinated in Florida, for example. At the beginning of February, Mississippi’s numbers were similar to Vermont’s, with around 5,300 people from out of state getting vaccines there. But that is a much smaller percentage of Mississippi’s total population of almost 3 million, compared to Vermont’s 626,000 or so.
Each state sets its own policy about vaccine distribution. In the Northeast, that means people are able to enter Vermont to get the vaccine. Some important differences in Vermont policy have created this situation.
According to the Vermont Department of Health, nonresidents who work in the state or whose primary care doctor is located in Vermont are eligible to get the vaccine in the state. And new arrivals who just moved here and intend to establish residency can get vaccinated, too.
But across the border in New Hampshire, that policy isn’t reciprocated.
Some hospitals say this is a sensible choice that’s good for the health of Vermonters. They point to the goal of getting as many people vaccinated as possible, regardless of where they happen to live.
“If there are people from another state who are working here, they’re going to be interacting with Vermonters. We definitely want them vaccinated, too,” said Laural Ruggles, vice president of marketing and community health improvement at Northeastern Vermont Regional Hospital. The St. Johnsbury hospital is less than 10 miles from the New Hampshire border.
Ruggles said she was aware of a modest number of people coming from New Hampshire to get vaccinated at the community clinics run by Northeastern Vermont Regional Hospital, but “we don’t see it as a problem.”
Neither does the state Department of Health, which said the policy reflects its goal to “get as many people vaccinated as quickly and efficiently as possible,” according to its spokesperson.
“We view these limited cross-border allowances as being a reasonable accommodation, and as not having a practical impact on our main goal of getting as much vaccine to eligible Vermonters as possible,” Truman said of the state’s policy.
“This may differ from other states’ policies, and I can’t speak to their choices,” he said.
According to Ruggles, Northeastern Vermont Regional Hospital has taken measures to assist Vermonters with primary care doctors located in New Hampshire. They set up a call line to answer questions, but so far they haven’t received very many calls, she said.
Ruggles doesn’t think out-of-staters coming into the state should worry Vermont patients.
“I don’t think anybody has been turned away because of that,” she said.
New Hampshire’s lack of reciprocity
Farther south in the state, at Mt. Ascutney Hospital and Health Center in Windsor, chief medical officer Joseph Perras said he was worried about a barrage of patients when he learned that New Hampshire wasn’t going to reciprocate Vermont’s inclusive policy.
Nearby Dartmouth-Hitchcock Medical Center isn’t immunizing any Vermonters, even those who get their primary care there. The hospital’s website attributes the policy “to N.H. state allocation requirements.”
“We are unable to vaccinate residents from other states at this time,” the website reads. “There are no exceptions for patients who receive their health care in N.H., but live in other states.”
But according to Perras, so far, that surge he worried about hasn’t materialized, in part due to two large vaccination clinics across the river, in Claremont and Lebanon, New Hampshire. Those sites are close to Mt. Ascutney. Plus, New Hampshire rolled out public vaccine options a little earlier than Vermont, which may have helped alleviate the rush across the border.
Still, it’s an option that some patients have chosen. About 25% of primary care patients at Mt. Ascutney live in New Hampshire, and just under half of them have opted to get the vaccine in Vermont, according to Perras. So far, Mt. Ascutney has administered around 2,900 doses.
Perras said he’s of two minds on the issue. “As a physician, I think patients should be able to get their vaccinations at their usual site of care,” he said.
But it troubles him that New Hampshire hasn’t reciprocated that.
“I think the state (of Vermont) would’ve certainly had a good case if they decided not to vaccinate anyone who lives in New Hampshire regardless of where they got their primary care,” he said.
“I can’t stress enough how conflicted I am over this issue,” Perras said.
Perras pointed out other significant differences in the states’ approaches. For New Hampshire residents getting the vaccine in New Hampshire, Mt. Ascutney hospital had to send significant data to New Hampshire so patients could prove they were eligible to get vaccinated there.
The honor system
In contrast, Vermont is allowing residents and nonresidents to enter their own information on the website they use for registration. The state tracks that information, but no identification is required to make or go to the appointment.
While Mt. Ascutney is entering that information into its hospital databases, Laural Ruggles at the St. Johnsbury hospital said they’re leaving it entirely up to the state to track that information.
“We just know they’ve scheduled online or through the state. They just show up. We’re not doing any screening as far as out-of-state,” she said.
Perras said the Vermont philosophy is relying on patients to be honest about their medical history and sign up for the vaccination appropriately, as opposed to “putting patients through the wringer as far as attestations go and signing affidavits saying that you get all your care in Vermont.”
According to Truman, the state asks questions when people make a vaccine appointment to determine their eligibility. He said if someone isn’t eligible, they won’t be able to make an appointment. Pharmacies have been asked to follow the same eligibility requirements, although they use a separate registration system.
But with broader conversations and cases of “vaccine tourism,” some Vermonters wonder if the state’s policies are too relaxed. While other states like New York are currently vaccinating anyone older than 65, waiting time to get a vaccine may be longer, which could be a temptation to come to Vermont.
According to the New York Department of Health website, the state has received around 300,000 vaccine doses per week, while more than 7 million people are currently eligible.
“We know there may be some risk of people finding ways to get a vaccine in Vermont even when they aren’t eligible,” Truman said. “But that minor risk is worth taking to ensure more equitable access for people in Vermont.”
