person getting COVID vaccine shot
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A severely limited supply combined with a decentralized rollout has led to confusion and anger over which groups are being prioritized to receive Covid vaccines first.

Controversy boiled over in January when many states announced they were adding smoking to the list of medical conditions prioritized for vaccination. Fury ran particularly high in New Jersey, where residents raged that smokers could get their shots before the state’s teachers and transit workers.

Similar conflicts are repeating across the country as Americans in high-risk groups — either due to profession, age or underlying medical conditions — say they are being passed over while other groups, sometimes they say with less pressing needs, have become eligible.

At the same time, confusion over federal and state guidelines has left many patients and workers in the dark about when they will get their turn for a coveted appointment.

ClearHealthCosts spoke with policy experts about how the vaccine priority system is supposed to work and the top three things patients need to know to make sense of the complicated rollout.

The state you live in will determine when your group can get vaccinated.

Each state is primarily responsible for determining its own order for vaccinating its residents Josh Michaud, researcher and associate director of global health policy at the Kaiser Family Foundation said in a phone interview.

“Currently states aren’t required to follow what the federal government recommendations — states are free to decide their own prioritization,” Michaud said.

For example, President Biden is “encouraging” states to vaccinate people over 65 but not all states have been able to yet. That also means that just because the Centers for Disease Control, recommends vaccinating smokers, for example, only some states have actually begun doing it.

Making matters more confusing, each state has its own process for implementing vaccine priority.

“For many states, there’s some kind of advisory committee or group that decides,” Michaud said. “So they weigh the CDC recommendations, which are the federal recommendations about prioritization, and then they design the state’s own guidelines.”

California’s Covid advisory panel recently opted not to prioritize vaccinating people with disabilities and chronic medical conditions before people over 65 while other states have already begun immunizing these groups.

States’ guidelines and recommendations are changing all the time

In response to changes in vaccine supply and arising data, states have begun exercising the flexibility afforded to them by the current system.

“States are kind of increasingly all over the map when it comes to which populations they are prioritizing,” Michaud said.

Research carried out by Michaud and his colleagues shows that even though most states are following federal recommendations on which groups to vaccinate, many are also opting to include groups that are not mentioned in federal guidelines. For example, while all states are currently offering shots to healthcare workers, in accordance with federal recommendations, some, like New York, have begun vaccinating teachers.

On Friday, New York Gov. Andrew Cuomo said the state would begin vaccinating residents with comorbidities beginning Feb. 15, adding that a full list of eligible conditions would be released soon.

Changes to state vaccine policy may allow states to address the specific needs and values of its population but Michaud’s research notes that in some cases, state policies have become more complicated and in turn more difficult to effectively communicate to the public.

What’s in the official guidelines may not be what’s actually happening on the ground

Jennifer Kates, researcher and director of global health and HIV policy at Kaiser Family Foundation said that there are three broad reasons why states’ official vaccination policies may not line up with who is actually getting vaccinated.

First, when a situation comes up where doses might go to waste, all bets are off.

“There are times when there might be doses left over at the end of the day, for whatever reason. And if those doses are doses that will go to waste, I think it’s sort of commonly advised at this point, to use them,” Kates said in a phone interview.

“That means that there are going to be people who by luck — by maybe, waiting at a CVS, or because they heard about it, are going to get vaccinated whether or not in a priority group.”

Second, confusion about who counts in certain priority groups has led to different states and medical staff interpreting things differently.

“Sometimes I think the way it’s described by some states may not be clear,” Kates said.

For example, advocates have argued that unpaid family caregivers should be included as frontline workers. A few states, like North Carolina, are making policy changes that specifically mention this group, while other states leave it up in the air.

“You’ll have people who both would probably fit into the category that states have laid out,” said Michaud. “But if you’re not affiliated with a specific medical institution or employee of a hospital system, whatever, there are people who fall through the cracks.”

Finally, there are people who are gaming the system by trying to get vaccinated even if they don’t meet the criteria.

A SoulCycle instructor prompted outrage when she got a vaccine by stretching the definition of educator.

“At the margins, you might see people jumping the line, and then people who weren’t in the priority group getting vaccinated,” said Michaud.

Kates said it’s not always clear how people have been able to get providers to give them the vaccine.

“Are they trying to say they’re in a [prioritized] category and they’re not? And how closely is the state monitoring that?”

What you can do

Several governmental and non-profit organizations have created user-friendly databases and tables where you can find out what groups your state is vaccinating now.

The Kaiser Family Foundation’s vaccine phase and prioritization table is sortable by location and phase.

The National Governors Association phased allocation table has information for American territories as well as states. The table also includes links to each state or territory’s official, detailed vaccine rollout plan.

The National Academy for State Health Policy has an interactive map showing how many phases each state has as well as a table with links and a breakdown of which groups are included in each phase, sorted by state.

Virginia Jeffries

Virginia Jeffries is a journalist in New York City. Since 2020, she has reported on long...