Even as many states are following Centers for Disease Control and Prevention guidance on COVID-19 vaccine priority groups, certain states are expanding access within those initial groups, potentially delaying vaccination of senior living residents and workers. 

A state analysis from the Kaiser Family Foundation looked at where states stand on vaccine prioritization populations and how they differ from the latest CDC Advisory Committee on Immunization Practices recommendations

The analysis was released one day before the federal government announced an expansion of the vaccination rollout, urging states to begin vaccinating individuals outside of the Phase 1a priority group, which includes healthcare workers and residents of assisted living communities and nursing homes. Specifically, federal officials advised states to start vaccinating people aged 65 or more years as well as younger individuals who have comorbidities.

In a letter Wednesday to Health and Human Services Secretary Alex Azar and CDC Director Robert Redfield, Argentum President and CEO James Balda expressing “extreme concern” over the broadening of vaccine distribution. The move potentially could leave older adults in jeopardy, he said, urging the administration to prioritize all senior congregate settings for both vaccine distribution and financial relief.

“These facilities have been on the frontlines of this pandemic since day one, working tirelessly and compassionately to keep everyone safe, and urgently need the financial resources to continue serving this most vulnerable population, and the vaccines that will help keep everyone safe,” Balda wrote. He also asked that adequate vaccine supplies be held in reserve for the second dose of the vaccine, something federal officials said Tuesday they no longer were going to do.

The KFF report found that even as many states are following the CDC guidance on vaccine priority groups, more are diverging from federal guidance and from each other. The result is a “vaccine rollout-labyrinth across the country,” the authors said. 

“This is especially true as states look to transition beyond Phase 1a and face the challenges of operationalizing broader COVID-19 vaccination,” the report reads. “Most of these divergences involve age, with many states moving to include expanded age groups earlier than recommended by ACIP.”

All states and the District of Columbia are vaccinating healthcare workers, and long-term care residents and staff, in Phase 1. The analysis revealed:

  • 10 states (Aransas, Georgia, Indiana, Maryland, Massachusetts, Nevada, New Hampshire, South Dakota, Virginia and Wyoming) are including law enforcement and / or fire personnel in this first phase.
  • Utah is including K-12 students and childcare personnel in the first priority group, whereas Louisiana limits healthcare workers to hospital staff only — remaining healthcare workers are included in Phase 1b.
  • Four states added seniors to this priority group, including people 65 and older (Georgia and Florida), 75 and older (Tennessee) and 80 and older (West Virginia).
  • Five states include other vulnerable individuals, including psychiatric patients (D.C., New Jersey and Ohio), those deemed extremely vulnerable to COVID-19 (Florida) and individuals who cannot live independently (Tennessee).
  • Two states include those living in congregate settings beyond long-term care residents, including incarcerated individuals (Massachusetts and New Jersey) and the homeless (Massachusetts).

According to the report, some states are broadening and simplifying priority groups, whereas others are creating new and more complex priority groupings. The authors noted that there are trade-offs to identifying specific priority groups — whereas they more effectively target a limited supply of vaccines, it can lead to greater difficulty in implementing vaccine distribution plans and make it more difficult to communicate those plans to the public.

Balda’s letter also said that excluding an estimated 400,000 independent living residents from the initial wave of vaccination was “short-sighted.” In addition, he asked for “equitable support” for vulnerable older adults and frontline workers in senior congregate care facilities. 

“From the outset of the pandemic, senior living communities have not received the same levels of support and assistance in the COVID-19 response as nursing homes,” he wrote. “This has led to a lack of prioritization for seniors and caregivers in these communities, both in the payments made available form the Provider Relief Fund, and in the prioritization of skilled nursing above assisted living (and now also independent living) for vaccine distribution.”

Most states were still in Phase 1a, overall, in their vaccine distribution timelines one month out from when doses were first shipped, according to the KFF report. Ten states and the District of Columbia were in Phase 1b, which as defined by the CDC includes people 75 or older as well as frontline essential workers who don’t work in healthcare. Michigan is the only state to move partially into Phase 1c, which includes people aged 65 to 74 years, those aged 16 or 18 (depending on the vaccine) to 64 years who have high-risk medical conditions, and any essential workers not included in Phase 1a or 1b.

“Because of these differences, for this next period, a person’s place in the COVID-19 vaccine priority line will increasingly depend on where they live,” the report states.

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