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COVID-19 State Vaccination Priorities Change, As Needed
Grace Halsey
As states implement the CDC ACIP's COVID-19 vaccination priorities, they are revising them as needed based on federal, state, and local conditions. Here is a recent snapshot.
As COVID-19 vaccine distribution continues across the country, states are refining priority groups based on rolling federal guidance, vaccine supply or distribution issues, and local conditions.
The Kaiser Family Foundation reports, in its ongoing survey of how states are implementing the phased rollout recommended by the CDC Advisory Committee on Immunization Practices (ACIP), that states are increasingly diverging from CDC guidelines -- and from each other. Varying timelines further interrupted by weather and supply chain problems have resulted in a "vaccine rollout labyrinth" across the US.
The latest ACIP recommendations for prioritization for vaccination of groups at high-risk for SARS-CoV-2 infection and/or severe complications are:
- Phase 1a: health care workers and long-term care facility residents
- Phase 1b: people ages 75+ years and non–health care frontline essential workers
- Phase 1c: people ages 65–74 years, persons ages 16–64 years with high-risk medical conditions, and essential workers not included in Phase 1b
In a recent update, the KFF survey found the situations sketched in the following slides.
Phase 1a: First responders added. States have added first responders to this priority group and some have added law enforcement and fire personnel.
CDC ACIP Phase 1a: Senior citizens added. A number of states have moved older adults into the first phase for vaccination and some also include vulnerable populations.
CDC ACIP Phase 1a: Other congregate settings. Persons living communally in settings other than long-term care are being vaccinated in this phase in several states.
CDC ACIP Phase 1b: Persons aged ≥75 years and frontline essential workers (non–health care workers).
CDC ACIP Phase 1b. 44 states have updated their Phase 1b
priority groups—14 follow ACIP recommendations exactly and 30 depart in some way, primarily by including additional age groups.
CDC ACIP Phase 1b: Local choice. jurisdictions may choose to
vaccinate residents of congregate living facilities at the same time as frontline staff due to their shared risk of disease; 18 states do so in this phase.
CDC ACIP Phase 1b: Younger ages, as defined. 23 states expand the age range in this phase, most commonly for individuals aged ≤65 yrs (ACIP recommends ≤75 yrs) though Alaska includes those aged ≤55 yrs.
CDC ACIP Phase 1b: Expansions/limitations. 8 states expand and 10 limit categories of frontline essential workers vs ACIP recommendations.
CDC ACIP Phase 1b: Educators. 8 states with limited definition of frontline workers in phase 1b do include educators, sometimes as the only such group.
CDC ACIP Phase 1b: High-risk, minorities. 15 states include persons with high-risk medical conditions in phase 1b (ACIP includes in phase 1c). Many include congregate settings, ie, prisons, homeless shelters.
CDC ACIP Phase 1c: Persons aged 65–74 yrs, persons aged 16–64 yrs with high-risk medical conditions, and any essential workers not included in Phase 1a or 1b.