COVID Vaccine Eligibility a ‘Crazy Quilt’ of State Rules

By Phil Galewitz, Kaiser Health News

Monday, March 22, 2021 (Kaiser News) – In North Carolina, the country’s largest tobacco producer, any adult who has smoked more than 100 cigarettes in their lifetime can now be vaccinated against covid.

In Florida, people under the age of 50 with underlying health conditions can only get the vaccine if they have written permission from their doctor.

In Mississippi, more than 30,000 appointments for the covid vaccine were open as of Friday – days after the state became the first in the contiguous United States to make vaccines available to all adults.

In California, along with about 30 other states, people are only eligible if they are 65 or older, have certain health conditions, or have high-risk jobs.

How does it all make sense?

“There is no logical justification for the system we have,” said Graham Allison, professor of government at Harvard University. “We have a crazy quilting system.”

Jody Gan, a professor in the Department of Health Studies at the American University in Washington, DC, said the lack of a national eligibility system reflects how each state also sets its own rules for public health. “It hasn’t been a great system for keeping, you know, the virus contained,” she said.


The federal government bought hundreds of millions of doses of covid vaccine from Pfizer, Moderna, and Johnson & Johnson – along with other vaccines still in testing – but left much of the distribution to the states. . Some states let local communities decide when to move on to broader eligibility phases.

When the first vaccines were cleared for emergency use in December, nearly all states followed the guidelines of the federal Centers for Disease Control and Prevention and limited their use to frontline health workers, staff and residents of nursing homes.

But since then, states have gone their own way. Some states have prioritized people aged 75 and over, while others have also allowed people in certain jobs that put them at risk of getting infected or had health issues that put them at risk. to be included with the elderly. Even so, job classes and medical conditions vary across the country.


As the supply of vaccines increased over the past month, states have broadened eligibility criteria. President Joe Biden has promised that by May 1 all adults will be eligible for vaccines and at least a dozen states say they will beat that date or, as in the case of Mississippi and Alaska, have already done so.


But the different rules between states – and sometimes the varying rules even within states – have created a mishmash. This has sparked “vaccine jealousy” as people see their friends and family in other states qualify before them, even if they are the same age or in the same profession. And he raised concerns that decisions about who are eligible will be made based on politics rather than public health.

The mishmash reflects the overall response of states to the pandemic, including wide disparities on mask warrants and restrictions for indoor gatherings.

“It’s caused a lot of confusion, and the last thing we want is confusion,” said Harald Schmidt, assistant professor of medical ethics and health policy at the University of Pennsylvania.

As a result, some Americans frantically search online every day for an appointment for an open vaccine, while vaccines in other states are lacking.

The various policies have also prompted thousands of people to cross national borders – sometimes multiple national lines – for an open appointment for a vaccine. Some states have residency requirements in place, although law enforcement has been uneven and those seeking vaccines are often in the honor system.


Todd Jones, an assistant professor of economics at Mississippi State University near Starkville, said the confusion signaled the need for a change in the way the government handles the vaccine. “The Biden administration should definitely think about how it might want to change state allowances based on demand,” Jones said. “If it becomes clear that some states are actually not using a lot of their doses, then I think it would make sense to make some appointments from those states to give other states that have a higher demand.” . “

Jagdish Khubchandani, professor of public health at New Mexico State University, said no one should be surprised to see 50 different eligibility systems because states oppose a uniform federal eligibility system .


“Many governors don’t want to be seen as someone who listens to the federal government or the CDC for advice,” he said. Florida Gov. Ron DeSantis, a Republican, bragged about ignoring CDC advice when he chose to make anyone aged 65 and over eligible starting in December.


“There are a lot of political postures in deciding eligibility,” Khubchandani said.

True, governors also wanted the flexibility to meet special needs in their states, such as rushing vaccines to farm workers or those in large food factories.

Jones said the decision to open vaccines to all adults in the state may sound like a good one, but Mississippi has one of the lowest vaccination rates in the country. Part of this is attributed to the reluctance of some minority and conservative communities. “It’s good news that anyone can get it, but there doesn’t seem to be a lot of demand for it.”

Jones, 34, was able to go online for a photo on Tuesday and was vaccinated at a large church a short drive from his home on Thursday morning. “I was very happy,” he said.

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