Several national polls and surveys show that a growing number of people are willing to get a COVID-19 vaccine when it’s their turn.
But with vaccine supply limited in the first weeks and months of distribution, Connecticut will have to prioritize exactly who comes next in line after hospital employees, health workers and people in long-term care facilities.
“I think that the goal for us is to try to be inclusive of those who truly need it and to allow the others then to get in line after those who truly need the vaccine,” said Dr. Michael Carius, an emergency physician at Bridgeport Hospital and Milford Hospital.
The state is vaccinating workers and residents who fall into Phase 1a. The next categories of people eligible for vaccines would be in Phase 1b, which state officials estimate will begin in late January or early February.
Members of the allocation subcommittee of Gov. Ned Lamont’s COVID-19 vaccine advisory group met Monday afternoon and affirmed federal recommendations for Phase 1b of vaccine distribution: residents 75 years and older, and front-line essential workers such as teachers, first responders and grocery store workers.
Phase 1c would then include residents 65 and older, people with underlying medical conditions that put them at risk of becoming severely ill or dying from COVID-19, and other essential, non-front-line workers.
Those are recommendations -- individual states are not obligated to adopt them exactly, though Connecticut’s vaccine advisers have previously stated they will likely closely follow the federal guidelines.
Still, the allocation subcommittee is considering some modifications, namely moving residents and workers in congregate housing environments as well as people with comorbid conditions, regardless of age, up the line.
Tekisha Dwan Everette, executive director of Health Equity Solutions, said prioritizing vaccines by age group without considering other factors could be damaging to achieving equity in vaccine distribution.
“I think the unfortunate part of the recommendations is this narrow bounding around age without looking deeper at some of the issues that intersect with age, for example, race and gender, geography,” she said.
“Because I think it ignores a huge group of people who will otherwise die if they don’t get this and at best, spread it to a whole bunch of people who will have poor outcomes.”
Then there comes the question of how to define front-line essential workers, and how specific it should be narrowed down even within certain industries or professions.
Andrew Mais, commissioner of the state Insurance Department, said, for example, that the federal guidelines consider those in food and agriculture as front-line essential workers, but people in food service as “other essential workers” to be considered.
“You could be in food and agriculture or manufacturing, growing the potatoes, making the french fries,” Mais said. “But the people at McDonald’s who are serving the french fries to a tremendous number of people per day wouldn’t be considered front-line essential workers.”
Zita Lazzarini, an associate professor of public health sciences at UConn Health and an attorney, said there could be a similar predicament for those who work in the legal system, which is broadly listed under “other essential workers.”
“I hope we would get to that point and think about stratifying that by people who need to have face-to-face contact with the people they’re working with or the setting they’re working in,” she said, “so that, for example, workers in courts who have public-facing jobs all the time would be included way before lawyers like me who sit at home and do Zoom meetings.”
Other people the allocation subcommittee is considering moving up in the line of vaccinations are behavioral health professionals, many of whom have shifted their services to telemedicine out of safety concerns during the pandemic.
However, Dr. Suzanne Lagarde, CEO of Fair Haven Community Health Center, said not all patients have been able to get the same access to care through telemedicine.
“The end result of it is, some degree of patient care may be suffering,” she said.
Dr. Marwan Haddad, medical director at the Center for Key Populations at Community Health Center Inc., said these gaps in mental health care created by the pandemic need to be addressed.
“So many of our patients can benefit from in-person individual therapy,” he said, “and even when we get to groups [therapy], that’s been a big loss and big sort of suffering of care."
The state’s allocation subcommittee will also have to wait for more clarification on underlying conditions and comorbidities, which is a broad category.
About 6 in 10 adults in the United States have a chronic disease, according to the U.S. Centers for Disease Control and Prevention.
Determining which conditions put someone ahead in line for a COVID-19 vaccine will be complicated when supply is limited, committee members said.
“I hear lay people saying, well I have asthma -- does that count?” Lazzarini said. “So, I think there’s a long way between cardiomyopathy and ‘has been diagnosed with asthma at some point.’”
The allocation subcommittee Monday agreed to generally confirm the two main population groups set out by the federal recommendations for Phase 1b of vaccine distribution.
Members will meet again at the end of the month or shortly after the new year to better define essential workers, comorbid conditions and other groups of people being considered for earlier vaccination in Connecticut.