New Jersey this week made millions of people eligible to get the COVID-19 vaccine, including smokers, a move that prompted gripes about them skipping to the front of the inoculation line.
Democratic Gov. Phil Murphy made people 65 and older and those 16 and older with medical conditions eligible to get the vaccine. That started Thursday. New Jersey's list of conditions mirrors that of the Centers for Disease Control and Prevention and includes cancer, kidney disease and other illnesses.
Also listed is smoking. Wait. Why?
Here's a closer look at a question that grabbed headlines this week.
WHY IS SMOKING ON A LIST OF MEDICAL CONDITIONS?
It goes back to people who are at “significant risk” of adverse illness from the coronavirus. Smokers are included in the group because their use of tobacco inhibits their lungs, and COVID-19 is a respiratory illness, health officials say.
But there's more to it.
Murphy and New Jersey Health Commissioner Judy Persichilli said the state's vaccination schedule is about getting as many people vaccinated as quickly as possible, starting with those who are most susceptible to severe illness from the virus.
Murphy put it this way: “We cannot be overly bureaucratic about this.”
Teachers in particular raised concerns that smokers could be getting the vaccine before them.
Don't break people down into “Job A versus Job B,” the governor said.
WHAT ABOUT OTHER STATES?
New Jersey, like other states, is using CDC guidelines to determine who is in which category. For instance, the 65-plus cohort and those with medical conditions are grouped together. Smokers are included in the CDC guidance, so this isn't New Jersey's idea.
But what varies by state is when each group receives the vaccine. New Jersey started with health care workers and nursing home staff and residents, then moved on to first responders like police and firefighters.
Next came seniors and those with medical conditions, but other states have gone in different directions. For example, teachers are eligible in many states as part of what the CDC calls the 1b population, including neighboring New York and Pennsylvania, according to the Kaiser Family Foundation, but not yet in New Jersey.
WHAT'S THE PROBLEM WITH SMOKING ANYWAY?
Smoking went from being widespread and fashionable to shrinking and stigmatized over the last several decades as more information about its dangerous effects on people's health became known. Businesses and governments cracked down on smoking in the workplace and at restaurants.
In 1998, a settlement between tobacco companies and most states limited marketing and required the firms to pay an annuity to states, forever.
Health insurers also charge smokers extra.
So why, people ask, should someone who knowingly took up smoking be on equal footing with, say, an octogenarian who is also at risk but doesn't smoke?
The state health department points out that nicotine in tobacco products is addictive and that people who smoke should quit, and if they need help can get it at njquitline.org.
A BIGGER PROBLEM?
While adding smokers to the list of people eligible to get vaccinated has attracted attention, a bigger issue is at play: the lack of vaccine supply.
For example, New Jersey is currently getting about 100,000 doses a week. But it would need around 470,000 per week to meet forecast demand, Persichilli said.
That would be enough to vaccinate 70 percent of the adult population, or 4.7 million people, in about six months, which is the state's goal.
The governor put it this way: Supply is not meeting demand.