Even as New York has expanded the ranks of healthy people who can get the coronavirus vaccine, it has wrestled with tough decisions about extending eligibility to people with medical conditions that might make them extra vulnerable.
Gov. Andrew Cuomo said Jan. 12 that New York would accept new federal guidance to expand vaccine access to younger people with certain health problems, including those with weakened immune systems.
The Democrat said state officials were working with the U.S. Centers for Disease Control and Prevention to decide what types of conditions should push someone nearer to the top of the vaccine priority list.
But weeks later, medically at-risk New Yorkers still can’t receive vaccinations unless they are age 65 or older, are in a nursing home or hold certain jobs.
That’s disappointed people like Patti Witten, a 63-year-old resident of Dryden, in central New York, who has an autoimmune disorder.
“I thought, ‘Great, I’m going to get vaccinated,’” Witten said. “And then you crash when you find out it isn’t available. Your hopes just crash.”
To explain the delay, Cuomo has cited low vaccine supplies that make it hard for anyone to get a shot. He’s also cited the challenge of determining which medical conditions should count. Millions more people could be eligible if the state included every condition on CDC’s list, he said.
“That category can get very large, very quickly,” Cuomo said Tuesday in a call with reporters, adding if everyone is eligible, no one will get the shot.
States get to define at-risk conditions themselves, though the CDC has provided a list that includes cancer, Type 2 diabetes, severe obesity, heart conditions, sickle cell disease, pregnancy and having a weakened immune system from a solid organ transplant.
At least 13 states have opened eligibility to some people under age 65 with certain health conditions, according to an Associated Press review of state vaccine plans.
Five states have extended eligibility to people with at least one condition on the CDC’s list. People who are overweight or have hypertension are eligible in New Mexico. New Jersey, Texas and Pennsylvania allow smokers.
Louisiana vaccinates dialysis patients. Cancer, dialysis or post-transplant patients are eligible in South Dakota. North Dakota and New Hampshire limit eligibility to people with at least two high-risk medical conditions.
Montana, Virginia and Florida let medical providers use their clinical judgment to decide whether someone should be prioritized for vaccination.
Even as New York has hesitated to add at-risk patients to the eligibility list, Cuomo this week empowered local health officials to give the shots to restaurant workers and taxi drivers, if they had the supplies to do so.
Currently, health care workers, police officers, teachers, grocery store workers and others also qualify because of their jobs, as well as everyone age 65 or older.
“To say we’re going to do all the 65-year-olds and none of the medically compromised is irrational,” said Richard Gottfried, the Democrat who leads the state Assembly’s health committee.
Public health experts interviewed by The Associated Press called for more clear federal guidance, and said the lack of a uniform federal approach has led to a confusing patchwork of policies.
But several experts said there’s a strong argument for states to prioritize vaccinations by age and occupation first.
“I agree with the approach of vaccinating those where their profession really puts them at close contact with COVID-19 and are essential for public function,” Memorial Sloan Kettering infectious disease specialist and physician Tobias Hohl said. “I think age is a very good discriminator in terms of risk … It makes for an easy way to administer vaccines without a large process of prioritizing patients.”
Hohl said it could be time-consuming for states to verify whether someone has an eligible health condition or decide whether to prioritize someone whose condition is well-controlled.
Still, Hohl said it’s “deeply frustrating” that he can’t offer the vaccine to particularly vulnerable patients under 65.
Oncology nurse Karines Reyes, a state Assembly member from the Bronx, said focusing on front-line workers can reduce spread.
“I do believe that there are people who are immunocompromised or are a higher-risk population who have the luxury of being able to stay at home, and they should take all the necessary precautions,” she said.
A growing body of research shows patients are more at risk if they have chronic kidney disease or active cancer, particularly of the lungs, immune system and blood and bone marrow.
About 44,000 people in New York have end-stage kidney disease, which requires dialysis or kidney transplant.
“They have to travel to their dialysis clinic three times a week,” said National Kidney Foundation Chief Medical Officer Joseph Vassalotti, who is also a kidney doctor at Mount Sinai Hospital in New York City. “They, by definition, cannot shelter at home the way others can.”
Robert Baker, an ophthalmologist and president of the Westchester County Board of Health, said residents with underlying health conditions who heard Cuomo’s announcement have tried to get appointments at vaccination clinics but were rejected.
“You have to be clear and transparent because you falsely raise people’s hopes, which is exactly what happened here,” Baker said.