Strain Grows for States to Open Vaccines to Extra Teams of Individuals

Pressure Grows for States to Open Vaccines to More Groups of People

Just weeks after the country's coronavirus vaccination efforts began, states have begun expanding access to the footage faster than planned. This is due to the enormous public demand and intense criticism of the speed of the rollout.

Some public health officials fear this could add even more chaos to the complex operation and increase the likelihood that some of the highest-risk Americans will be skipped. However, the debate over how quickly eligibility can be upgraded is intensifying as the death toll from the virus continues to rise, hospitals are overwhelmed with seriously ill patients, and millions of vaccine doses dispensed in the last month remain in freezers.

Governors are under tremendous pressure from their constituents – especially older people, who vote in large numbers and are at greatest risk of dying from the virus – to quickly get their hands on the doses they are given. President-elect Joseph R. Biden Jr.'s decision, announced on Friday, to give almost all of the available cans to states when he takes office on Jan. 20, rather than holding half, to ensure that each recipient is a few weeks later gets a refresher shot the first is likely to add to that pressure.

Some states, including Florida, Louisiana, and Texas, have already expanded who are now eligible to get a vaccine, despite many people in the first priority group recommended by the Centers for Disease Control and Prevention – the 21 million health care workers of the Landes and three million residents of nursing homes and other long-term care facilities – have not yet received a shot.

On Friday afternoon, New York became the last state to do so, announcing that people aged 75 and over and certain key workers could get a vaccine starting Monday.

Reaching a larger segment of the population, however, requires a lot more money than the states were given to do the job, say many health officials, and more time to tweak systems for the rapid movement of surplus vaccines to increase the number of vaccination sites and people who have favourited Give the shots and establish reliable appointment systems to avoid endless queues and waiting times.

The enlargement of some states has led to desperate and often futile efforts by older people to get vaccinated. After Florida opened vaccinations to people 65 and older late last month, the demand was so great that new online registration portals quickly overloaded and crashed, people spent hours on the phone trying to secure appointments, and others overnight on scattered pop-up Websites waited for recordings based on availability.

Similar scenes have played out in parts of Texas, Tennessee, and a handful of other states.

With C.D.C. Data suggesting only about a third of the doses previously distributed have been used, Health and Human Services Secretary Alex M. Azar II told reporters last week: "It would be much better to move forward quickly and on Some end up vaccinating people with lower priority than leaving vaccines lying around while states try to manage this process. Faster management would now save lives, which means we cannot allow the perfect to be the enemy of the good. "

The C.D.C. The guidelines were prepared by an independent committee of medical and public health experts that advised the agency on vaccination practices. For months there was thought about who should be vaccinated first while supplies were still very limited. The committee weighed scientific findings on who is most at risk or who may die from Covid-19, as well as ethical questions on how best to ensure equitable access between different races and socio-economic groups.

Although the committee's recommendations are non-binding, states usually follow them. In this case, the Committee suggests that states could consider expanding to other priority groups “if the demand appears to have been met at the current stage”, “if the supply of approved vaccines increases significantly” or “if the supply of Vaccines present in a given place are at risk of going unused. "

Dr. Kevin Ault, an obstetrician at the University of Kansas Medical Center who serves on the advisory committee of the C.D.C. Guidelines said it was sensible for states to vaccinate new groups before quitting others, but that they should be careful to exacerbate inequalities and bite off more than they can chew.

"Obviously if you want to vaccinate this group you need to have a well-thought-out plan in place," he said, referring to the 65-year-old woman. "Having people camping for vaccinations is less than ideal I would say."

He added, "We've put a lot of thought and effort into our policies and I think they are good."

After the first vaccines were administered in mid-December, there was a dichotomy between governors who followed closely the guidelines and others who quickly evolved into non-healthcare populations and nursing home residents.

By Friday, New York City Democrat Governor Andrew M. Cuomo had threatened to punish hospitals that shot people who are not health care workers. In contrast, Florida Republican Governor Ron DeSantis traveled to retirement communities in his state to emphasize the importance of getting vaccinated quickly for people 65 and over, who are more than five million people there.

"In Florida we have to put our parents and grandparents first," DeSantis said shortly before Christmas at The Villages, the country's largest age group.

Decisions about when the eligibility for the shots should be extended have not been made according to party-political standards.

Covid19 vaccinations>

Answers to your vaccine questions

If I live in the US, when can I get the vaccine?

While the exact order of vaccine recipients may vary from state to state, most doctors and residents of long-term care facilities will come first. If you want to understand how this decision is made, this article will help.

When can I get back to normal life after the vaccination?

Life will not return to normal until society as a whole receives enough protection against the coronavirus. Once countries approve a vaccine, they can only vaccinate a few percent of their citizens in the first few months. The unvaccinated majority remain susceptible to infection. A growing number of coronavirus vaccines show robust protection against disease. However, it is also possible for people to spread the virus without knowing they are infected because they have mild or no symptoms. Scientists don't yet know whether the vaccines will also block the transmission of the coronavirus. Even vaccinated people have to wear masks for the time being, avoid the crowds indoors and so on. Once enough people are vaccinated, it becomes very difficult for the coronavirus to find people at risk to become infected. Depending on how quickly we as a society achieve this goal, life could approach a normal state in autumn 2021.

Do I still have to wear a mask after the vaccination?

Yeah, but not forever. The two vaccines that may be approved this month clearly protect people from contracting Covid-19. However, the clinical trials that produced these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected with the coronavirus can spread it while they don't have a cough or other symptoms. Researchers will study this question intensively when the vaccines are introduced. In the meantime, self-vaccinated people need to think of themselves as potential spreaders.

Will it hurt What are the side effects?

The vaccine against Pfizer and BioNTech, like other typical vaccines, is delivered as a shot in the arm. The injection is no different from the ones you received before. Tens of thousands of people have already received the vaccines, and none of them have reported serious health problems. However, some of them have experienced short-lived symptoms, including pain and flu-like symptoms that usually last a day. It is possible that after the second shot, people will have to plan to take a day off or go to school. While these experiences are not pleasant, they are a good sign: they are the result of your own immune system's encounter with the vaccine and a strong response that ensures lasting immunity.

Will mRNA vaccines change my genes?

No. Moderna and Pfizer vaccines use a genetic molecule to boost the immune system. This molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse with a cell, allowing the molecule to slide inside. The cell uses the mRNA to make proteins from the coronavirus that can stimulate the immune system. At any given point in time, each of our cells can contain hundreds of thousands of mRNA molecules that they produce to make their own proteins. As soon as these proteins are made, our cells use special enzymes to break down the mRNA. The mRNA molecules that our cells make can only survive for a few minutes. The mRNA in vaccines is engineered to withstand the cell's enzymes a little longer, so the cells can make extra viral proteins and trigger a stronger immune response. However, the mRNA can only last a few days before it is destroyed.

Maryland Governor Larry Hogan, a Republican, announced Tuesday that he would immediately switch to the so-called "Southwest Airlines" model of vaccine allocation, with reference to the airline's open seating policy. "We will no longer wait for all members of a particular priority group to complete," he said, "before we start the next group in line."

Ohio Governor Mike DeWine, a Republican, urged patience in a news conference Tuesday when he refused to estimate when the state would begin vaccinating people beyond the first priority group known as "1a".

"We ask every health department, 'Don't go outside, stay on your trail," he said, adding about the vaccines, "This is a scarce resource. "

By Thursday, Mr DeWine had set a date for people 80 and over to receive the vaccine – January 19 – and said he would introduce everyone 65 and over by February 8, as well as teachers.

The reasons why so many doses received by states have not yet been given to the first priority group are many. The fact that vaccination started around Christmas, when many hospital workers were on vacation, slowed things down. More health care workers are refusing to receive the vaccine than many of their employers expected, and some hospitals and clinics have been given more doses than necessary but have felt government regulations prevent them from giving it to anyone outside of the first priority groups. Some initially feared they might not even offer leftover doses in open vials to people in lower priority groups and let them go to waste.

And federal funding for vaccination efforts was slow to reach states and municipalities: by the end of last year, they received just $ 350 million, a little more than $ 1 per inhabitant of the country. The economic rescue package that Congress passed in December included $ 8 billion to distribute vaccines that state health officials had been looking for, but the first tranche of that, about $ 3 billion, is only now being shipped.

"The development of these products has been very financial and the infrastructure to ship and bring them out has been great," said Dr. Steven Stack, Commissioner for the Kentucky Department for Public Health. "But then there was no meaningful funding for the vaccine administration, which is the last mile of this journey."

The C.D.C. has recommended vaccinating a "1b" group next, made up of people aged 75 and over and certain key workers, including teachers, proofreaders and grocery store workers. The second group is much larger, around 50 million people. And the third recommended priority group – those aged 65 to 74, those aged 16 and over who are at high risk, and key workers not yet reached – number nearly 130 million people.

Pfizer and Moderna have pledged to provide enough vaccine doses to 100 million people by the end of March to receive the two required vaccinations, and many more in the second quarter. Several other vaccine candidates are well in the pipeline and having them approved here for emergency use could help accelerate the spread of the virus.

The C.D.C. The committee initially considered recommending that a wide range of key workers be vaccinated before older Americans. The rationale was that many key workers are low-wage blacks who are disproportionately affected by the virus and have limited access to good health care. That sparked a backlash, and several governors, including Mr DeSantis, were quick to make it clear that they would take care of the elderly first.

Dr. Mark McClellan, formerly the F.D.A. and now heads the Duke University Health Policy Center, saying vaccinating the elderly and other particularly vulnerable groups would accelerate the overall effort. "We will miss a lot of people at higher risk along the way."

"I am concerned that access will become uneven," he said during a press conference. "With lower-income groups, minority groups may be in a tougher position if we don't make it very easy for people in these countries." Groups at risk to get vaccinated. "

Dr. Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials, said he was surprised to hear federal officials like Mr. Azar and Dr. Jerome Adams, the surgeon general, advocate widening access to vaccines so far so soon.

"We didn't come up with priority populations to slow things down, but because we knew there would only be a limited number of doses," said Dr. Plescia. "If we try to do this in a just and fair way, it won't be as quick as if our only goal is to get the vaccine into as many arms as possible."

Whether or not they expand access now, governors are increasing pressure on hospitals to use their assigned doses faster. Mr Cuomo threatened to punish those who hadn't used their original assignments by the end of last week and stop sending them.

Mr. Hogan warned hospitals last week, "Either use the doses you have been assigned or they will be forwarded to another facility or provider."


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