Feds to States: Give COVID Vaccine to 65+ and Those With Comorbidities

Alicia Ault

January 12, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Federal health officials are urging states to vaccinate all Americans over age 65 and those ages 16 to 64 who have a documented underlying health condition that makes them more vulnerable to COVID-19.

US Department of Health and Human Services (HHS) Secretary Alex Azar and Centers for Disease Control and Prevention (CDC) Director Robert Redfield, MD, made the recommendation on a briefing with reporters Tuesday, saying that the current vaccine supply was sufficient to meet demand for the next phase of immunization as recommended by the CDC's Advisory Committee on Immunization Practices.

"We are ready for a transition that we outlined last September in the playbook we sent to states," Azar said. Both he and US Army General Gustave F. Perna, chief operations officer for Operation Warp Speed, said that confidence in the distribution system had led to the decision to urge wider access.

The federal government will also increase the number of sites eligible to receive vaccine — including some 13,000 federally qualified community health centers — and will not keep doses in reserve as insurance against issues that might prevent people from receiving a second dose on a timely basis. 

"We don't need to hold back reserve doses," Azar said, noting that if there were any "glitches in production" the federal government would move to fulfill obligations for second doses first and delay initial doses.

Azar: Use It or Lose It

In a move that is sure to generate pushback, Azar said that states that don't quickly administer vaccines will receive fewer doses in the future. That policy will not go into effect until later in February, which leaves open the possibility that it could be reversed by the incoming Biden administration.

"We have too much vaccine sitting in freezers at hospitals with hospitals not using it," said Azar, who also blamed the slow administration process on a reporting lag and states being what he called "overly prescriptive" in who has been eligible to receive a shot.

"I would rather have people working to get appointments to get vaccinated than having vaccine going to waste sitting in freezers," Azar told reporters.

Azar had already been pushing for broader vaccination, telling states to do so in an Operation Warp Speed briefing on January 6. At that briefing, Azar also said that the federal government would be stepping up vaccination through an "early launch" of a federal partnership with 19 pharmacy chains, which will let states allocate vaccines directly to some 40,000 pharmacy sites.

Perna said during the January 12 briefing that the aim is to further expand that to some 70,000 locations total.

The CDC reports that as of January 11 some 25.4 million doses have been distributed, with 8.9 million administered. An additional 4.2 million doses were distributed to long-term care facilities, and 937,000 residents and staff have received a dose.

"Pace of Administration"

Alaska, Connecticut, North Dakota, South Dakota, Washington, DC, West Virginia, and the Northern Mariana Islands have administered the most vaccines per capita, according to the CDC. But even these locations have immunized only 4% to 5% of their populations, the New York Times reports. At the bottom: Alabama, Arizona, Arkansas, Georgia, Mississippi, and South Carolina.

The federal government can encourage but not require states to move on to new phases of vaccination.

"States ultimately determine how they will proceed with vaccination," said Marcus Plescia, MD, MPH, chief medical officer for the Association of State and Territorial Health Officials. "Most will be cautious about assuring there are doses for those needing a second dose," he told Medscape Medical News.

Plescia said that ensuring a second dose is available is especially important for healthcare workers "who need to be confident that they are protected and not inadvertently transmitting the disease themselves."

He added that "once we reach a steady state of supply and administration, the rate-limiting factor will be supply of vaccine."

That supply could now be threatened if states don't comply with a just-announced federal action that will change how doses are allocated.

Beginning in late February, vaccine allocations to states will be based on "the pace of administration reported by states," and the size of the 65-and-older population, said Azar, who has previously criticized New York Governor Andrew Cuomo for fining hospitals that didn't use up vaccine supply within a week.

"This new system gives states a strong incentive to ensure that all vaccinations are being promptly reported, which they currently are not," Azar said.

Currently, allocations are based on a state's or territory's population.

Prepandemic, states were required to report vaccinations within 30 days. Since COVID-19 vaccines became available, the CDC has required reporting of shots within 72 hours.

Redfield said the requirement has caused some difficulty, and that the CDC is investigating why some states have reported using only 15% of doses while others have used 80%.

States have been scrambling to ramp up vaccinations.

Just ahead of the federal briefing, Cuomo tweeted that New York would be opening up vaccinations to anyone older than 65.

https://twitter.com/NYGovCuomo/status/1349026589825245188

The Associated Press is reporting that some states have started mass vaccination sites.

Arizona has begun operating a 24/7 appointment-only vaccination program at State Farm Stadium outside of Phoenix, with the aim of immunizing 6000 people each day, according to local radio station KJZZ.

California and Florida have also taken steps to use stadiums, while Michigan, New Jersey, New York, and Texas will use convention centers and fairgrounds, Axios has reported.

In Florida, Palm Beach County health director Alina Alonso, MD, told county commissioners on January 12 that there isn't enough vaccine to meet demand, WPTV reported. "We need to realize that there's a shortage of vaccine. So it's not the plan, it's not our ability to do it. It's simply supply and demand at this point," Alonso said, according to the TV station report.

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