Are you eligible for a Covid-19 vaccine? This is how states are deciding.

According to a survey by the New York Times, many states across the country allow people with certain medical conditions to receive the Covid-19 vaccine. However, qualification requirements vary widely from state to state, making subjects a “jack of all trades” in convincing health and state officials to add different requirements to the eligibility list.

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According to the Times, in the first few months of the vaccine’s rollout, states aimed to assign doses to older people, who in general are most likely to die from the virus, and to those in jobs that increase their risk of exposure to Covid-19. CDC Its guidelines recommended that states, after vaccinating these populations, next prioritize vaccines for people with conditions associated with an increased risk of severe Covid-19.

Currently, a total of 37 states and Washington, DC allow some residents with certain health conditions to receive the vaccine. However, acceptable health conditions vary widely from state to state and even county to county, the Times reports.

For example, at least 35 states allow people with Down syndrome to be vaccinated, but some of these states do not offer the same eligibility for people with other types of developmental disabilities. Similarly, at least 30 states allow certain people with type 2 diabetes to be vaccinated, but only 23 states allow people with type 1 diabetes to do so. Meanwhile, at least 19 states are expanding eligibility to the vaccine to include certain people with cystic fibrosis, at least 15 are expanding eligibility for people who smoke, and at least 14 are expanding eligibility for people with liver disease, according to the Times.

In addition, 30 states are allowing overweight or obese people to receive the vaccine. However, that eligibility varies considerably, the Times reports. Some states require that a body mass index (BMI) of 25 is considered eligible, and other states require a BMI of 30 or 40.

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This further complicates matters, while most states require people to provide evidence of qualified health, at least 16 states and Washington, DC does not. In at least 12 states, people who have received a notice from a health care provider recommending that they get the vaccine can go even if their health is not officially prioritized by the state.

A gloomy ethical situation

According to the Times, states are largely following the directions of the CDC in their efforts, which has itself identified 12 conditions associated with higher risk for severe Covid-19, including obesity, smoking, type 2 diabetes and Down syndrome. However, medical ethicists have indicated that in the absence of extensive, rigorous studies of how the novel coronavirus affects people with other medical conditions, “few clear principles” exist to determine the appropriate order of priority access.

In addition, some medical ethicists argue that the CDC’s list itself may be misleading as it could mean that the potential medical risks a person could face have been assessed and compared. But as they point out, it is almost impossible to compare the risks of Covid-19 between, for example, a 50-year-old with type 1 diabetes, a 25-year-old with sickle cell disease and a 35-year-old. One year old with an intellectual disability.

While some studies have actually been done to assess the relative risks of severe Covid-19 with certain health conditions and factors such as age, researchers simply haven’t had enough time to figure out exactly how the disease interacts with other medical problems, Times reports.

“We have a long history of making risk-based recommendations based on a lot of data,” said Grace Lee, CDC Vaccine Advisory Board member and pediatrician at Stanford University. “The problem with Covid is that the information is coming in now and is different than it was two months ago when we were thinking about vaccine allocation.”

An “all-rounder”

These disparate state guidelines, which change from week to week, have resulted in a “flood of jockeys driven by interest groups” to persuade health and government leaders to prioritize certain diseases, the Times reports.

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In New York, for example, about 36 health associations jointly sent a letter to Governor Andrew Cuomo (D) in January, urging him to point out that the state would give priority to people with HIV for the vaccine. Ultimately, New York became one of 14 states, plus Washington, DC, to officially list HIV on the list of eligible diseases, despite a state spokesman this week saying the state had always planned to include HIV patients on the list .

And in Ohio, a bone marrow transplant patient, Hanna Detwiler, directly tweeted Governor Mike DeWine (R) about her inability to access the vaccine last month, despite organ transplant patients being eligible. Last week the state added their condition to its prioritization list.

But many patient advocates, even in areas where they have seen success for their initiatives, say that if only the loudest voices are heard, the system is not enough. “That is not how our public policy should be decided who is better committed to it,” said Kara Ayers, director of the Center for Health Dignity for People with Disabilitiessaid.

For their part, state officials have said they base their decisions on a combination of research, logistics and “political reality,” the Times reports. For example, Maryland currently only allows vaccines for people with medical conditions if they are currently in outpatient or inpatient treatment, said Jinlene Chan, the state’s assistant assistant secretary for public health, because “we can currently only offer a subset of vaccines to our people with the highest risk. ”

And while vaccine supply should ultimately catch up with demand, bioethicists have suggested that these vaccine priority lists can feel like an individual’s social worth is being measured – an especially difficult experience for many people who may already be socially aware of their underlying health feeling stigmatized conditions. “It feels like a lot of the prejudices I’ve fought against all my life are being fought in a bucket to get access to this vaccine,” fights Jessica von Goeler, a type 1 diabetes Patient in order to get her state of Massachusetts to add condition to its eligibility list, said Harmon / Ivory, New York Times, 3/10.

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