Gov. Ned Lamont said Monday he is throwing out the state’s current playbook for the COVID-19 vaccine rollout – which had prioritized people with underlying medical conditions and certain types of workers, such as grocery store and agricultural employees – and is shifting to a system that is strictly age-based, with the next round of shots open to people who are 55 to 64 beginning March 1.
The announcement came just as the state was supposed to open up the next round of vaccines to “essential workers” such as teachers and other school staff, grocery store employees and transportation workers, as well as people 16 and older who have underlying health conditions like heart disease and diabetes.
State officials said teachers and others who work in the schools will still be prioritized in the coming weeks, with special clinics devoted just to those employees. Schools staff is expected to become eligible beginning March 1, with a goal of giving all workers who want a shot access to a first dose by late March.
For everyone else, age will be the determining factor in access to the vaccine. People ages 55 to 64 can sign up starting March 1. Those aged 45 to 54 will be able to schedule an appointment beginning March 22, and people aged 35 to 44 will be eligible starting April 12. Those 34 and younger will be eligible beginning May 3.
Lamont defended his decision to overhaul the process, saying he looked at other states that are prioritizing the vaccine by co-morbidities and job title, and pointed to examples in which the process caused confusion.
“I’m going to focus on the old business motto, KISS: Keep it simple, stupid — because a lot of complications result from states that tried to finely slice the salami and it got very complicated to administer,” Lamont said. “The CDC said grocery and food service workers [get priority]. Then we started getting calls of, ‘I’m not in a grocery [store] but I’m in a convenience store and it’s a convenience store that serves … we have doughnuts, we have coffee, we have food.’ How about, ‘I’m a big box store, but I also have food; I think we should all be prioritized as well.’ … Those are the type of questions we had. And it was very difficult.”
Max Reiss, Lamont’s spokesman, said the process is being changed to simplify who is next in line.
“We’ve seen what’s been going on around the country, and complexity when it comes to eligibility has been the enemy of speed, efficiency and equity,” Reiss said. “That has played out in just about every state in the country. We feel that by simplifying the process this way, it makes everything clearer when it comes to eligibility access, and an easier process makes it more equitable, instantly. People aren’t left wondering – ‘OK, am I earlier because I work at Sam’s Club, but I don’t work at a gas station?’”
I am pleased there is some notion that we need to focus on equity. I’m displeased that we’re still looking at age. ”
While the governor insists his plan prioritizes high-risk communities — by focusing more vaccines on heavily populated communities — the health policy chairman for the Connecticut NAACP, James E. Rawlings, said Monday there are other factors the administration needs to consider.
Low-income residents who lack access to affordable health care, don’t have a regular relationship with a family doctor and struggle with unstable housing and food insecurity are far more likely to live in Connecticut’s urban centers, said Rawlings, who is an epidemiologist.
Minority populations in these cities also are far more likely to suffer from diabetes and hypertension, factors that place them at higher risk of contracting a severe case of the coronavirus.
“It is the perfect storm for the virus,” Rawlings said.
Low-income communities also have a larger share of workers in retail, hospitality and manufacturing jobs that often cannot be performed remotely, further intensifying the need for vaccines in these communities, he said.
“The lower socio-economically classified you are, the more dependent you are on that job,” Rawlings added. “Those individuals are put at extreme risk because they don’t have a choice.”
Tekisha Everette, a member of Lamont’s vaccine allocation subcommittee and an assistant clinical professor at the Yale School of Public Health, withheld any initial endorsement of the governor’s new direction, pending further details.
“Right now it’s a wait-and-see for me,” said Everette, who also is executive director of Health Equity Solutions, a Hartford-based health care advocacy group. “I am pleased there is some notion that we need to focus on equity. I’m displeased that we’re still looking at age” as the key prioritization factor.
Everette echoed many of the concerns raised by Rawlings, adding that she hopes the Lamont administration focuses on those communities with health vulnerabilities.
“Where are we seeing the highest incidents of spread?” Everette added. “Target those areas and move outward.”
In a 2011 analysis of health outcomes by state and race published in the Health Services Research journal, the average life expectancy for Black women in Connecticut was 74.7 years — 4.6 years less than that of white women.
The analysis also found an average life expectancy of 69.7 years for Black men in Connecticut, six years less than that for white males.
The shift by the Lamont administration represents a significant break from the recommendations issued in December by the federal Advisory Committee on Immunization Practices (ACIP), the group that advises the Centers for Disease Control and Prevention on who should receive priority in the vaccine rollout. The ACIP recommendations had prioritized grocery store employees, public transit staff, food and agricultural workers and others in Phase 1B of the rollout.
Connecticut is in the middle of Phase 1B. As part of this phase, it has already begun vaccinating people ages 65 and older. It is also in the process of immunizing people and workers in congregate settings such as homeless shelters, prisons, group homes and psychiatric hospitals.
Next in line were “essential” employees in certain industries, including grocery store workers, farmers, agricultural inspectors and food scientists; air rail, water and ground transportation employees; manufacturing staff such as industrial production employees, chemical processing staff, textile, metal and plastics workers, and plant and system operators; and firefighters, fire inspectors, ambulance drivers and dispatchers.
People with underlying medical conditions outlined by the CDC were also next to receive the vaccine. Conditions included cancer, chronic kidney disease, chronic obstructive pulmonary disease (COPD), Down syndrome, heart conditions (heart failure, coronary artery disease, cardiomyopathies), weakened immune system from solid organ transplant, obesity, severe obesity, pregnancy, sickle cell disease, smoking and Type 2 diabetes.
Reiss said that while few other states had overhauled the vaccine rollout the way Connecticut announced on Monday, the administration feels it is the right thing to do.
“Who are we to decide which conditions are more serious? We’re trying to get as many people vaccinated as quickly and equitably as possible, and we feel this approach does that,” he said. “We feel that doing it this way, it’s very clear for everyone to understand, and it also provides predictability, so people have an idea of when they’re getting vaccinated.”
Still, in making their recommendations, members of the ACIP stressed that frontline workers, such as postal staff and transit employees, be prioritized because more people of color work in those jobs, and those communities have been disproportionately harmed by the pandemic.
Black residents in Connecticut are 2½ times more likely to die from a coronavirus infection than whites when adjusted for age. The death rate for Hispanics is 67% higher than for white residents.
“Racial and ethnic minority groups are disproportionately represented in many essential industries, which may be contributing to COVID-19 racial and ethnic health disparities. Jurisdictions may want to consider the distribution of the workforce in these industries as they prioritize vaccine allocation,” the CDC guidance from Jan. 1 reads.
The CDC released research showing prioritizing certain professions will help out Black and Hispanic residents.
“Racial and ethnic minority groups are disproportionately represented in essential work settings such as health care facilities, farms, factories, warehouses, food processing, accommodation and food services, retail services, grocery stores, and public transportation,” the CDC reported in December. “Some people who work in these settings have more chances to be exposed to COVID-19 because of several factors. These include close contact with the public or other workers, not being able to work from home, and needing to work when sick because they do not have paid sick days.”
Teachers optimistic; others less so
For many teachers and administrators, however, Monday’s news was welcome.
“I think it’s a great step in getting schools that sense of normalcy once we’re vaccinated,” said Sheena Graham, music teacher at Harding High School in Bridgeport. “I think it’ll do a whole lot for teachers and students alike in regard to social-emotional health, in addition to physical health. So that’s exciting news, to know that we’re on the horizon.”
Connecticut Education Association Executive Director Don Williams said his group has had conversations with the governor’s office and the state Department of Education recently to figure out how to set up a district-based vaccine program that would get school staff vaccinated quickly.
He said districts will need to work with local health departments and providers to put protocols and procedures in place for the vaccines. The process will not be exactly like the system districts now have for the annual flu shot, since more people are expected to get the COVID-19 vaccine, but it will provide a blueprint so that educators can be vaccinated efficiently.
“We know that there are logistics that school districts are in the process of working out right now, and everyone has their fingers crossed in terms of the supply of vaccines. But the fact that we’re moving forward with a plan to get this done in the very near future is very encouraging to our members,” he said.
Williams said getting teachers vaccinated as soon as possible will help schools stay open, as one of the main reasons for closures has been due to staff needing to quarantine after being exposed to COVID-19.
“When fully vaccinated, those quarantine disruptions will end and will provide much more stability and get rid of the disruptions that we’ve seen due to those kinds of school closures,” Williams said.
Bridgeport teacher Hilary McDevit said she believes the shift allowing her to get the vaccine, but not other frontline workers, threatens an equitable rollout.
“I think we trade some fairness for efficiency here, and I’m worried about frontline workers (especially those with pre-existing conditions). But open to everyone by May 3 sounds pretty great to me,” she Tweeted Tuesday afternoon.
“Great for teachers and student and bodes well for a full return,” Joseph Sokolovic, a Bridgeport Board of Education member, tweeted in response. “I suspect the demographics will continue to skew disproportionately to favor Caucasians. I’m in transport (currently eligible at work and not impacted if I want shot now) most of my coworkers are people of color.”
Andrew Feinstein, an attorney who represents students with physical and learning disabilities, said if the state wants to get schools open full-time, they need to get teachers vaccinated immediately.
“If you want to open schools, teachers should be very high up in line or they should have already gotten it,” he said, adding the impact that not being in school for some of his clients has been hard. “CDC has said that schools can be open with certain safety precautions in place, but teachers should certainly be getting it before people in their mid 40s.”
“A lot of them are really suffering,” he said.
But, he added, grocery store workers should be up there with teachers.
“If I am going to catch COVID anywhere, it’s going to be [at the grocery store]. That’s who I want vaccinated. They come in contact with the most people,” he said.
Food service workers and advocates for Connecticut’s disability community expressed disappointment Monday.
Matthew Boucher, a florist in a grocery story in Norwalk, said he is disheartened that people who can work from home just got moved ahead in line.
“Based on what I know, I think it’s absolutely wrong. We’re more in front of the public right now during the pandemic than anyone. It’s just wrong,” he said.
George Cabrera, a spokesman for the United Food and Commercial Workers 919 and a Democratic state senator, called the move “a little frustrating” and said many workers were looking forward to getting vaccinated soon.
“Grocery stores have never closed, and they’ve been on the front line from the beginning,” he said. “So there is some disappointment that it’s going to be changed now.”
Kathy Flaherty, executive director of the Connecticut Legal Rights Project, criticized the decision to erase priority for people with disabilities.
“People with disabilities have been left behind for the last 11-plus months, and to think that we are just continuing to be told to stay home because this state can’t figure out how to do hard and complicated things — and clearly values its place in the vaccine standings more than addressing issues of vaccine equity — is heartbreaking,” she said. “I just don’t want more of my friends to die.”
The administration did not say Monday what would happen to the state’s vaccine advisory group. A panel convened by Lamont last year provides guidance on who should be vaccinated and when. The governor and his staff did not make clear Monday to what extent the group was consulted prior to the announcement and did not say how long the panel would continue functioning. The panel had last recommended that people with underlying conditions and “essential workers” such as grocery store employees be part of Phase 1B.
CT Mirror reporters Jacqueline Rabe Thomas, Adria Watson and Dave Altimari contributed to this report.