Even in states that have started offering vaccines to older adults — to those 65 and over, 70 and over, 75 and over or 80 and over, depending on the state — getting a vaccination appointment can be a huge challenge. State and county vaccination sign-up websites have crashed under the weight of tremendous traffic, and health department phone lines have been overwhelmed. Scheduling issues and ever-evolving state distribution plans have led to a slow vaccine rollout. More than 27 million doses of vaccines have been shipped across the country, but fewer than 10 million people had received their first dose as of Jan. 13.
And distribution varies from one state to the next, even though the federal government is asking states to begin vaccinating people at least 65 years of age and people of any age with serious medical conditions.
In Florida, where Gov. Ron DeSantis bucked a Centers for Disease Control and Prevention (CDC) advisory panel’s recommendation that states prioritize those age 75 and up after vaccinating nursing home residents and staff and frontline health care workers, vaccines are already available to people 65 and older. But getting an appointment has been frustrating in many counties, with some people camping out overnight at vaccination sites.
In nearby Alabama, vaccines will only be available to people 75 and older starting on Jan. 18. In Pennsylvania, older adults likely won’t be able to get a vaccine until late January or early February. All of these state plans are evolving in real time.
The CDC is recommending states prioritize health care workers and residents and staff of long-term care facilities — where nearly 40 percent of the nation’s more than 373,000 COVID deaths have occurred. Most are doing this, though Florida and Georgia have added adults 65 and up to their top priority group, known as “phase 1a” in many state vaccine plans.
Vaccine distribution after phase 1a is where many states diverge. The CDC recommends that vaccines gradually become available to older adults — with adults 65 and up accounting for 8 in 10 deaths attributed to COVID-19 — and certain types of essential workers like police officers and grocery store workers.
A CDC advisory panel is recommending states place people at least 75 years of age and “frontline essential workers” — including teachers, police officers, grocery store workers and postal employees —in their second phase of vaccine distribution (1b). But formal vaccine plans are being drawn up by individual governors and state health officials, who aren’t obligated to follow CDC recommendations to a T.
Most states are currently grouping older adults in their second phase of vaccine distribution, referred to by many states as phase 1b. But the definition of “older adult” varies: Pennsylvania is focusing on adults 75 and up, while neighboring West Virginia is vaccinating adults at least 80 years of age. And because plans are evolving, older adults younger than 75 or 80 may eventually find themselves prioritized higher than where they currently sit, especially given the new federal guidance to prioritize the 65-plus.
As a result, confusion has cropped up over who can get vaccines and when they’ll be more widely available. “You are going to get access to this. It may not be today for everyone — may not be next week,” DeSantis said at a news conference. “As long as we continue getting the supply, you’re going to have the opportunity to get this.”
Many state plans suggest older Americans will likely be vaccinated in the first half of the year. “There are complexities involved, and there’s going to be some learning as we go here,” says Megan O’Reilly, vice president for federal health and family issues at AARP. AARP is fighting for older Americans to be prioritized in getting COVID-19 vaccines because the science has shown that older people are at higher risk of death.
First in line: 24 million Americans
The CDC estimates that 21 million health care workers and 3 million people in congregate community settings such as nursing homes and assisted living facilities will need to be vaccinated. Millions of these people have already received at least their first dose of vaccine.
More than 354,000 health care workers are confirmed to have contracted COVID-19, along with more than 1.1 million long-term care residents and staff, according to data from the CDC and the Kaiser Family Foundation.
The federal government is working with CVS and Walgreens to get vaccines into nursing homes and long-term care facilities at no cost to residents and staff. The two drugstore chains say that more than 48,000 of the 50,000 skilled nursing and assisted living communities in the U.S. are participating in the program.
Many states are prioritizing nursing home residents and staff alongside assisted living and other types of long-term care in phase 1a of vaccine distribution. But some states like Maryland group nursing homes in phase 1a and other assisted living facilities in phase 1b. And the federal Pharmacy Partnership for Long-Term Care Program with CVS and Walgreens has gotten off to a slow start. Although more than 4 million doses have been distributed for use in long-term care more broadly, only 22 percent were actually administered as of mid-January.
How quickly will vaccines be shipped out?
The federal government is working with state officials and vaccine manufacturers to ensure doses are sent where they’re needed. The Department of Transportation is helping oversee vaccine shipments on a rolling basis, with shipments proportional to state population size, according to Army Gen. Gustave Perna, chief operating officer of the federal Operation Warp Speed vaccine initiative.
So states with larger adult populations are receiving larger vaccine shipments. “We are not waiting for a cluster of vaccines to be available and then push,” Perna said, explaining that they will be shipped “every week based on availability.”
But distribution and shipping issues have forced the government to repeatedly downgrade their vaccination forecasts. Moncef Slaoui, a vaccine expert and chief scientific adviser to Operation Warp Speed, said in mid-December he believed 20 million Americans could be vaccinated by the end of 2020, with an additional 30 million vaccinated in January and 50 million in February. But a little more than 9 million people had received their first dose as of Jan. 13.
Among the factors causing the slow rollout are smaller-than-expected vaccine shipments from the federal government and delays in distributing vaccines to specific types of health care workers and through a relatively small number of hospitals.
Vaccine availability is expected to increase if the FDA signs off on vaccines being developed by Johnson & Johnson, AstraZeneca and others. But few experts believe the general public will be able to get a vaccine much before summer 2021.
Where can I get one?
For people who don’t live in long-term care facilities, vaccines were first available in much of the U.S. through hospitals and local health departments, since the shots were going primarily to high-risk health care workers and, in some cases, first responders and EMS personnel.
But as vaccines become more available, states are expanding their options for where to get a shot. California is setting up mass vaccination sites, with the Disneyland Resort in Anaheim and Dodger Stadium in Los Angeles slated to be among the first to open for California’s top priority groups. Gillette Stadium in Massachusetts will similarly be used to vaccinate eligible residents.
Other states have started tapping pharmacies. In Louisiana, people 70 and up can get vaccines at roughly 100 pharmacies statewide. Some pharmacies in New York are also vaccinating residents 75 and up after Gov. Andrew Cuomo expanded vaccine eligibility on Jan. 11. The federal government on Jan. 12 recommended that states work with pharmacies and community health centers to distribute the vaccine to those eligible. But that guidance is not mandatory, and many states have not yet factored it into their distribution plans.
Most states that have begun offering vaccines to older adults more broadly have posted information about where to get it on their public health websites. Many have also set up toll-free vaccine information numbers.
‘Vaccines are useless if they are not used’
Even with all the steps to speed vaccination, not everyone wants it. A recent poll found that 76 percent of people 60 and up want to get a COVID-19 vaccine. But many would rather wait to see how others respond to the doses first. The poll, conducted by the Steven S. Hornstein Center for Policy, Polling and Analysis at Long Island University, suggests just 46 percent of older adults would get a vaccine as soon as it’s available to them.
Older adults appear to be more receptive to a vaccine than younger Americans — and resistance has softened over time, with the percentage of older adults willing to get a vaccine double what it was in October. “Vaccines are useless,” Slaoui says, “if they are not used to vaccinate people.”
Some state officials, including Cuomo, are considering outreach programs to educate people and make them more comfortable getting a vaccine. But state budgets are strapped after almost a year of pandemic fallout. Many states may need financial help just to distribute their vaccines — let alone fund education and outreach programs.
“One of the issues we’re watching Congress on is funding to help states operationalize the distribution of the vaccines,” says AARP’s O’Reilly. “Right now, the money isn’t there.”
If enough Americans do get vaccinated, the country is likely to return to “a considerable degree of normality” in the second half of 2021, says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. He recently cautioned that masks and social distancing measures are likely to stick around for much of 2021 but said he was optimistic about the vaccines in development.
Still, their efficacy depends in part on widespread participation by the public. “What would be really a terrible outcome is we have vaccines that are shown to be really good, and yet half of Americans decide not to use them,” Francis Collins, director of the National Institutes of Health, told AARP during a recent tele-town hall. “And then this epidemic could go on and on and on. We need to get about 90 percent of the population immunized if we’re going to basically tell this virus that it’s done.”
Editor's Note: This story will be updated periodically with new developments in states' vaccine distribution. Check back regularly.