Vaccines are now available to older adults in every state. But the definition of “older” varies. States are variously vaccinating those age 65 and over, 70 and over, 75 and over or 80 and over. In some states, like Tennessee and Arizona, age distribution varies by county.
Many of those eligible for a vaccine have encountered huge logistical hurdles in simply making an appointment. Vaccine supply remains very limited and demand is high. State and county vaccination sign-up websites have crashed under the weight of tremendous traffic, and health department phone lines have been overwhelmed. Ever-evolving state distribution plans have further slowed vaccine distribution. More than 71 million vaccine doses have been shipped across the country, but fewer than 40 million people had received their first dose as of Feb. 16.
Distribution varies from one state to the next, even though the federal government is asking states to prioritize people at least 65 years of age and people of any age with serious medical conditions.
In Florida, vaccines have technically been available to people 65 and older for a month. But in many counties getting an appointment has been frustrating, with some people camping out overnight at vaccination sites.
In nearby Arkansas, vaccines are available only to people 70 and up. In Oregon, adults 75 and older weren’t able to make a vaccine appointment until Feb. 15. All of these state plans are evolving in real time.
The CDC is recommending that states prioritize health care workers and residents and staff of long-term care facilities — where nearly 40 percent of the nation’s more than 455,000 COVID-19 deaths have occurred. Most followed those recommendations, though Florida and Georgia 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 and the Biden administration recommend that vaccines gradually become available to older adults, since adults 65 and up account for 8 in 10 deaths attributed to COVID-19. The CDC also recommends states begin vaccinating certain types of essential workers, like police officers and grocery store workers, after working through Phase 1a.
A CDC advisory panel recommends 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 the actual 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 states haven’t agreed on age brackets: Rhode Island is focusing on adults 75 and up, while neighboring West Virginia, which initially vaccinated residents at least 80 years of age, is vaccinating those 65 and up and teachers and school staff who are at least 50.
These differences have fed confusion about who can get vaccines and when they’ll be more widely available. Even in states that have for weeks offered vaccines to their older residents, getting a vaccine appointment is still a challenge due to high demand. Many state plans say that 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, which is fighting for older Americans to be prioritized in getting COVID-19 vaccines.
First in line: 24 million Americans
The CDC estimates that there are 21 million health care workers and 3 million people in congregate community settings such as nursing homes and assisted living facilities who should be vaccinated.
More than 405,000 health care workers are confirmed to have contracted COVID-19, along with more than 1.2 million long-term care residents and staff, according to data from the CDC and the Kaiser Family Foundation.
Millions of health care workers and residents and staff at long-term care facilities have already received at least their first dose of vaccine as part of the first phase of all state vaccination plans.
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 program has finished first-round nursing home vaccinations; the second round is now underway, along with first-round vaccinations at assisted living facilities. A survey found that the overwhelming majority of nursing home residents got a first shot but that less than half of nursing home workers received one.
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.
How quickly will vaccines be shipped out?
The federal government is shipping more doses to states and to certain cities, such as Philadelphia and New York, each week. And it’s sending vaccines directly to certain pharmacy and grocery chains under a program launched in February. Retail partners vary by state but include certain Walmart, CVS, Costco, Rite Aid and Kroger locations. And the administration in late January announced plans to purchase an additional 200 million vaccine doses from Pfizer and Moderna, with the goal of vaccinating 100 million people in Biden’s first 100 days and 300 million people by the end of the summer.
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 under former President Donald Trump, said in mid-December that he believed that 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 only 22 million people had received their first dose of a vaccine as of Jan. 26, and fewer than 40 million had received a first dose by Feb. 16.
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. Johnson & Johnson submitted its vaccine for FDA authorization on Feb. 4 and is awaiting a decision. But few experts believe that the general public will be able to get vaccinated much before this summer.
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 has opened mass vaccination sites at the Disneyland Resort in Anaheim and Dodger Stadium in Los Angeles. Massachusetts is using Gillette Stadium, home to the New England Patriots.
The Biden administration has tasked the Federal Emergency Management Agency (FEMA) with setting up 100 community vaccination sites across the country. Two have already opened in California: at the Oakland-Alameda Coliseum and at California State University, Los Angeles.
Information about where to get a vaccine and who is eligible to receive one is listed on most state public health websites. Many states 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 was 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 and federal officials are launching outreach programs to educate people and make them more comfortable about 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. The White House plans to funnel additional aid to states, but Congress has yet to pass such legislation.
“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 uptake. “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.