Vaccines are now available to older adults in every state, and President Biden’s administration is pushing for all adults to be able to schedule appointments to receive their shots by mid-April. In more than 35 states, including Florida, New York and Texas, that’s already possible. But in other states, the definition of an “older” adult who gets vaccine priority varies. States are variously vaccinating anyone age 16 and over, 45 and over, 50 and over and 55 and over — along with other groups, like certain essential workers and people with underlying medical conditions. In some states, like North Carolina and Arizona, age cutoffs for distribution have varied by county.
Vaccine availability has improved in recent weeks as states get more shipments and as more local and federal mass vaccination sites open. More than 245 million vaccine doses had been shipped across the country as of April 13. And more than 122 million Americans have received at least one dose, including nearly 80 percent of people age 65 and older. More than 75 million people are fully vaccinated in the U.S.
But it’s still hard to get a vaccination appointment in many states, and it could get even more difficult now that federal officials have recommended pausing the Johnson & Johnson vaccine distribution following reports of rare blood clots forming in a small group of vaccinated women. White House officials have said there should be enough Pfizer and Moderna shots available to make up for the pause, although hundreds of thousands of vaccine appointments will likely need to be rescheduled.
Appointments on state and retail pharmacy websites are often booked as soon as they’re posted. And eligibility still varies considerably from one state to the next, even though the federal government is asking states to offer vaccines to all adults by mid-April.
In Florida, vaccines have technically been available to people 65 and older for more than two months and were opened to people 40 and up on March 29 and all adults on April 5. In Oregon, anyone 45 and older can get a vaccine, but residents younger than 70 were only made eligible in early March. States’ plans are evolving in real time.
The Centers for Disease Control and Prevention (CDC) initially recommended states prioritize health care workers and residents and staff of long-term care facilities — where a third of the nation’s more than 559,000 COVID-19 deaths have occurred. Most followed those recommendations, though Florida and Georgia listed adults 65 and up in 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 recommended 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 and the White House have also recommended states prioritize certain types of essential workers like grocery store employees and teachers.
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 grouped older adults in their second phase of vaccine distribution, referred to by many states as Phase 1b. But age brackets vary by state. For instance, Massachusetts is focusing on adults 55 and older, while West Virginia — which initially vaccinated residents at least 80 years of age — was focused on vaccinating those 50 and up before making doses available to the state’s entire adult population in late March.
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. “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 estimated there were 21 million health care workers and 3 million people in congregate community settings such as nursing homes and assisted living facilities who needed to be vaccinated when shots were first made available. More than 463,000 health care workers are confirmed to have contracted COVID-19, along with more than 1.4 million long-term care residents and staff, according to data from the CDC and the Kaiser Family Foundation.
Millions in these vulnerable groups have already been immunized.
Most residents and staff of long-term care facilities were vaccinated through a federal program that contracted with CVS and Walgreens to administer the two-dose COVID-19 vaccines at free on-site clinics. Nationally, almost all long-term care facilities have finished or are close to finishing their final clinics.
Nationally, almost all nursing homes, which were given first priority, have completed their vaccination clinics. Most assisted living and other long-term care facilities are conducting their final clinics. All vaccination clinics are slated to wrap up by late March.
Many states prioritized nursing home residents and staff alongside assisted living and other types of long-term care in Phase 1a. But some states, like Maryland, group nursing homes in Phase 1a and other assisted living facilities in Phase 1b.
How quickly are vaccines being 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. 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. Those vaccines each require two doses.
When March began, more than 50 million Americans had received a first dose. That total nearly doubled over the course of the month, climbing to nearly 100 million by April 1.
Where can I get one?
As vaccines have become more available, states are expanding options for where to get a shot, which were initially available only in certain hospitals, local health departments and long-term care facilities. 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 federally backed community vaccination sites across the country. More than 30 pilot vaccination sites are open, or will open soon, in California, Florida, Georgia, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania and Texas.
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'
Willingness to get a COVID-19 vaccine has increased over time, but recent polling shows that not everyone wants one. A study published in March by the University of Michigan found that 71 percent of people between 50 and 80 years old had either already been vaccinated or plan to get vaccinated as soon as possible. That’s up significantly from October but means that nearly 3 in 10 older Americans still have reservations.
“Vaccines are useless if they are not used to vaccinate people,” says Moncef Slaoui, a vaccine expert and former chief scientific adviser to Operation Warp Speed under former President Donald Trump.
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, M.D., 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, M.D., 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 is updated periodically with new developments in states' vaccine distribution. Check back regularly.