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Feds Shift COVID-19 Vaccine Focus to People 65 and Over or With Underlying Conditions

States with higher share of older residents, faster vaccination pace will get more doses

spinner image A woman wearing a face mask stands outside a COVID-19 vaccination site in New York City.
A woman waits for her COVID-19 vaccination at Bathgate Industrial Park in the Bronx borough of New York City.
Bloomberg / Getty Images

Americans age 65 and over should get access to coronavirus vaccines right away, Health and Human Services (HHS) Secretary Alex Azar said Tuesday, and states with the highest concentration of older residents will get more vaccine doses to support that effort.

People younger than 65 who have medical conditions that put them at risk for severe COVID-19 should also be prioritized for vaccination, Azar also said.

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"We clearly have enough vaccine at this point to begin to expand and get more and more of the vulnerable individuals in our country vaccinated,” Centers for Disease Control and Prevention (CDC) Director Robert Redfield told reporters at a briefing on the vaccine effort.

AARP has been urging federal officials to speed up vaccinating older adults. CEO Jo Ann Jenkins sent a letter to Azar on Monday calling for him to immediately prioritize older adults and fix the problems that have led to the slow vaccine rollout nationwide.

Azar outlined four ways that HHS will encourage states to adopt a new vaccination approach in order to get more shots in the arms of Americans and target the 65-plus population.

1. Expand eligibility

Azar wants states to allow any resident 65 and older and anyone younger than 65 with health conditions that put them at risk for contracting the coronavirus to begin getting vaccinated right away.

Initial guidance from the CDC advised states to put the first priority on vaccinating health care workers and residents and staff in nursing homes, followed by Americans age 75 and older and frontline essential workers.

Expanding those getting the vaccine “is the most effective way to save lives now,” Azar said at the briefing. States make the ultimate decisions on when specific populations get vaccinated. A number of them have already begun vaccinating their 65-plus residents.

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2. Open more vaccine sites

Federal officials also want states to greatly expand the places people can go to get a COVID-19 vaccine, including local pharmacies, health centers and mass vaccination sites, which HHS will help states set up.

The government has partnerships with 19 pharmacy chains and associations, ranging from CVS and Walgreens to Kroger and Walmart, and states can allocate vaccines directly to those partners, which would then schedule vaccination appointments, Azar said.

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Using the pharmacies means the public can go to “a place where the American people are comfortable going and receiving the shot,” said U.S. Army General Gustave Perna, chief operating officer of Operation Ward Speed. Some pharmacies have already been administering vaccines to health care workers and nursing home residents.

3. Distribute more doses

Since the vaccine effort began in December, HHS has held back millions of doses so enough vaccine would be available to give people their second shot. The Pfizer-BioNTech vaccine calls for a second shot after 21 days, while the second shot for the Moderna vaccine is supposed to be administered 28 days after the first one.

HHS will now release the doses it has held in reserve and send them to the states. Azar stressed that both pharmaceutical companies are producing enough vaccine to keep up the pace to provide second shots to everyone who has gotten a first dose.

There has been debate in the scientific community over whether a single dose is sufficient to provide some protection, and whether it's critical to provide a second dose precisely at the prescribed three- or four-week interval the companies have advised. “Based on the science and evidence we have it is imperative that people receive their second doses on time,” said Azar. That is also the position the U.S. Food and Drug Administration (FDA), which authorized the vaccines, has taken.

4. Use all available vaccine

States with a high older population will get more vaccine and doses will also be allocated based on how quickly states are getting shots in their residents’ arms. Up to now, vaccine allocations have been based on a state's total population.

Azar said the data that shows a wide variance in vaccine administration may be due to underreporting by states. So, HHS is giving states time to correct their data. Beginning in two weeks, Azar said, states that are lagging behind in using the doses they have been allocated will see their vaccine allotments decreased and given to states that are more efficient in getting the vaccine administered.

This procedure “gives states a strong incentive to go to work protecting people rather than (the vaccine) sitting on shelves or in freezers,” Azar said. “With the case counts we face now there is absolutely no time to waste."

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