As U.S. states have started vaccinating people with medical conditions that can increase the risk of a severe case of Covid-19, they are setting very different rules on which conditions to prioritize.
Confusion of guidelines has sparked a race among people with health conditions like cancer or type 2 diabetes to convince state officials to add certain conditions to an evolving list of immunization priorities.
In the town of Royal Oak, Michigan, Megan Bauer, who has cystic fibrosis, a genetic condition that can cause serious lung infections, said she was grateful that other high-risk people were vaccinated: Health workers , teachers, his 81 years old. – former grandmother. years.
If Bauer lived in states like Montana, New Mexico, Virginia, or Washington DC, she could also be vaccinated now – but not in Michigan.
“The wait seems endless,” said Bauer. “With cystic fibrosis, every day is precious, so it’s hard to waste that time.”
In the early months of the Covid-19 vaccination, US states attempted to balance between prioritizing older people, who are more likely to die from the virus, and people in occupations more likely to be exposed to it. .
As recommended by the Centers for Disease Control and Prevention (CDC), people with medical conditions associated with an increased risk of severe symptoms of the virus will be as follows.
At least 37 states, as well as the capital, Washington, now allow residents with certain health conditions to be vaccinated, according to a New York Times survey. But priority health issues differ from state to state, and even from municipality to municipality.
Some people with Down syndrome can be vaccinated in at least 35 states, for example, but some of them do not vaccinate people with other developmental problems. At least 30 states allow some people with type 2 diabetes to be vaccinated, but only 23 states include people with type 1 diabetes.
At least 19 states make the vaccine available to some people with cystic fibrosis; at least 14 included people with liver disease; and at least 15 considered that some smokers were eligible for vaccination.
At least 30 states have prioritized vaccinating overweight or obese people, according to the NYT survey, although they vary in body mass index: 25, 30, or 40.
Some states require people to prove they have a health problem, although at least 16 of them, in addition to the capital, do not. And at least 12 states allow people to get a referral from a healthcare professional to receive the vaccine, even if their medical condition is not considered a priority by the state.
In the absence of extensive and rigorous studies of the effect of the coronavirus in people with other health conditions, experts say there are few clear principles to apply in determining a sequence of priorities among many. conditions.
Many states are relying on a list of 12 types of conditions that the CDC considers to have substantial evidence of a high risk of Covid, including obesity, type 2 diabetes, smoking, and Down syndrome. CDC officials said they regularly review the scientific literature and will expand the list where appropriate.
But some medical ethics experts say the list itself is misleading because it suggests that the risks for all diagnoses have been considered and ranked. Does a 50-year-old with type 1 diabetes have a higher risk of Covid than a 25-year-old with sickle cell disease or a 35-year-old with an intellectual disability?
The issue has sparked a rush from civil rights groups to influence health officials and politicians in state congresses to put certain health conditions on the priority list.
Since vaccination rules can be set by governors – who often consult with hospital officials and their own groups of medical advisers – many requests have taken on a personal tone.
“Governor Mike DeWine,” Hanna Detwiler, a bone marrow transplant patient in Columbus, Ohio, wrote on her social media about her inability to get the vaccine last month, “is working better.”
About 35 advocacy groups sent a letter in late January to New York Governor Andrew Cuomo after fearing the state would explicitly include people living with HIV on the priority list.
The groups cited the State Department of HIV’s own research on HIV as a risk factor for contracting severe cases of Covid-19. New York eventually became one of at least 14 states, with the capital, Washington, to announce that HIV is on the priority list for immunization. A spokesperson for the State Department of Health said this week that New York already intends to include these patients on the list.
Across the country, vaccine requirements are a moving target. Ohio added bone marrow transplant patients like Detwiler to the list last week, after initially offering the vaccine only to those who had received solid organ transplants.
Next week, California, where only a few counties offered vaccines to people with health problems, will allow millions of sick people to be vaccinated. This reversed the state’s previous plan to prioritize vaccines based solely on age, which led to opposition from disability advocates using the hashtag #HighRiskCA (California high risk).
Connecticut recently turned in the opposite direction, ending plans to extend immunization eligibility to people with pre-existing health conditions in favor of age-based priorities. And even some patient advocates who pushed for inclusion are disheartened by what could be a system in which the voices of people with more money or influence prevail.
“This is not how our public policies should be decided, as to who is best placed to defend themselves,” said Kara Ayers, director of the Center for Dignity in Health Care for People with Disabilities, which created a panel priority over vaccinations with the Johns Center. Hopkins Health Disability Survey to help people identify their situation.
State officials say their decisions on which health conditions to include often come down to a combination of evidence, logistics and political reality.
In Michigan, a recent announcement confused Bauer. This week, the state expanded the right to be vaccinated to people with cystic fibrosis and other health conditions, as long as they are over the age of 50.
In 2019, the median age of death for people with cystic fibrosis in the United States was 32, according to a patient record maintained by the Cystic Fibrosis Foundation.
“Most people with cystic fibrosis may not be in this group,” said Bauer, who is 24.