Balancing Speed With Equity: Connecticut’s Messy Vaccine Math
Gov. Ned Lamont’s announcement this week that Connecticut’s vaccine rollout will be done almost exclusively by age has stirred major controversy, particularly among some essential workers and people with preexisting conditions.
But top state officials said it’s a decision based both on data and a lack of it.
Josh Geballe, the governor’s chief operating officer, said Tuesday that COVID-19 disproportionately kills older people, so if the state wants to quickly reduce severe illness and death, it makes sense to roll out vaccines by age.
“When you look at the data, people who are dying from COVID, regardless of what race or ethnicity they’re in, it correlates very strongly to how old they are,” Geballe said. “There’s very few people at all who’ve died below the age of 45 in this state.”
Right now, state numbers show about 98% of all COVID-related deaths in Connecticut are people age 50 and older.
“Making sure we get everyone in there, regardless of what industry they’re in, regardless of what medical condition they may have, regardless of whether they’re employed or unemployed, or whether they have good access to health care or not -- is going to help us get the most equitable outcome the most quickly,” Geballe said.
But the Lamont administration decision goes against guidance from the U.S. Centers for Disease Control and Prevention. The CDC recommends certain front-line workers and people with comorbidities should be next in line to get the shot.
Shifting From State Advisory Group Recommendations
Those federal recommendations were reinforced by the governor’s COVID-19 vaccine allocation subcommittee, which includes leaders from a broad spectrum of business industries, professional sectors, and organizations.
For months, the subcommittee has been tasked with weighing in on who should get priority in the rollout and when, with equity in mind.
“Things that address the needs of the most marginalized communities in Connecticut, the ones that are already experiencing health inequities so that we need to make sure they don’t become further marginalized during a process like this,” said Zita Lazzarini, a co-chair of the subcommittee.
In January, members agreed that prioritizing front-line workers and people with certain preexisting conditions after the state’s oldest residents would best protect people who had high exposure risks, and those who were most at risk of hospitalization and intubation should they contract the coronavirus.
They concluded that this strategy would better reach across income levels and to Black, Hispanic and other races and ethnicities that account for disproportionate shares of comorbid conditions.
Geballe said that’s good in theory but tough in practice.
“We were headed toward probably about a million and a half people potentially being eligible without even really answering all the questions about how do you even strictly define who is in or out of one of those categories?” Geballe said.
Deidre Gifford, acting commissioner of the state Department of Public Health, said if the state had stuck with CDC guidance, it would still have implemented age brackets within the next group of eligible participants because the pool of people would have been so large.
“We were going to need to stratify in any case,” Gifford said. “And also develop a fairly complicated system for people showing some kind of documentation that they fit into one of these categories.”
However, public health experts and equity advocates have pushed back on this narrative.
Balancing Equity And Speed
Wizdom Powell, director of the Health Disparities Institute at UConn Health, and others have been critical of plans that rely heavily on age.
“If you look at the life expectancy differentials by race and ethnicity, you will quickly acknowledge that individuals who are in the 65 years age or older category are more likely to be non-Hispanic whites,” she said.
Powell said this leaves fewer Black, Hispanic, indigenous and other people of color eligible for vaccines in the older age groups.
“If you only solve for the age issue in an equity equation, then you miss considerable numbers of members of the population who by virtue of both their age and race, or age and gender, or age and socioeconomic status are also at risk for more serious COVID-19 complications and mortality,” she said.
Lazzarini, an associate professor of law and public health at UConn’s School of Medicine, said balancing speed and equity is a complicated but crucial task.
“There is clearly strong interest towards getting vaccine out there as quickly as possible,” she said.
But Lazzarini added that the most efficient, quick way of doing things can reinforce existing inequities in society.
“More privileged people will get the vaccine, and fewer disadvantaged and vulnerable people will get it,” she said. “It’s necessary to take concrete steps to address the inequities in society if we want them to diminish. And that is not the easiest way, ever.”
Gifford said as the state works through age brackets, it will work with vaccinators to require data on how many vaccines go to socially vulnerable or “SVI” communities, where people may lack access to medical care or the resources and time to shop around for vaccines online.
Right now, it’s unclear what those metrics will be and how they will be made public.
“We have begun working with our vaccine providers on the details of this program,” Gifford said. “We intend to have the details released later on in the next few days. So, I can’t give you specifics about what will be on a website for whom, but certainly we intend to make public what our general targets are for impacting high SVI communities and how we’re doing on reaching those targets.”
Front-Line Worker Exceptions And Tossing Comorbidities
Meanwhile, Geballe said all school staff, including teachers, janitors and school bus drivers, will be allowed to get vaccinated in March.
Monday’s announcement also made it clear that underlying medical conditions or comorbidities will not be determining factors for eligibility going forward.
Eileen Healy, who sits on the governor’s COVID-19 vaccine main advisory group, didn’t get advanced notice of the changes to the state’s vaccine allocation plans and said she was shocked by Monday’s announcement.
As the executive director of Independence Northwest for the Connecticut Cross-Disability Lifespan Alliance and chair of the Connecticut Association of Centers for Independent Living, Healy said she’s concerned with how the age bracketing will affect people in certain communities.
“People with disabilities and those with comorbidities have been quarantined in their homes for almost a year. Their caregivers, paid or unpaid family members, got vaccinated but not the individuals they cared for,” she said in an email.
Healy added that while she recognizes the new plan as easier to administer, she wouldn’t defend it as rational or fair.
“Many felt as though their lives didn't matter,” she said, “and yet again, many will be pushed to the end of the line for vaccinations depending on their age.”
People age 55 and older can begin scheduling appointments on March 1, with other age groups to follow in three-week increments. According to the state’s current timeline, anyone age 16 and older will be eligible for vaccines by May 3.