Colorado will start vaccinating teachers and people in their late 60s Monday, frustrating older residents who are still trying to get an appointment and essential workers who wonder when their turn will come.
Gov. Jared Polis announced Friday that “student-facing” staff in schools, child care workers and people between the ages of 65 and 69 would be eligible for the vaccine starting Feb. 8.
But less than 40% of the 70-and-up population had gotten the first shot when Polis announced the state would move to the next category, and it was at least the second time essential workers like bus drivers, mail carriers, grocery store employees and public health workers were bumped down in priority.
Polis has argued putting senior citizens first is the fastest way out of the pandemic, because the risk of hospitalization or death increases with age. Protecting them means the economy can reopen, because hospitals likely won’t be overwhelmed if a major wave of cases affects young and middle-aged people, he said.
“There simply won’t be enough people 70 and up to use all the vaccines” that will be available after Feb. 8, Polis said at a news conference Monday. “We’ll be going as fast as we can.”
Some researchers counter that prematurely expanding eligibility could actually hurt the state’s efforts to protect the most vulnerable.
When doses are in short supply, getting a vaccine depends on being able to navigate an online signup process that works against people who don’t speak English or have low levels of literacy, said Nancy Berlinger, a research scholar at the Hastings Center, a bioethics research institution. That means the people who most need protection – especially those who live in crowded housing with frontline workers – are the least likely to get it, she said.
“By default, it’s going to the healthiest people,” she said.
Appointments still hard to find
Bob Cogswell, 70, said he’s concerned that expanding eligibility to people in their late 60s will mean even longer waits for his age group. He said that to get an appointment, he visited the online portal for Banner Health three times a day from Jan. 6 to Jan. 22. When his luck finally changed, he and his wife had to get their shots on different days in different cities near their home in Johnstown.
“Why put more people on the highway when the highway’s not big enough to handle what you have now?” he said.
Colorado National Guard Brigadier Gen. Scott Sherman, who is leading Colorado’s vaccination push, said this week the state will continue to focus on people over 70, and about half of those in their late 60s will have to wait for their shot until March. He didn’t specify how the state would ensure providers reach older people first, though, and the Colorado Department of Public Health and Environment also didn’t directly answer questions.
Polis said Friday that opening a new group will avoid delaying distribution, and that “the people who really wanted it” will have gotten their first shot by the time teachers and younger seniors are eligible. “Stragglers” can continue to sign up and get vaccinated, and enough doses will be available for everyone 70 and older in February, he said, without explaining how the state would ensure that.
“You will get it,” Polis said Monday. “You will have an opportunity in the next few weeks to get it at a place that’s convenient for you.”
Who gets the vaccine first doesn’t necessarily reflect who wants it most, because people who don’t have internet access or the time to make many phone calls are less likely to successfully navigate the sign-up system, said Dr. Matt Wynia, director of the Center for Bioethics and Humanities at University of Colorado’s Anschutz campus. They also are less likely to have a car to drive to a mass event, and may not have a primary care doctor to turn to, he said.
“The people who are easier to reach will tend to be the first to get vaccinated,” he said. “That will create some early disparities within each tier.”
People of color are more likely to face barriers to getting vaccinated, and state data shows Black and Latino Coloradans are underrepresented among those who got the shot compared to their share of the overall population. Colorado’s 70-and-older population is more likely to be white than younger age groups, however, which may explain some of the imbalance.
Essential workers wait again
Kim Cordova, president of United Food and Commercial Workers Local 7, said she understands the need to prioritize teachers so schools can stay open, but people working in the food industry should also be near the top of the list.
Meat-processing plants tied with assisted living facilities for the most deaths due to COVID-19 outbreaks among staff — 10 in each setting — according to data from the state health department.
In the state’s initial plan, essential workers would have received the vaccine at the same time as the 70-and-over group. In early January, the guidance changed, but they were still ahead of those in their 60s. Now, essential workers will have to wait until at least March.
Food processing and grocery store workers are still working without proper protective equipment, Cordova said, adding that employees in meatpacking plants can’t stay 6 feet apart and stores have been reluctant to force customers to put on their masks.
“They continue to risk their lives every time they clock in,” she said of essential workers. “They’ve been on the front lines for this entire pandemic.”
There’s an added risk for workers in food processing, because workplaces don’t allow for social distancing, and many workers live in crowded homes because of low wages, Berlinger with the Hastings Center said. Their work is largely invisible, however, and they may be unable to bring their concerns to politicians because they fear retaliation from their employers or being targeted for immigration enforcement, she said.
“That’s a huge challenge, when you have a population that is at high risk, and no one is especially responsible for their health care,” she said.
Reaching the hardest populations
In a perfect world, a large number of people would be vaccinated quickly, those at highest risk first. As it is, it’s difficult to meet both parts of states’ public health goal at the same time, Wynia said. But states and health care providers can offset some of the imbalance by reaching out to people who are less able to navigate the system, he said.
“Speed and simplicity are often in tension with equity,” he said. “It takes more energy and resources to achieve equity.”
Cordova said she expects it will be difficult to get most food-processing workers vaccinated, even when they become eligible. Employees of the JBS plant in Greeley alone speak 38 languages, many of which the state isn’t using in its communications. They also tend to rely on carpooling, she said, so it will be difficult to make and keep appointments.
“It’s not like they can just go on their lunch break,” she said.
Another way not to sacrifice speed is for states to focus on populations rather than individuals, Berlinger said. For example, it’s not necessary to identify all of the individuals who live in crowded housing if you can find the neighborhoods where those conditions are prevalent and set up a clinic there, she said.
Sherman said the state is hosting “equity clinics” in parts of the state with the highest concentration of low-income seniors, such as the San Luis Valley. Five pop-ups targeted the most vulnerable communities last weekend, he said, and another eight are scheduled for this week.
“We’re working hard on equity,” he said.
Some local health departments also are trying to reach the hardest-hit areas, like in Denver, which is relying on existing health care infrastructure to deliver the shots and having the city “fill in the gaps,” said Bob McDonald, executive director of the Denver Department of Public Health and Environment. That could include pop-up or mobile efforts, as well as working with existing organizations in underserved communities, he said.
It’s tempting to fault people who seem lower-risk for getting the shot while some of the oldest still wait, Wynia said, but skipping the shot or calling out others doesn’t solve the overall problem. If you’re offered the vaccine and turn it down, there’s no guarantee it will go to a person who needs it more, he said.
“We’re trying to get this vaccine into as many people as possible. If you’re offered the vaccine, you should take it,” he said.
But Berlinger disagreed: If you’re healthy and can safely work from home, she said, you should hold off getting the vaccine even if you qualify.
“I think we need to watch that we don’t rush for the good stuff and trample the vulnerable people,” she said.
This content was originally published here.