Jim Kenyon: No rhyme or reason in how we dole out vaccines

  • Jim Kenyon. Copyright (c) Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Columnist
Published: 3/9/2021 11:09:37 PM
Modified: 3/10/2021 2:53:39 PM

I’m glad New Hampshire and Vermont have finally recognized that teachers should get their COVID-19 vaccines sooner rather than later.

Still, it’s not enough.

People who work in restaurants, stores and on college campuses at jobs that put them at high risk for contracting the coronavirus continue to be left out. Prison inmates also need to be a higher priority for vaccines.

But don’t take my word for it.

Anne Sosin, a policy fellow at the Nelson A. Rockefeller Center at Dartmouth College, has argued for a while that states should move away from doling out vaccines primarily by age.

Recent outbreaks at Dartmouth and the Northern State Correctional Facility in Newport, Vt., “highlight the importance of prioritizing people who work or live in high-risk settings,” she told me on Monday.

Age-banding, as it’s called, “assumes everyone is equally vulnerable,” Sosin said. “But not everyone has an equal chance of being exposed in the first place.

“If you have a 40-year-old who works from home and has been getting groceries delivered curbside for a year, they have a low risk of getting infected.”

Compare that to the 30-year-old single mom, who works as a waitress. What choice does she have other than to surround herself with strangers who, for the most part, aren’t wearing masks while dining indoors? She has to work to get paid.

In New Hampshire, health workers, first responders, the “medically vulnerable” and anyone age 65 and older make up the bulk of the 9% of residents who are fully vaccinated.

This week, New Hampshire moved into Phase 2 of its rollout, which covers K-12 school and childcare staff. Next up are residents between ages 50 and 64.

In Vermont, people age 65 and older and health workers of all ages are among those currently eligible for vaccines. Starting this week, teachers, public safety workers and people 16 and older with high-risk medical conditions can also get shots.

Meanwhile, two dozen officers in Dartmouth’s Department of Safety and Security are still waiting. “They have frequent contact with students, and they can’t get vaccinated. It’s ridiculous,” said Chris Peck, president of Local 560 of the Service Employees’ International Union, which represents 540 rank-and-file workers at the college, including security officers.

The officers are often called upon to give rides to students to their dorms, and if they’re not feeling well, to Dick’s House, the college’s infirmary. They also have to break up on-campus parties, which again puts them in potentially high-risk situations.

Dartmouth custodians who clean dorms also have not had their number called in the vaccine lottery. One exception is the custodians who work at Dick’s House.

“The college has been fighting to get as many people vaccinated as they can,” said Peck, a college painter. “But it’s state controlled.”

In an email, Dartmouth spokeswoman Diana Lawrence told me the college is “actively tracking vaccine developments and preparing to help distribute and administer vaccines if and when we are asked or permitted to do so.”

It doesn’t appear the Dartmouth outbreak, which reached more than 120 confirmed cases last week, has spread beyond campus. Still, the outbreak raises the question: Should Dartmouth students be moved up in the vaccine pecking order?

“It’s probably too early to prioritize them, given the short supply,” Sosin said. “But they need to be vaccinated before they come back in the fall.”

While Dartmouth tried to contain its outbreak by requiring students to eat alone in their rooms and remain on campus, the Vermont Department of Corrections had placed the state’s largest prison, with 340 inmates, in the Northeast Kingdom in lockdown.

Since the outbreak was reported in late February, 136 prisoners and a dozen staffers have tested positive. “The outbreak really demonstrates the limitations of the age-banding approach that Vermont has adopted,” said Sosin, who co-leads Dartmouth research on COVID-19 and rural health equity in northern New England. “When we fail to prioritize prisons, it threatens the health of whole communities.”

That’s because even prisons encased by high fences aren’t self-contained bubbles. Prison employees live in surrounding communities, where they shop and their children go to school. Nationally, rural prisons could increase the COVID-19 infection rate by some 15% to 35% over comparable counties without prisons, according to a study by the Prison Policy Initiative.

With the one-shot Johnson & Johnson vaccine becoming available, Vermont expects its supply to increase enough to begin vaccinating corrections officers this week. New Hampshire has already started.

Neither state, however, is in a hurry to get shots into inmates’ arms. Across the country, the decision not to prioritize inmates seems more about politics than public health.

“Some would say prisoners do not deserve to be prioritized for a vaccine because they’ve harmed society,” U.S. News & World Report wrote last month. “In any event, there is no room for moral judgment about who deserves the vaccine — only about who needs it.”

Since many prisoners are in their 20s and 30s, sticking with vaccination plans that focus on age groups rather than risk factors allows states to sidestep the need to prioritize their incarcerated population.

In January, the nonprofit Kaiser Family Foundation wrote that some states are “creating new and more complex priority groupings. Identifying specific priority groups may more effectively target a limited supply of vaccines, but also lead to great difficulty in implementing vaccine distribution plans and make it harder to communicate those plans to the public.”

Sosin understands why states are largely holding to vaccinating by age groups. “They have lots of competing claims for a limited supply of vaccines,” she said. “Age-banding is really efficient and simple, but it’s not an equitable approach to vaccination.”

Jim Kenyon can be reached at jkenyon@vnews.com.


Anne Sosin is now a policy fellow at the Nelson A. Rock efeller Center at Dartmouth College. An earlier version of this column gave an outdated reference to Sosin's position at Dartmouth.

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