As vaccines have rolled into states, it looks like the national prioritization plan has fallen by the wayside. That’s not entirely true but also not entirely false, which means that your patients are likely to have questions about when they will be eligible. Here’s what happened and how you can keep track of who’s eligible and who’s next in your state.

The CDC’s Advisory Committee on Immunization Practices (ACIP) updated its recommendations for allocation of COVID-19 vaccine on December 20, 2020 to guide federal, state, and local jurisdictions while demand for the vaccine exceeds supply.

Essentially, the ACIP provided a road map. When the rubber met the road, however, other officials were driving—governors, public-health directors, sometimes health-system administrators, and even pharmacists. Some of them chose to go a significantly different route; others decided to change the stops along the way.

Everyone started out on the same path with phase 1A. Across the board, the first group to receive vaccines has included nursing home residents and healthcare workers. Then, the divergence started.

The ACIP’s recommendation put people aged 75 years and older, front-line essential workers, and first responders in phase 1b. Phase 1c included individuals aged 65 to 74 years, those aged 16 to 64 years with high-risk medical conditions, and essential workers not in 1b.

However, the facts on the ground turned out to be different than expected. In rural Georgia, for instance, many healthcare workers declined early access to the vaccine, leaving extra doses in some parts of the state, while hospitals in Atlanta clamored for enough to immunize their staff. Gov. Brian Kemp vowed to get more people vaccinated through redistribution and expansion of eligibility to anyone over age 65 years in phase 1a. Arizona stuck with the ACIP’s recommendations, but some counties have moved on to 1b while others remain at 1a. Florida, North Dakota, and Texas have opened 1b to anyone over age 65 years, but Arkansas has prioritized essential workers over those aged 65 to 75 years.

Alaska also added everyone over age 65 years to phase 1b. The state’s Chief Medical Officer, Anne Zink, MD, explained that Alaska had a smaller elderly population than other states and that the state’s limited number of nursing home beds meant that few older Alaskans would have been vaccinated in phase 1a. She also noted that there “was just a real emphasis, I think culturally, on elders as a priority group in the state overall,” in an interview with Alaska Public Media. Those elders will have priority over others in phase 1b, such as teachers, postal workers, grocery store employees, and bus drivers.

In Maryland, the rollout started out slower than anticipated, with hospitals using just 34% of their allocations and the program, with Walgreens and CVS to administer shots at nursing homes, distributing only 14% of its doses in the first 3 weeks. To get doses into arms faster, Gov. Larry Hogan moved all Marylanders over age 74 years into phase 1a and added teachers and childcare providers to phase 1b. He also mandated reporting of all shots administered within 24 hours and ordered all providers with excess vaccine to notify the health department for reallocation. More generally, Hogan said that the state would not wait to complete vaccinations of everyone in one priority group before moving on to others.

The state-by-state and, in some cases, county-by-county variation makes staying in touch with your county public health department and carefully following your state’s department of health announcements vital for planning purposes. With priorities and vaccine availability changing daily, community pharmacies may find their state is eager to get them involved in the vaccination process sooner than expected. Stay tuned!

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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