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Fighting for a place in line

Months into the vaccine rollout, many Americans with underlying medical conditions are desperate to know: When can I get vaccinated?

The answer, it turns out, depends almost entirely on where you live.

At least 37 states are inoculating people with certain medical conditions that may increase their risk of severe Covid-19, but the details can vary from state to state and even county to county, according to a Times survey. This hodgepodge of rules has set off a free-for-all among vulnerable individuals who are pleading with health and political officials to add their condition to the vaccine priority list.

The problem, medical ethicists say, is that because the coronavirus is new, we don’t yet have a lot of data on which medical conditions make people most vulnerable.

Some studies have shown that people with certain conditions are more likely to be hospitalized or fall severely ill with Covid-19. The Centers for Disease Control and Prevention has established a list of 12 conditions that elevate a person’s risk, based on substantial evidence — including obesity, Type 2 diabetes, smoking and Down syndrome.

But medical ethicists say the list is misleading because it suggests that the risks for all medical conditions have been evaluated and ranked. Is a 50-year-old with Type 1 diabetes at higher risk than a 25-year-old with sickle cell disease or a 35-year-old with intellectual disabilities? At this moment, it’s hard to know.

In the absence of extensive data, and because vaccine rules are set by governors, people are resorting to social media, letters and public pleas to have their health conditions bumped up on the vaccine priority list. State government officials say their decisions often come down to some combination of evidence, logistics and politics.

“That is not how our public policies should be decided — on who is better at advocating,” said Kara Ayers, the director of the Center for Dignity in Healthcare for People With Disabilities.

The result is that people with cystic fibrosis can get vaccinated now in at least 17 states, but patients with the condition in other states have to wait. Ohio added bone marrow transplant patients to its list last week after initially offering the vaccine only to those who had received a solid-organ transplant. Smokers can get shots in some states, but not in New Hampshire, which requires two medical conditions to qualify for a Covid vaccine.

Across the country, people like Jessica von Goeler, of Arlington, Mass., feel left out. She has Type 1 diabetes and started a petition to persuade her state to add her condition to its eligibility list.

“It feels like many of the prejudices I’ve fought my whole life I’m fighting all in one bucket to get access to this vaccine,” she said.
The New York Times