As New Jersey expands its coronavirus vaccine distribution this week, state officials announced that anyone 65 or over can now get the shots, as well as those between 16-64 with certain medical conditions.

One group covered among those medical conditions, though, has raised backlash – namely, the state’s roughly two million smokers, who can now get the vaccine before teachers or public transit workers.

State officials say smokers should be a priority for the nearly 732,000 doses New Jersey has received so far because, just like those suffering from other underlying medical conditions, they run the risk of experiencing more severe covid-19 symptoms.

“Smoking puts you at a significant risk for and adverse result from covid-19,” state Health Commissioner Judith Persichilli said at a Wednesday news conference.

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But some public health experts said they struggled to make sense of that decision.


“This would not be a group that would bubble up to high priority,” Eric Topol, a cardiologist and the founder and director of the Scripps Research Translational Institute, told The Washington Post. “Just smoking doesn’t cut it in my view,” arguing that only smokers also suffering from a chronic respiratory condition should get early vaccines.

The conflict highlights the difficult decisions that state officials must make in deciding how to deliver millions of doses of the vaccine and who should get first dibs, a process that has been delayed and hampered by uneven federal coordination, experts say.

New Jersey Gov. Phil Murphy, D, announced the changes Wednesday as the state seeks to accelerate a lagging vaccination operation that has failed to meet immunization targets. As of Thursday, at least 263,422 first doses had been administered in New Jersey, covering 7.5 percent of the prioritized population, according to The Post’s vaccine tracker.

The state had first opened up its vaccine supplies to health care workers, nursing home employees and residents, and later, police and firefighters. In his Wednesday announcement, Murphy said the medical conditions that will now be covered under the expansion include cancer, Type 2 diabetes, and chronic kidney disease, among others. State officials won’t require any documentation of the medical condition or the recipient’s age, Persichilli said.

By including smokers, the state health department noted that New Jersey was following Centers for Disease Control and Prevention guidance, which says smoking puts people at higher risk of developing severe symptoms of covid-19.

“Nicotine is one of the most powerful addictions,” a spokeswoman with the state’s health department told NBC New York in a statement. “Smoking put individuals at higher risk for more severe disease. If an individual who smokes gets covid, they get sicker much quicker.”


Some critics argued that smokers are choosing to put themselves at higher risk, and many could stay home to protect themselves – as opposed to taking a vaccination that could go to someone at higher risk.

Nick Zaneto, a teacher and coach at Metuchen High School told many at his school were shocked the state had prioritized smokers.

“It’s not a medical condition that you’re a smoker,” Zaneto told the local paper. “You’re making a personal choice to either vape or smoke cigarettes. As a teacher, we try to teach our students to stay away from bad habits like smoking, and this almost seems like a reward for those individuals.”

But Esther Choo, an emergency physician and professor at Oregon Health and Science University, says it’s wrong to de-prioritize smokers or others with substance abuse.

“There’s a very steep and judgmental slippery slope when we start to say that one group or the other does not deserve vaccines based on your health behavior, particularly when we understand smoking to be a substance use disorder,” Choo told The Post.

She added, “It’s a nuanced and balanced decision, but I actually agree with considering high-risk factors when it comes to vaccine prioritizing, and smoking is a high-risk factor.”

But Topol said many smokers don’t actually have the underlying medical issues that would put them at higher risk of covid-19 complications.

“Just being a smoker without chronic obstructive lung disease, that isn’t considered a coexisting condition,” he said. “It doesn’t deserve special priority in my view. If they have lung disease, asthma, diabetes, that’s a different matter.”