The United States has passed a significant milestone in its vaccine rollout: As of Monday, all adults are eligible for the COVID-19 vaccine in every state. More than half of the adult population has received at least one dose of a vaccine.
The country has come a long way since vaccines first arrived at hospitals and long-term care facilities in December. More than 209 million doses have been shot into arms. And universal eligibility comes on the heels of a confusing, patchwork system that may make a person eligible in one state, but not another.
But the next phase of the rollout will bring new challenges. Some scientists and state and local health officials believe that making more people eligible will ultimately get more people vaccinated more swiftly. But others have said they are worried that some of the most vulnerable people, including those 65 and older, may have trouble competing for a shot.
As it stands now, older adults are the most vaccinated age group in America — quite likely because they have been eligible in most states for months. But about one-fifth of those 65 and older, a group that is particularly vulnerable to serious complications and death from the virus, have not received even one shot. Among them are some residents of long-term care facilities, which have represented more than one-third of overall coronavirus deaths in the United States for much of the pandemic.
In mid-March, President Joe Biden challenged states to accelerate the rollout and expand eligibility to include all people 16 and older. And for the past several weeks, states have been shifting away from complicated phase-based plans that have prioritized certain vulnerable individuals, like older Americans, critical workers and those with certain medical conditions.
“No more having to sort out if you’re in or if you’re out,” Julie Willems Van Dijk, the deputy secretary of the Department of Health Services in Wisconsin, said in a speech in late March as the state made plans to expand eligibility. “It’s time to just move forward and get everybody with a shot in their arm.”
Vaccinations have sped up considerably since Biden’s announcement, when providers were administering, on average, about 2.2 million doses each day. Now, about 3.2 million shots are given, on average, every day.
One by one, states have made eligibility universal, meaning all people 16 and older qualify for shots. On Monday, the last group of states opened the floodgates, and some experts expressed worry over unvaccinated older adults.
It may not just be those in some parts of the country who have difficulty snatching up fast-changing appointments online. Cindy A. Prins, a public health researcher at the University of Florida, said that high-risk people who had been eligible for a vaccine for months but had not gotten one might be struggling with access.
“There may be people who are not necessarily homebound, but maybe they don’t drive,” Prins said. “Maybe it’s not easy and convenient for them to get somewhere to get vaccinated.”
She said that adding more younger people into the mix could spur states and counties to open more mass vaccination sites, but those sites might be intimidating or uncomfortable for older people — or anyone who is particularly vulnerable to the virus and does not want to participate in a crowded event.
“I think there are some folks who want to get the vaccine, but they’re still very worried about getting exposed to other people,” Prins said. “It’s a little bit of a strange situation where we’re like, ‘Stay away from everyone, but please come here to our massive vaccine clinic.’”
Prins added that some older adults could be waiting until their regular doctors or other health care providers can give them the vaccine.
There are many reasons eligible people may not be vaccinated, including, in some areas, lingering issues of short supply, limited access to vaccination sites and confusing procedures for booking appointments. Some older people may also be hesitant or unwilling to get a shot.
The New York Times recently analyzed vaccine records and voter records in every county in the United States and found that both willingness to receive a coronavirus vaccine and actual vaccination rates were lower, on average, in counties where a majority of residents voted to reelect former President Donald Trump in 2020.
But the partisan split is smaller among older adults, and polling has suggested that older Republicans are less reluctant to get a shot than younger ones.
Back in March, when Debra Furr-Holden, a public health researcher at Michigan State University, heard Biden urge states to make all adults eligible for the vaccine by May 1 — essentially, to scrap slower plans that emphasized certain priority groups with higher vulnerability — she said she started to tear up with disappointment. It was not what she wanted to hear.
“The eligibility categories were designed to ensure that those most at risk were served first,” said Furr-Holden, who was appointed last year by Gov. Gretchen Whitmer to Michigan’s Coronavirus Task Force on Racial Disparities. “We’ve fallen very short of that goal.”
In March, a Times analysis showed that people of color in the United States, for example, had received a smaller share of available vaccines.
Furr-Holden said she worried that vulnerable people, who, for whatever reason, had not gotten a shot quickly enough were inappropriately being made to forfeit their place in line. And she worried that a new privileged priority group would emerge.
“This is tantamount to sanctioned line-jumping,” she said. “You have transportation? You’re at the front of the line. You’ve got the kind of job where you can stand at a mass vaccination site for five hours? You’re at the front of the line.”
Those who are concerned that universal eligibility might sacrifice equity are thinking about creative solutions. Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity, suggested that, with the eligibility floodgates opened, health officials might directly encourage young people to help them vaccinate the older people in their lives.
She explained, “We need to start asking the younger folks, ‘Where’s your mom? Your grandmother? Have they all gotten their vaccines yet? If not, we’ve got several slots and we want your whole family here.’”