Washington will next prioritize vaccinating anyone who is 70 years and older, or anyone 50 and above who lives in a multigenerational household, the Washington state Department of Health announced Wednesday.

Dr. Umair Shah, the state’s health secretary, said the state has not yet approved vaccinating people in this tier, called B1, but plans to later in January. Health providers and industry groups have been waiting for the guidance to begin preparations.

The new guidance establishes a complex web of priority tiers and charts the state’s course through the next four months of vaccination. As much of the nation struggles to increase the pace of vaccination, the guidance highlights the dual concerns of health officials, who must get vaccines into arms quickly, but also provide doses for those who stand to lose the most from COVID-19 if they are not protected.

“These are really tough decisions,” said Michele Roberts, the state Department of Health’s acting assistant secretary, who said the plan is designed to be an “equitable way to protect people in our state most at risk.”

Meanwhile, state data suggests the pace of vaccine administration continues to trail delivery, though it has improved since last week.

The federal government has sent to Washington state 522,550 doses of vaccine from Pfizer and Moderna to date, Shah said. Vaccine providers have administered at least 126,602 doses, Shah said, noting that data reporting of administration lags by about three days.

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In addition to the next tier of vaccinations the department detailed through April who else would be eligible for a COVID-19 vaccine, in phases B2, B3 and B4.


Phase B2, slated to begin sometime in February, prioritizes critical workers who are 50 and over and at high risk because they work closely with others, including K-12 school staff, jail or corrections workers, food processing workers and agriculture workers.

Phase B3, planned for March, includes anyone over the age of 16 who has two or more health conditions that overlap and cause concern with COVID-19.

Phase B4, which is aimed for April, includes high-risk critical workers of any age, as well as people and staff in congregate settings like homeless shelters, correction facilities and group homes.

Overall, the tier system refines and differs somewhat from federal guidelines, which suggested prioritizing those 75 and up, along with essential workers.

Roberts said the prioritization is designed to first protect seniors, who are most at risk of dying or suffering from severe disease.

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“We know many families take care of elders in their home and we want to make sure we’re reaching those families as well, to protect those at most risk,” Roberts said.

Roberts said the Health Department assessed data on risk specific to Washington state and also used feedback from the public in adjusting the state plan.

“75 is a pretty high age to start with,” Roberts said, adding that lowering the bar could avoid disproportionate impacts of the disease in some racial and ethnic groups that have lower average life expectancies.

Janet Baseman, a professor in the Department of Epidemiology at the University of Washington, said it was clear state health officials sought to strike a thoughtful balance with their system.

“Prioritizing vaccine, when there are vaccine shortages, is always fraught because there are clearly a lot of people who should get priority and not enough vaccine to get it to everybody at the same time,” Baseman said. “Trying to weigh the really elevated risk of death among the older age group and the greater risk of exposure among the essential workers is a real challenge.”

Baseman said speed is imperative, and if the system proves too complicated for those administering vaccine, it should be changed.

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“Anything that slows down the delivery of vaccine we have needs to be adjusted,” Baseman said.

Hospitals and industry groups for weeks have been clamoring for the state’s guidance.

“We’re pleased to have it,” said Cassie Sauer, chief executive of the Washington State Hospital Association, who said she was happy the groups outlined were “not so narrow” because hospitals had a difficult time parsing earlier advice on which health workers qualified.

Some industry groups still sought more information, though.

Tammie Hetrick, the president and chief executive officer of the Washington Food Industry Association, said she remained unsure if convenience store workers would qualify.

“I am waiting for clarification,” Hetrick said.

Hetrick said she understood the state’s reasoning with the tiers, but was disappointed with the timeline for vaccination, particularly because of its implications for the economy.

“I definitely wish we could find a way to expedite this. My next concern is when are we going to open up?” Hetrick said, acknowledging that federal vaccine supply and state administration are factors that could drive reopening plans. “Does this get us really where we need to be? Maybe it’s the best we can do.”  

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Meanwhile, some advocacy groups were displeased.

“The prioritization they have proposed does not protect our food supply and ultimately that is what this should be about,” said Erik Nicholson, who is representing the nonprofit United Farm Workers Foundation. Farmworkers younger than 50 would likely have to wait until April for vaccination, according to the state’s plan.

“It’s too late,” he said. “There are a large number of farmworkers working right now in the fields,” pruning grapes, cherries and other fruit.

Shah said the general public should avoid calling hospitals with questions about when they can be vaccinated.

Health officials said they plan to make available on Jan. 18 an online questionnaire tool called PhaseFinder, to help Washington residents identify when they are eligible to receive vaccine and where they could seek vaccination. The tool, and the state’s plan, rely on an honor system and for Washingtonians to faithfully represent themselves.

Shah said it was the department’s “top priority” to figure out how to speed vaccination’s first phase, which includes health care workers, first responders and long-term care residents.

Vaccine arrived in Washington state on Dec. 14., and some hospital workers received shots the next day. The effort to vaccinate at long-term care facilities largely relies on a federal partnership with CVS and Walgreens pharmacies that launched Dec. 28.

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Public health experts promised early days of vaccination would be marked by logistics hiccups, with underfunded health agencies and hospitals stressed by COVID-19 leading the effort to get vaccines into people’s arms. Indeed, the rollout in Washington has been uneven at times.

Early on, miscommunication between state and federal officials clouded the state’s expectations of vaccine supply, and shipments to hospitals were delayed or changed, confounding plans.

Some hospitals in rural areas have reported receiving an excess of vaccine for the number of people eligible in their communities. Many health care providers who qualify to be vaccinated, but are not connected to a large medical system, have reported difficulty finding sites to receive their first shots.

As concern grew over the pace of vaccination, the Health Department expanded the first phase to allow health workers not on the front lines to receive shots.

Some 96,000 doses of the allotment the federal government has sent to Washington have been set aside for people in long-term care facilities.

The federal program to vaccinate those in long-term care facilities is off to a “slower start than, I think, ideally, than we all wanted to see,” Roberts said.

Roberts said the state is working with Walgreens, CVS and the federal government to speed up that process, but said it was a complicated endeavor with about 2,400 facilities to visit. Those administering vaccine must sometimes travel from room to room.

“It’s a much slower pace than having employees standing in line,” Roberts said, making a comparison to hospitals.