A new KFF analysis examines the different approaches states are taking to manage the limited initial supply of COVID-19 vaccines and balance the desire to vaccinate those at greatest risk first with the need to ensure a fast and effective statewide vaccination effort.
Based on a review of state vaccination plans, the analysis finds that states are increasingly departing from the Centers for Disease Control and Prevention’s recommendations as they move through the first three phases of distribution (known as Phases 1a, 1b and 1c).
Key findings include:
- All states and the District of Columbia are prioritizing health care workers and long-term care residents and staff in Phase 1a of their plans as recommended, though 16 states depart from the recommendations in some way. This includes 10 states that are prioritizing law enforcement and/or other first responders in the initial group, and one state (Utah) that is vaccinating K-12 and childcare workers.
- Of the 44 states that have updated their Phase 1b priority groups, 14 follow the CDC’s recommendations exactly and will prioritize people ages 75 and older and frontline essential workers outside of health care, including first responders, corrections officers, food and agriculture workers, postal workers, manufacturing workers, grocery store workers, public transit workers, teachers and education support staff, and child care workers.
- Among the 30 states that depart from the Phase 1b recommendations, 23 include a broader range of older residents (generally ages 65 and older), 18 use modified definitions for eligible frontline workers, including several that limit frontline workers to educators and/or first responders. Many also include those in other congregate settings, particularly people who are incarcerated and homeless, in their priority groups.
- Of the 33 states that have updated their Phase 1c priority groups, 17 follow the CDC’s recommendation to prioritize people ages 65-74, younger people with high-risk medical conditions, and any essential workers not included in earlier phases. In most cases, the variations stem from decisions to include some groups earlier in the vaccination line, though some states expanded the age groups and/or narrowed the definition of essential workers in Phase 1c.
- Most states (40) still remain in Phase 1a of their vaccine roll-out overall or for some counties within the state; only 10 states and the District of Columbia have moved into vaccinating those in Phase 1b.
The analysis concludes that identifying specific priority groups may more effectively target a limited supply of vaccines, but may also lead to greater difficulty in implementing vaccine distribution plans and make it harder to communicate those plans to the public. The growing variations across states suggest that a person’s place in the COVID-19 vaccine priority line will increasingly depend on where they live.
The analysis includes a data table showing how each state is prioritizing vaccination efforts in these early phases. KFF will update this data as states reveal, clarify and revise their prioritization plans.