How Did Ohio Decide Who Is First In Line For The COVID-19 Vaccine?

More people are becoming eligible for the COVID-19 vaccine in Ohio, with teachers and people over the age of 70 getting the shots this week. But some groups who are at risk – such as police officers, funeral directors, and low-wage essential workers – are still not prioritized in the state’s plans.

The COVID-19 vaccines have to be rationed because there is such a limited supply, but some people have questioned how the priority groups were decided and whether the distribution has been ethical thus far.

The federal  Centers for Disease Control and Prevention (CDC) has an official list of recommendations for who should get the vaccine and in what order, but it is ultimately up to each state to determine its own priority list.

“If [states] differ from the CDC, that’s one thing, but they don’t want to be really out of step,” said Mark Aulisio, department chair of bioethics at Case Western Reserve University (CWRU).

The CDC based its priorities around protecting people most at risk of dying of COVID, while also preserving the essential functions of society, Aulisio said.

Ohio’s list is close to the CDC’s, but it is not an exact match, he said.

For instance, both the CDC and Ohio have front line health care workers and residents of nursing homes in the very top priority group. In fact, Ohio moved nursing homes to its first phase after the CDC came out with its recommendations, Aulisio said. 

Nursing homes were also a top priority for vaccine distribution because of that population's vulnerability – more than half of Ohio's coronavirus deaths have occurred in long-term care facilities. 

While the CDC put first responders in its second phase, Ohio included them in its first phase, but this came with some controversy.

Ohio’s first responders group only included emergency medical services (EMS) responders and firefighters – not the police, which is not sitting well with officers across the state.

Adam Chaloupka, a local attorney for the Ohio Patrolmen’s Benevolent Association (OPBA), said police are exposed on the front lines every day.

“Police may have more so interaction with the public at large, because of everything that they’re responsible with dealing with, all the different types of calls,” Chaloupka said.

The OPBA sent a letter to the governor at the beginning of January asking for police officers to have access to the vaccine. The state is now in Phase 1B of distribution, and police are still not eligible.

A possible rationale for prioritizing EMS over police could be because those workers deal with sick people every day, and are possibly more at risk of coming into contact with COVID, said Sharona Hoffman, co-director of the Law-Medicine Center at CWRU.

“We know that they are transporting people with COVID, so I think there’s a difference,” Hoffman said.

“A police officer may or may not come into contact with people who have COVID, though it’s certainly a possibility," she said.

Chaloupka has heard from law enforcement personnel that they are eager to get this vaccine, especially corrections officers.

“They are basically in lockdown with coronavirus patients, no different than medical personnel, inside the jails and the prisons,” Chaloupka said.

Many of these facilities, including the Cuyahoga County Jail, struggled to contain COVID-19 outbreaks among inmates, and nine prison staff members have died in Ohio since the start of the pandemic.

In the Cleveland area, some police officers may already have had access to the vaccine depending on where they work, Chaloupka added. For example, MetroHealth, which was one of the first hospitals in the state to receive a supply of vaccines back in December, allotted doses to its security staff.

While Chaloupka applauds MetroHealth's efforts with security staff, he wishes more of his clients also had access, he said.

In addition to police officers, others who work directly with the public are also frustrated by Ohio’s distribution plans.

Funeral directors sent a letter to the governor’s office asking to be prioritized, saying they are often handling bodies of people who died of COVID.

Child care workers have also voiced concerns, as they were not included with teachers, who are eligible this week.

Essential workers, such as restaurant and grocery store employees and people in the manufacturing sector, are also still waiting to be prioritized. While the CDC put this group in its Phase 1B, Ohio opted to instead prioritize people over the age of 65 and individuals with certain medical conditions over essential workers in this current distribution phase.

There could be major ethical implications in not prioritizing essential workers, Aulisio said.

“They’re also at increased risk from the nature of the job, and on top of all that they’re not compensated very well. And then if you bridge that over to who tends to fill those jobs. You do have a racial and ethnic disproportionate representation from those groups,” Aulisio said.

“Low-paying jobs, even if deemed essential, often don’t have health benefits. So, should those people be prioritized? I think the answer is yes," he said.

Aside from being a scarce resource, the current COVID-19 vaccines have come with another problem during distribution: they must be kept at cold temperatures, and once vials are opened, the doses inside have a limited amount of time before they expire.

If a vial is opened and there are no more vaccine appointments for the day, vaccine providers scramble to administer the extra doses before they go to waste.

In some parts of the country, pharmacies have offered up the extra doses to anyone in the general public, bypassing people the priority groups.

While Hoffman at CWRU thinks providers should try as best they can to contact people in the eligible groups to get the shots before opening them up to the general public, she recognizes that there is not enough infrastructure in place for this to happen every time.

“We want them to be vaccinating, not making a whole lot of phone calls and doing research on who can we get in here,” she said. “There are a lot of things to balance.”

The Ohio Department of Health has asked health departments and other vaccine providers to put plans in place to ensure no doses go to waste. The Tuscarawas County Health Department, located in Dover about 90 minutes south of Cleveland, created a ‘no waste’ waitlistthat anyone aged 18 and over in the county can sign up for.

If people in Phase 1B do not show up for their vaccine appointments, or if there are extra doses available at the end of the day, the health department calls people from that list who can get there quickly before the vaccine expires, bypassing other people in the 1B population, said Jennifer Demuth, director of community relations at the health department.

“The current priority groups are older individuals, [and] it can be very difficult for them to get to the health department quickly when they have these last-minute needs to use the vaccine serum,” Demuth said.

More than 2,000 people have signed up for this list so far, she said, and health officials have already called some people on the list in the past couple of weeks.

“They’re very happy. They usually rush to get to us, and they’re usually overjoyed to be able to get this life-saving serum,” Demuth said.

Aulisio at Case agrees with Hoffman that plans like this are ethically sound.

“In the cases where you’ve got vaccine, and you’re having trouble finding willing recipients, and you don’t have an alternative … it’s pretty understandable that people want to get vaccines in the arms,” he said. “We’ve got to have a significant portion of the population vaccinated.”

Overall, both ethics experts at Case think Ohio’s vaccine distribution has made good sense, with few hiccups from an ethical standpoint.

“You can certainly argue about where the lines were drawn and what judgment calls were made, but I think there was an effort to be thoughtful about it,” Hoffman said.

State officials have not yet released plans for the next phase of Ohio's vaccine distribution, although Aulisio speculates essential workers will likely be the next eligible group.