As the ongoing coronavirus pandemic deepens, with death tolls mounting and an even more infectious strain of the coronavirus now knocking at the door, the United States continues to drive headlong into a decentralized and disorganized vaccine rollout. As of January 8, the United States has vaccinated roughly six million Americans—far below the Trump administration’s goal of twenty million by the end of 2020. Worse yet, the federal government has largely left the states to their own devices in developing an actual vaccine distribution plan. Many states have simply opted to follow the CDC’s own problematic guidelines, which attempt to both curb the spread of the virus and minimize the death toll by prioritizing healthy essential workers alongside vulnerable seniors. The result is an incoherent vaccination strategy that not only fails to achieve either goal but also carries grave consequences for those groups most at risk of death.
One need not look further than recent developments in Maryland to grasp this strategy’s potential tragic results.
On Tuesday, Maryland Governor Larry Hogan announced new measures intended to hasten the state’s sluggish pace of vaccinations. Of the 273,000 doses allotted to the state last month, more than half remain in storage, unused. “While none of us are thrilled with the pace of this rollout over the first couple of weeks, I can assure you that it is improving every day,” Hogan told reporters.
The governor has activated the Maryland National Guard to assist local health clinics in vaccinating frontline health workers and has even threatened to redirect future vaccine doses away from hospitals that fail to use 75% of their allocation.
Regardless of these new efforts, however, Hogan cautioned Marylanders that the state is still constrained by a paltry allotment of doses from the federal government. With 72,000 doses delivered each week, the state is on track to vaccinate only 1.8 million residents by the end of May—just 30% of the population. “This is going to be a long haul,” he warned.
Given this limited supply, one might assume that Governor Hogan would opt to minimize Maryland’s death toll and prioritize the state’s most vulnerable residents—namely, seniors aged 65 and over, who account for roughly 80% of coronavirus deaths nationwide. Instead, he has revised the state’s distribution plan to reflect CDC guidelines, which prioritize essential workers alongside seniors. Phase 1B of the state’s plan now lumps seniors aged 75 and over together with teachers, prison inmates, and “continuity of government” personnel, while seniors between 65 and 74 are downgraded to Phase 1C, grouped together with workers in grocery stores, public transit, agriculture, and manufacturing. More astonishing yet, residents with serious underlying health conditions have been relegated to Phase 2, which might not begin until late spring or early summer.
This “have it both ways” approach creates a grotesque, shameful and unacceptable situation where those most at risk of death must now compete elbow-to-elbow with relatively younger, healthier residents. Grouping the elderly alongside essential workers all but guarantees that many seniors—who otherwise might have been swiftly vaccinated—will in fact die. Billionaire investor Bill Ackman has accused public health officials of ageism and even denounced their logistical mismanagement as a “genocide” against elderly Americans, arguing officials would never accept such high mortality rates among young people. In essence, Hogan is guilty of dereliction of duty. His bungling will likely result in further deaths among the most vulnerable part of the population.
With Maryland now set to hold off on vaccines for seniors aged 65 to 74 until early March, many residents have asked why the state does not simply follow the example of other states.
In neighboring Washington, D.C., Mayor Muriel Bowser has announced that the city will open vaccine appointments for DC residents aged 65 and over as soon as January 11—two weeks before essential workers will be able to do the same.
In other states, vaccinations for seniors are already well underway. In late December, Florida Governor Ron DeSantis announced he would place seniors ahead of essential workers in receiving the vaccine. While some state officials have praised the governor’s plan to prioritize vulnerable residents, Florida’s rollout is still plagued by mass confusion. Multiple news outlets have reported long waiting lines throughout the state, with hundreds of residents even camping outside overnight in frigid temperatures to receive a shot. Even in the face of such large-scale mismanagement, demand among Florida’s seniors for the vaccine remains high.
Former FDA commissioner Dr. Scott Gottlieb has emphasized this high demand as a key reason for states to prioritize the elderly ahead of other groups. Last week he told CNBC:
“If we have a group of Americans that we know wants the vaccine very badly and would take it quickly, and happens to be at the highest risk of a bad COVID outcome—and I’m thinking in particular about senior citizens in this country—I would just give it to them. I would make it generally available to them to the extent possible.”
Gottlieb continues to stress the importance of getting the vaccine in “as many arms as possible,” and cited vaccine skepticism among younger people, including health workers, as yet another reason to focus vaccination efforts on the elderly. “We shouldn’t be spending three weeks trying to push the vaccines into arms where you have some reluctance when we know those vaccines are sitting on a shelf and building on a shelf,” he concluded.
Thursday marked a grim new milestone for the United States, as the daily death toll surpassed 4,000 deaths for the first time since the pandemic began. Public health officials warn that darker days still lie ahead. As a new, more infectious strain of the virus begins to spread across the country, time is of the essence in vaccinating vulnerable Americans. Will state health officials like Hogan continue to imperil them or will they finally change course?
Jordan Henry is a research associate at the Center for the National Interest.