TALLAHASSEE — Gov. Ron DeSantis on Tuesday declared elderly Floridians will be next in line to get vaccinated for COVID-19, before essential workers and younger people with underlying health conditions, cementing the state’s position in a shifting public health policy debate.
During a press conference in The Villages retirement community, DeSantis said the state will be prioritizing people over the age of 70 for the next round of vaccine doses. He bristled at proposed recommendations from the U.S. Centers for Disease Control that would give the vaccine to essential workers and adults of any age with certain underlying conditions at the same time, in Phase 1b of the roll out.
“The vaccines are going to be targeted where the risk is going to be greatest, and that’s in our elderly population,” DeSantis said. “We are not going to put young, healthy workers ahead of our elderly, vulnerable population.”
The state is still in Phase 1a, with officials receiving and distributing two types of vaccine doses: Pfizer BioNTech and Moderna, both of which use messenger RNA technology and require two doses. The first doses of those vaccines are going to the vast majority of healthcare workers and residents of long-term care facilities, and DeSantis said the state has made considerable progress rolling them out.
That progress has led to a new debate over who should get vaccinated next in Florida. It’s a balancing act that touches on two demographics: those most at risk for severe outcomes, and those most at risk for exposure, said Natalie Dean, an infectious disease expert and professor of biostatistics at the University of Florida.
Dean pointed to one recently published COVID-19 vaccine prioritization model by researchers at Harvard University’s T.H. Chan School of Public Health and the University of Colorado. The model showed that inoculating younger people stops more transmission of the virus, but focusing on older people prevents more deaths.
But there are also ethical and logistical considerations, Dean emphasized, making the debate tricky.
“Obviously there’s a big differential in risk of severe disease by age, so the opportunity to prevent that mortality and directly protecting older adults is important,” Dean said. “On the flip side, older adults are more able to take cautious behavior and stay home. Essential workers can’t do that.”
While the Harvard and University of Colorado model relies on the vaccine being highly effective at blocking transmission, something which scientists view as likely but not yet proven, other studies have taken a wider view.
Researchers at the University of Washington’s Fred Hutchinson Cancer Research Center found that a less effective vaccine should be allocated to older people first, but with a highly-effective vaccine — such as those by Pfizer and Moderna — focusing on halting transmission among younger people would provide greater coverage.
Threading the needle
The nuances of the vaccine prioritization debate have left governors with some latitude in deciding how much to stick to the CDC’s recommendations.
Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security, published his team’s first vaccine priority recommendations in August, putting those over the age of 65 just ahead of essential workers. Toner said there are valid arguments for both sides.
“There’s no right or wrong here,” Toner said. “And it probably does vary from state to state, depending on the number of elderly in your state, which in Florida is probably pretty high.”
Toner said that the sheer number of essential workers was the determining factor in his group’s decision to recommend allocating doses to the elderly first. In some estimates, up to 40% of the workforce could be considered essential, he said, which could delay fully vaccinating the elderly for several months.
“I don’t fault any governor for going one way or the other,” Toner said. “I think that [the CDC’s Advisory Committee on Immunization Practices] was trying to thread the needle with a pretty tricky set of issues.”
More than just numbers
Dean, the University of Florida professor, emphasized that there could be logistics at work in choosing vaccine priorities.
At his press conference, DeSantis mentioned that it would be difficult for health officials to determine which underlying conditions qualified an adult under the age of 70 for a vaccine and which didn’t. The federal guidelines define that group as adults “with comorbid and underlying conditions that put them at significantly higher risk.”
“The problem is, how do you administer that?” DeSantis sasked. “Do you want to have the hospitals having to slice and dice everyone’s comorbidity? Do I say this person’s comorbidity counts, and this person’s doesn’t?”
There’s another factor at play, Dean said, which is the capacity of the vaccination program to boost morale and build confidence in the state’s efforts to achieve widespread vaccine coverage.
To that end, Dean said, vaccinating essential workers was an important opportunity for garnering buy-in from disenfranchised and working-class communities.
“There’s more to it sometimes than just the cold hard numbers,” she said. “There’s something to be said for the appearance of the vaccine program.”
As far as appearances go, the DeSantis event raised some questions about who in the elderly population would be prioritized in the absence of more detail about how the general public will actually get their shots.
Among the people at DeSantis’ event was longtime Republican state Sen. Dennis Baxley, a 68-year-old funeral home operator from nearby Ocala. Baxley’s presence appeared to take DeSantis by surprise.
“Sen. Baxley?” he asked. “Did you get offered to come do this, or what?”
Later, Baxley told the Times/Herald in an interview that while he was there, he did not get vaccinated but that there was a man there who bore a striking resemblance to him who did.
Florida has more than 3 million residents over the age of 70, and DeSantis said hospitals and community sites will vaccinate them over the next six weeks.
“If you’re in the elderly population, this is coming soon, and just stay tuned,” DeSantis said. “We’re a lot further along than we thought we’d be four months ago.”
Lawrence Mower reported from Tallahassee and Ben Conarck reported from Miami.
The video with this story is courtesy of Florida Channel and can be viewed in its entirety here.