California officials on Friday said that people between the ages of 16 and 64 who are disabled or at high risk for morbidity and mortality from COVID-19 will be eligible to be vaccinated beginning next month.
The move comes after weeks of debate over who will get to the front of the line for precious doses, which remain in short supply. Officials estimate the move will make 4 million to 6 million more people eligible for the vaccine, bringing the total number of Californians eligible to between 17 million and 20 million, or about half the state.
But supplies remain very limited. Based on current allocation projections, California won’t come close to meeting demand for some time. It will ultimately be up to local providers to decide who gets the vaccine immediately, with medical workers, first responders, people 65 and over, teachers and essential workers all vying for shots.
The underlying conditions explicitly stated include cancer; chronic kidney disease of stage four or above; chronic pulmonary disease; Down syndrome; immunocompromised immune system from solid organ transplant; pregnancy; sickle cell disease; heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies (excluding hypertension); severe obesity; and Type 2 diabetes mellitus.
The state also broadly defined eligible individuals as those who are likely to develop a severe life-threatening illness or death from a COVID-19 infection or are limited in their ability to receive ongoing care or services vital to their survival.
These groups can begin getting the vaccine March 15.
State Health and Human Services Secretary Mark Ghaly did not provide details on what verification individuals would need to provide in order to receive the vaccine.
The news follows a meeting last week set by a high-level task force with members from the departments of Aging, Disability Services and Health and Human Services that hashed out details of a proposal raised by a vaccine advisory committee.
Gov. Gavin Newsom’s previous announcement last month that the state would shift vaccine priority to an age-based eligibility structure sparked concerns from groups representing the disability community who may now have to wait longer to get vaccinated, with hundreds sharing their frustrations on social media.
Friday’s announcement was welcomed by advocates.
“There’s no question that there’s going to be a lot of challenges, but there’s also no question that this new policy is dramatically better,” said Andy Imparato of Disability Rights California, who also serves on the state’s vaccine advisory committee. “This creates a safety valve for people under 65,” who may still face significant risk.
Imparato said he hoped the new rule would ease the disparities that have plagued the vaccine rollout so far. Many of the same factors that have made the pandemic more deadly in Black, Latino and Native American communities also create or intensify disabilities, so extending the current tier to include those with significant comorbidities would mean more doses reached hard-hit communities than in an age-based system, he said.
“We can look on a map and say which ZIP Code has the most COVID cases — these are often the same communities that have higher rates of diabetes and other comorbid conditions,” said Dr. Kirsten Bibbins-Domingo, an epidemiologist and co-founder of the UCSF Center for Vulnerable Populations. “But that type of language [around severe risk] is hard to implement, and programs that are hard to implement create problems with efficiency and problems with equity.”
In particular, she and others worried that the documentation requirement could gum up the works of California’s already sluggish vaccination program.
“We need to be careful about not splitting hairs about who’s disabled enough to get vaccinated,” said Dr. Alyssa Burgart, a bioethicist at Stanford. “It’s so easy to show what your age is. But there is immense variety in the type of disability that can place you at higher risk from COVID.”
Alice Wong, 46, a disabled activist in San Francisco who created the hashtag #HighRiskCA in response to the change, agreed.
“There are lots of people who don’t have a primary care provider [to provide documentation],” she said. “We don’t need more hurdles.”