Who is next for COVID vaccine in Texas? Abbott advisor says maybe middle-aged people

Asher Price
Austin American-Statesman
Republican State Rep. John Zerwas answer questions from the local news media during an update of  COVID-19 in the State of Texas.  Monday, June 22, 2020. Seated from left to right: Commissioner, Dr. John William Hellerstedt, Department of State Health Services Nim Kidd serves as the Chief of the Texas Division of Emergency Management and Texas Gov. Greg Abbott looks on during the press conference.

A top medical adviser to Gov. Greg Abbott said Texas could pursue an unusual approach as vaccine rollout continues: priority could be given to older middle-aged people instead of teachers, bus drivers and grocery store workers, among other frontline workers.

Such a strategy would run counter to federal recommendations and vaccination priorities of most other states — and raises questions of equity and fairness. 

The backlash could be fierce, particularly among public school teachers, most of whom have been back in classrooms since the fall because state education officials have given districts no choice but to offer in-person learning for any student who wants it.

"I’m more of one who likes to follow the epidemiology," Dr. John Zerwas, executive vice chancellor for health affairs for the University of Texas System, told the American-Statesman. "If there are people getting sick and dying related to particular industry, we need to address that. If not, if the highest risk groups are age related, we need to look at that."

Zerwas advised Abbott on reopening businesses following Abbott's stay-home order in April and serves on the state's Expert Vaccine Allocation Panel, which makes recommendations on vaccine distribution.

"Other countries are just going to go down age frames," Zerwas said, adding that he was speaking for himself and not the panel. "That's something we should look at."

Currently, state officials are limiting vaccination access to health care workers, emergency responders, residents of long-term care facilities, school nurses, people who provide mortuary or death services, people aged 65 and above and people aged 16 to 64 who have certain underlying health conditions — people designated in Groups 1A and 1B. 

Republican State Rep. John Zerwas answer questions from the local news media during an update of  COVID-19 in the State of Texas.  Monday, June 22, 2020.

An enormous number of Texans fall into those categories — at least 12.5 million people, or just under half the state's population, according to minutes of the state vaccine allocation panel obtained by the American-Statesman.

The panel has been discussing in recent weeks who should get vaccination priority next.

Composed of elected officials, medical experts, epidemiologists and emergency management officials, the 17-member panel makes recommendations to Dr. John Hellerstedt, commissioner of the Texas Department of State Health Services, for final vaccination distribution approval. Hellerstedt was appointed by Abbott and it's not clear what role, if any, Abbott plays in the decision.

State documentsobtained by the American-Statesman show that requests to the panel for early vaccine access came from representatives of home health care workers, rice farmers, federal judges, dialysis patients, journalists, 911 operators, veterinarians, tax assessor-collectors, the Salvation Army and Meals on Wheels, among other groups.

By far the most requests came on behalf of teachers, in public and private schools.

The weekly meetings of the state expert vaccine allocation panel are closed to the public. The Statesman filed a request under the Texas Public Information Act for recordings of the meetings, but was told none were made. Other members of the panel did not return Statesman requests for comment.

Minutes of the meetings obtained by the Statesman give the contours of deliberations about the next vaccination group.

On Jan 18, for example, the panel discussed federal recommendations for the next phase of vaccine rollout, including that first responders, corrections officers, food and agriculture laborers, postal workers, teachers and child care workers, and grocery workers be counted as essential workers — as well as options for how to define the category, known technically as Phase 1C, in Texas.

The minutes say "epidemiological evidence for inclusion of non-healthcare essential workers is discussed," adding that "some industries or occupational groups have high percentage of demographic groups who are disproportionately affected by COVID-19" and that "almost one quarter of essential workers live in low-income families."

There is no record in the minutes of who among the board members led these parts of the discussion.

The panel already has differed from federal guidance, which states that frontline essential workers, including teachers, should be vaccinated in group 1B.

Republican state Rep. John Zerwas, a physician from Richmond gives an update on Texas Hospital bed capacity and the strategy to fight COVID-19 in the state of Texas during a press conference at Texas Department of Public Safety.

Vaccination patchwork

As of early February, 24 states and Washington, D.C., were making vaccine available to teachers of kindergarten through high school.

Abbott, for his part, told the Statesman that he views vaccinating teachers as "very important as a key component of getting the state fully open, which I'm going to be working very aggressively to achieve as quickly as possible." 

"I want kids back in the classroom," Abbott said. 

Abbott said his chief goal when it comes to vaccine distribution is to save lives, followed by reducing the number of COVID-19 patients in Texas hospitals. 

"The math and science show the people who are most likely to lose their lives, face severe hospitalizations are people who are age 65 and older," he said. "Once we're through with that, (the vaccine distribution) will be opened up far more broadly."

The U.S. Centers for Disease Control and Prevention has recommended that Group 1B include "people who work in transportation and logistics, food service, housing construction and finance, information technology, communications, energy, law, media, public safety, and public health."

Phase 1C, according to the CDC, should include people aged 65-74 and people 16-64 with underlying medical conditions — those Texas prioritized in Phase 1B. The CDC recommends 1C also include a wider range of essential workers, including people working in transportation, food service, housing construction, information technology, communications, energy, law, media, public safety and public health. 

"As vaccine availability increases, vaccination recommendations will expand to include more groups," the CDC says in a Feb. 3 advisory.

Nursing student Kristen Tucker administers the Pfizer coronavirus vaccine to Dr. Carlos Meza at the University of Texas Health Austin Dell Medical School on December 15.

Leaders in some states — such as Alabama and Michigan, have said they will follow the CDC recommendations and soon release vaccines to workers in particular industries.

Other states are making the vaccine available to people in essential industries as well as to older middle aged people.

In California, for example, authorities have said they will follow CDC guidelines for the next phase of vaccine rollout — plus allow anyone over the age of 50 to get vaccinated. Kentucky is taking the same approach, but beginning at age 60.

Texas has not yet taken the step of singling out workers in a single industry — other than health care workers — as eligible for the vaccine. It is one of 18 states that have not yet landed on who will get priority with the next phase of vaccinations. And it is one of eight states not to release the vaccine to any essential workers, other than ones involved in health care.

Vaccination eligibility rules vary markedly by state, according to data compiled by the Kaiser Family Foundation: In Iowa, school teachers and daycare workers currently qualify for the vaccine; in Colorado, front-line journalists are among those now eligible; in Massachusetts, a person aged 16 to 74 must have at least two underlying conditions to be eligible.

Some Texas officials, including lawmakers, have asked the vaccine allocation panel to open up the rollout to teachers. 

On Monday, nearly all the members of the State Board of Education — Republicans and Democrats — asked that public school teachers and staff be immediately made eligible for the vaccine "to safeguard our academic recovery while preventing further, uncontrolled outbreaks."

Ascension Seton staff have begun vaccinating Austin ISD staff with a COVID-19 vaccine, giving priority to staff who work on campuses who are 65 and older.

Only one member of the board, Will Hickman, a Republican attorney from Houston, differed. He said teachers should not be made eligible until Phase 1C and that the state has rightly prioritized senior citizens.

Zeph Capo, president of the Texas branch of the American Federation of Teachers, said the delay in vaccinating teachers and other essential workers in puts lives at risk because "they are a conduit for this disease." 

"You can limit capacity at the Home Depot," he said. "That doesn’t happen in public education."

Vaccinating by age

The strategy of vaccinating by age group instead of occupation has precedence overseas.

The United Kingdom has already, in phases, made the vaccine available first to people over 80 and health care workers and in January to people in their 70s and those who are considered extremely vulnerable.

Going forward, beginning in late February and through the spring, authorities in the UK plan on opening up the vaccine in the following order: Those aged 65-69; those aged 16-64 with underlying conditions; those aged 60-64; those aged 55-59; and those aged 50-54, before releasing it to the general population. 

Taken together, the priority groups are estimated to represent 90% to 99% of those at risk of dying from Covid-19.

Experts have debated whether such an approach neglects some vulnerable people, particularly people of color working in frontline jobs.

While distributing by age "looks fair," said Jamboor Vishwanatha, director of the Texas Center for Health Disparities at the University of North Texas Health Science Center, the method means vaccination delays for some of the people most at risk — exposed, essential workers, many of them people of color. 

"They may be younger, but many of them may not realize they have underlying health conditions," Vishwanatha said. "Basically you’re making them at risk by putting them behind in the line for vaccinations. Occupation-wise would be a better way to go about it."

But in the United Kingdom, a government-appointed panel of top vaccinologists, epidemiologists and medical doctors came to a different conclusion.

The Joint Committee on Vaccination and Immunisation, which advises UK health departments on immunization, issued a December bulletin that declared that because its age-based distribution plan captures almost all preventable deaths from COVID-19, the committee "does not advise further prioritisation by occupation during the first phase of the programme."

The report said that while there is "clear evidence" that minority groups have higher rates of infection and serious disease and that "societal factors, such as occupation, household size, deprivation, and access to healthcare can increase susceptibility to COVID-19 and worsen outcomes following infection," prioritization of persons with underlying health conditions will "provide for greater vaccination of (minority) communities who are disproportionately affected by such health conditions."

A follow-up report in January by the UK Department of Health and Social Care declared that "an age-based programme will likely result in faster delivery and better uptake in those at the highest risk."

'Fair and equitable'

The Expert Vaccine Allocation Panel meets weekly, virtually, for sessions that generally convene around 7:15 a.m. on Mondays and last a couple of hours.

The minutes obtained by the Statesman show that the meetings typically start with officials at the state health department briefing panelists about distribution of the vaccine from the federal level, news of vaccination approvals, and problems vaccine providers are encountering.

Discussions in recent weeks have ranged from the distribution of vaccine within prisons to how to improve vaccine registration. 

The membership of the panel, chaired by Hellerstedt's deputy, Imelda Garcia, the associate commissioner for laboratory and infectious disease services, was drawn up to bring urban and rural and other perspectives, Department of Health Services spokesperson Lara Anton said.

Anton said the governor's office was consulted about the makeup of the panel. The Statesman has filed open records requests regarding the appointment of its members.

The lawmakers on the panel are state Sen. Lois Kolkhorst, R-Brenham, who chairs the Health and Human Services Committee; Rep. Senfronia Thompson, D-Houston, who has chaired the Public Health Committee; Rep. Stephanie Klick, R-Fort Worth, a registered nurse; and Sen. Eddie Lucio, D-Brownsville. 

Zerwas, an anesthesiologist and former Republican lawmaker, said that politics have played no role in the committee's deliberations.

The focus is "really getting the vaccine into arms of people who need it most. Once you let epidemiology drive the decision making, the politics evaporate, frankly," he said. 

The privacy of the panel "does allow for very open, candid conversations, without the worry that the conversation is going to be picked up by outlets in way that doesn't give the full flavor of the conversation."

"I think the panel is having a significant impact on commissioner (Hellerstedt)’s decisions," Zerwas said, pointing, as an example to the development of hubs to hasten the distribution of the vaccine in populous counties. 

"The commissioner has a great deal of confidence in the deliberations of the panel," Zerwas continued, "and the ultimate recommendations of the panel. This is not a group of people that's shy about letting their voice known. Not everyone agrees with what comes out — but everyone agrees that they've all been able to provide input."

Hellerstedt did not make himself available for an interview to answer questions about the panel.

"The regular cadence that we’ve developed is to try to allocate the vaccine in a fair and equitable way," Zerwas said.

Staff writer Nicole Cobler contributed to this report.