ALBANY – Lobbying at the State Capitol is a business of considerable interests and advocacy.
But the latest behind-the-scenes cause, never quite before imagined, has taken on a life-versus-death appeal: who gets priority status to receive access to a vaccine that could keep people from dying and contribute to the end of a pandemic ravaging the world since last winter.
As thousands of health care workers began receiving inoculations since the start of New York’s Covid-19 vaccination program, many more interests – from medical examiners and social welfare workers to teachers – want a spot in the line that, in the words of one group, provides access to the vaccine, “sooner rather than later.”
With initial vaccine doses limited, supply is now nowhere near meeting demand, and that’s with strict rules about who can be inoculated.
For weeks even before the first boxes of vaccines crossed into New York last weekend, groups representing an assortment of occupations and vulnerable populations have been reaching out to Gov. Andrew M. Cuomo, his advisers and state health officials to try to score a higher spot in the pecking order for who gets a Covid vaccine and when.
“It is with a sense of urgency that we present our concerns today. To keep vulnerable adults and children safe, we need the staff that have personal contact with them to be vaccinated sooner rather than later," Sheila Harrigan, executive director of the New York Public Welfare Association, wrote in a Dec. 10 letter to Cuomo.
The group, which represents 58 local social services departments run by counties, urged Cuomo to provide a “higher priority for vaccination” for child welfare and adult protective services staff who investigate abuse and other claims, as well as social services workers who have direct contact with people to consider applications for everything from Medicaid to food assistance programs.
“Vaccinating these staff keeps the public safe," Harrigan wrote to Cuomo.
The push has worked for some, but not others.
A week ago, 19 Democratic members of the Assembly wrote an urgent appeal to Cuomo and Dr. Howard Zucker, the state health commissioner, to raise concerns that emergency medical services workers were not going to be in the initial wave of people to get the first of two vaccine doses. They said the state was not complying with federal health guidelines – designed by an advisory panel at the U.S. Centers for Disease Control and Prevention – to ensure all health care workers, including EMTs, have access to the vaccine early on if they have potential exposure to Covid patients.
In a Dec. 11 letter, the lawmakers said EMS workers had to be included in what’s called Phase 1A or “else our already overburdened system will face collapse."
The day before, the New York State Volunteer Ambulance & Rescue Association asked Cuomo to do “everything in your power” to rapidly obtain vaccines for front-line health care workers, saying he should “shorten the gap” between vaccinating hospital workers and EMS personnel who also care for Covid patients. EMS workers regularly come in contact with Covid patients, and they called getting access soon to vaccines “a vital step in protecting our members.”
Within hours of the letter from Assembly Democrats, Cuomo administration officials called them with an assurance: EMS workers would be in an initial vaccination wave. Administration officials later said, via Twitter and in a Cuomo news conference, that EMS workers were always going to be in Phase 1, but that there are not enough vaccine doses in the first batch to cover all eligible health care workers. Between vaccines developed by Pfizer, the first federally approved vaccine maker, and Moderna, which got federal backing on Friday to release its vaccine to the public, the state expects to have about 500,000 doses available to various health care workers.
“I’m relieved that emergency workers are in that group because they put themselves in harm’s way even before Covid,’’ said Assemblywoman Karen McMahon, an Amherst Democrat who signed the letter about the EMS personnel.
“It’s going to be tough covering people. It’s going to take a while and I am concerned that there are people in the lines not getting vaccinated," she said.
A long rollout
New York, with 19 million residents, was granted access to 170,000 doses in the first round of the Pfizer vaccine distribution. On the initial priority list: certain hospital workers, such as those in intensive care and emergency units, as well as residents and staff of nursing homes, which continue to be especially hard hit by the pandemic. More than 600 facilities are enrolled in a federal program that will see the doses administered through CVS and Walgreens.
The state has strict prohibitions against a hospital “re-directing” vaccine doses to anyone not in a population being targeted during one of the phases for inoculation. “Adherence to the NYS prioritization and allocation framework is an essential part of maintaining equity and fairness throughout the distribution process," states a state health department form that hospitals, for instance, can fill out to redirect a vaccine to other eligible workers if there is an excess in supplies.
Next in line for vaccines, according to the state, will be long-term and congregate care residents and staff, EMS workers and other health care providers, coroners and medical examiners.
The county coroners and medical examiners made a public pitch to Cuomo on Dec. 11 – three days before the first person was vaccinated in New York.
“We think that it’s very important that if a vaccine comes out that coroners, medical examiners and people who actually go to the scene and handle deceased patients be protected with a vaccine when that becomes available," Dr. Robert Cole, the Steuben County coroner and first vice president of the New York State Association of County Coroners and Medical Examines, said that Friday.
A changing metric
The vaccination program has not been a static one in New York or other states, as governors have fine-tuned how they would oversee what is part of the largest vaccination effort in world history. Ideas promoted in September or October have been revised, depending on the state, as more information about the federal vaccine program has also been revised.
The Kaiser Family Foundation, a California-based, nonpartisan health research group, recently noted that seven states depart in some way from federal guidelines for the initial vaccination phase. Nevada, New Hampshire and Nevada, for instance, include law enforcement in the first round, while Massachusetts includes people incarcerated or living in homeless shelters.
Cuomo last week made a major change in the vaccination program: In New York, after Phase 1 – covering key health care workers and jobs like EMS and coroners – Phase 2 will begin, possibly in late January. That phase will be overseen by the state government, but local hospital systems will be in charge of vaccine distribution. In Western New York, the Catholic Health System will oversee the local effort.
Phase 2 covers what the administration has said will be people considered to be “priority general public.” Those are people with certain underlying health conditions. Phase 2 also covers “essential” workers.
What is an essential worker? The administration did not specifically say, pointing to a new Cuomo policy that will decide that issue – using state and regional input – in the weeks ahead. The state last spring designated certain essential jobs that could continue operating during the economic shutdown; it was unclear if that list would be followed for the vaccine program or if some job sectors could be dropped or added.
Groups weigh in
Various job sectors are expected to lobby to get their workers on that “essential” list for the Phase 2 vaccinations.
Andy Pallotta, president of the New York State United Teachers union, made clear what he expects from the state for inoculating any of the more than 200,000 public school teachers who want to get the vaccine.
“All education professionals – both teachers and support staff – provide critical services to their communities, and we believe they should be given priority access to the Covid vaccine should they choose to receive it when it becomes available," Pallotta said in a statement Thursday.
Some have already been successful in their vaccination priority outreach with the state. On Thursday, New York Disability Advocates, which represents nonprofits that provide care and support for 40,000 people with intellectual and developmental disabilities, released a statement praising Cuomo for putting its community of staff and clients on the priority list.
Tom McAlvanah, president of the group, said it took several months of outreach to the state to get its community of caregivers and clients onto that list. Among the pieces of ammunition: a Syracuse University and SUNY Upstate Medical University study showing how people with intellectual and developmental disabilities living in certified residential settings are at “especially high risk” with the Covid virus.
“We were heard. It was a great victory for us," McAlvanah said of the effort that saw letters and calls start about two months ago to Cuomo officials. Inoculations are due to begin sometime in the coming week.
The effort was based on scientific evidence, he said, that proved the need for their request. “We did that,’’ he said, adding: “It was clear that this population is vulnerable.”