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NY vaccine eligibility expansion called 'too far, too fast,' but unavoidable

Drivers lined up to get the COVID-19 vaccine

Drivers lined up to get the COVID-19 vaccine at Jones Beach on Jan. 31. Credit: James Carbone

New York keeps expanding its COVID-19 vaccine eligibility list even though people already on it are having a hard time getting an actual shot.

If you think another round of expansion seems "too fast, too soon," some lawmakers would agree. Some say the state has "gone from A to D to C to F to E" when it comes to determining eligibility. And adding to the list exacerbates an already maddening problem of getting a vaccination appointment.

But they also say the state has had to follow zigzagging federal guidelines and expanding lists and can’t go backward on eligibility now. Vaccine supply — 10 million eligible New Yorkers are "chasing" the 300,000 or so doses the state receives each week — is the most important issue, they say.

"The quick answer is we never should have expanded the list to 65 (years old) and older because of the lack of supply," Assemb. John McDonald (D-Cohoes), a pharmacist, said of one of the decisions that exploded the state’s eligibility list.

"But that die was cast" when the Trump administration said states should include that population, McDonald said.

"The reality is people would have been really mad if (New York) didn’t," he said. "We followed the federal government and we went too far too fast, all with the best of intentions."

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At issue was Gov. Andrew M. Cuomo’s decisions to add those at least 65 and quickly add taxi drivers, then restaurant workers and then people younger than 65 who have comorbidities. Combined with the others already on the list — health care workers, long-term care residents, essential front-line workers — it grew the eligibility for the pool to roughly 10 million New Yorkers.

The crush came partly because of shifting federal recommendations on eligibility, which Cuomo said he is following, even though they are not binding.

"What they did was like opening the floodgates of eligibility, and you have a rush of seven million people: ‘I want the vaccine. I want it now. I was told I’m eligible,’ " Cuomo said at the time the Trump administration told states to allow 65-year-olds to register.

"We are going to accept the federal guidance," Cuomo said on a separate day in January. "I don’t want New Yorkers to think that we are not doing everything we can to make them eligible for the vaccine, because I want to keep people in New York as calm as we can ... in these anxious times."

At the same time, Cuomo acknowledged continual expansion could make getting an appointment harder and increase anxiety.

"You’re telling people today, ‘You’re eligible.’ But you’re simultaneously telling people, ‘We don’t have enough dosages to get to you for the next six months,’ " Cuomo said. "Is that helpful? I don’t think so. I think it creates more frustration and more anxiety."

There has been some zigzagging about who was eligible and who wasn’t, state and local officials said.

And many of those decisions should have been months ago, before a vaccine was even viable, said Assemb. Richard Gottfried, chairman of the Assembly Health Committee.

But the Manhattan Democrat doesn’t fault Cuomo for expanding eligibility so quickly: "Given there's going to be a degree of resistance in any one group, it's better to have too many eligible than too few — because you don't want sites with too many vaccines for too few patients, resulting in throwing away unused doses.

"Considering how difficult it is for a lot of people to find their way through the sign-up process, it does make sense to give people a lot of notice of when they’ll be eligible," Gottfried said.

He said the state perhaps should have gone with 68 years old and up or a more limited list of comorbidities, then, after those people had time to sign up, gradually expand the list. But he acknowledged it’s "hard to say which group should be ahead of another group."

"The state has done some things out of order. But we just have to catch up," said Marc Molinaro, the Dutchess County executive and 2018 Republican gubernatorial nominee. He has been one of the most outspoken county leaders critical of Cuomo for not sooner deploying county health departments, all of whom have mass vaccination plans.

"Everyone feels powerless right now," he said.

Rich Azzopardi, a Cuomo spokesman, said expanding eligibility "makes sense" given most health care and front-line workers are "basically done."

"Counties have been vaccinating front-line workers for weeks and we were able to get additional vaccines to allow counties to opt in to vaccinate cab drivers, restaurant workers and the developmentally disabled as some have wanted," Azzopardi said. "At the same time, hospitals have been focused on health care workers for weeks and close to hitting all those who wanted the vaccine. It makes sense to move onto the next group that is the most susceptible to this virus."

A new national Gallup Poll shows about two-thirds of Americans are frustrated with how hard it is to get vaccinated — long lines, confusing sign-up process, shortages of doses.

On the positive side, interest in getting the vaccine is growing — now up to 71% of those surveyed.

Now, with President Joe Biden announcing the U.S. has purchased enough vaccines to inoculate almost all Americans by July, some say the focus should be on improving the systems for getting people signed up.

Molinaro said the state should "redistribute doses a bit" to send more to county health departments, federal clinics and some doctor offices to meet local demand.

McDonald and other legislators have advocated a universal "preregistration system" that would allow the state to keep its COVID-19 vaccine prioritization goals, set appointments efficiently and reduce anxiety. It’s a method Florida and other states are using.

"The concern I have now is people getting disillusioned" about getting an appointment, McDonald said, "and then just not caring anymore."

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