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CDC: States should prioritize people with disabilities as they broaden vaccine access

J&J’s one-shot vaccine ‘might be desirable’ for people who move frequently and for prisoners and people who are in homeless shelters, the agency advises

With the arrival of the first doses of Johnson & Johnson coronavirus vaccine, federal health authorities Tuesday issued new guidance about who should be first in line for shots. (Gaelen Morse/Reuters) (Stringer/Reuters)
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With the nationwide demand for coronavirus shots continuing to far outstrip supply, the Centers for Disease Control and Prevention said Tuesday states should consider prioritizing people with disabilities or cognitive decline as officials broaden access to vaccines.

The guidance is part of the agency’s latest recommendations for administering doses now that three vaccines are authorized and recommended for use to combat covid-19, the disease caused by the coronavirus. Any of the three can be used during these initial phases when supply is sharply limited, officials say.

The newest addition to the pandemic arsenal — the one-shot Johnson & Johnson vaccine that does not need to be kept frozen — might be best for people who want to be immunized quickly or would have difficulty returning for a second shot. The other two authorized vaccines — one from pharmaceutical giant Pfizer and German biotech company BioNTech, and the other from U.S. biotech firm Moderna — require two doses.

The Johnson & Johnson vaccine may be most suitable for people who move frequently or those who live and work in homeless shelters or correctional facilities, the CDC said.

Experts noted that the latest guidance reflects more attention to the real-world challenges that have surfaced throughout the country as many people who are prioritized for the shots are unable to make appointments online. States and localities have adopted widely differing approaches, resulting in a patchwork of guidelines governing who should get early access to the vaccines as more transmissible and possibly more dangerous variants circulate in this country. State officials announce changes to those priorities frequently, causing further confusion.

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Many older adults designated as the highest priority for inoculation have been unable to register for vaccinations because of glitchy online systems or lack of Internet access. That has often left children and grandchildren spending hours hunting for appointments. Volunteer groups and individuals have sprung into action to help in some cases, while technology columnists have offered advice on strategies to master vaccine websites.

“There is growing concern about reaching those who may face unique barriers to access — people who are disabled, those in congregate settings outside of long-term care facilities, and those who have technological or geographic barriers,” said Jennifer Kates, a senior vice president at the Kaiser Family Foundation, which has been tracking how states have prioritized groups for vaccination.

“Whether states will follow this guidance remains to be seen,” she added.

The guidance gives flexibility to local officials, and “many real-world care providers would really welcome this,” said Jeanne Marrazzo, the director of the infectious-diseases division at the University of Alabama at Birmingham.

The potential downside, she said, is that it does not provide as much specificity as some might like when supply is scarce and many people are clamoring for a first dose and assurances they will get their second.

“The solution to all of this debate is to get more vaccine out there, period,” she said. “We don’t have time to quibble about the nuances of who deserves to get it first.”

The latest CDC guidance urges states to consider the “unique needs” of people with disabilities or cognitive decline and their caretakers, and “those with limited access to technology,” as appointments open to new groups. After health-care workers and nursing home staff and residents, the CDC vaccine advisory panel has recommended the next priority groups include adults 65 and older, essential workers, and those 16 to 64 with medical conditions that put them at high risk for severe cases of covid-19. Many states are already vaccinating those 65 and older. Fewer states have begun inoculating those with high-risk conditions.

Advocates for people with disabilities say the updated guidance is a step in the right direction but does not go far enough.

“It doesn’t resolve the overall uncertainty and lack of clarity for people with disabilities and their families,” said Peter V. Berns, chief executive officer for the Arc of the United States, which advocates for people with intellectual and developmental disabilities.

The implementation guidance said the easier-to-use Johnson & Johnson vaccine might be the best fit for certain populations. Because it does not have to be frozen, it can be used in mobile clinics or sites that do not have freezer capacity and “may be desirable” for mobile populations or populations with high turnover, such as homeless shelters or correctional facilities.

One of every five prisoners in state and federal corrections facilities has tested positive for the coronavirus, a rate more than four times that of the general population, according to data collected by the Associated Press and the Marshall Project. In some states, more than half of prisoners have been infected.

“It’s not just that the covid-19 virus spreads faster behind bars, it’s that the preexisting medical conditions that make covid-19 more dangerous are more common behind bars, not to mention that you have people in prison working jobs like the kitchen and the laundry room that are essential to the prison itself being able to function,” said Wanda Bertram, a spokeswoman for the Prison Policy Initiative, a nonprofit research and advocacy group for criminal justice reform.