Why Washington's Rollout of COVID Vaccine Eligibility Has Been Slower Than in Other States


Perhaps you are reading this and you are young(ish) and healthy and have the luxury of being able to work from home. Maybe you should count your blessings.

But perhaps you've also been working from home and avoiding restaurants and indoor gatherings and crowds and fun for more than a year and you'd really like a vaccine and a return to normal life.

And there's your cousin in New York who booked an appointment for next week. And your college roommate in Texas who got his vaccine a while back. And your friend in California who's younger than you are and awfully healthy and lives on the beach and how on earth did she get it already?

Vaccine longing. Vaccine envy. Vaccine FOMO.

As more and more states across the country open vaccine eligibility to all adult residents, Washington has taken a more measured approach, opening eligibility to ever-larger tranches of the population, but holding off on the free-for-all that open eligibility would bring.

Some of that angst was assuaged Wednesday, as Gov. Jay Inslee announced that all Washington residents age 16 and up will be eligible to receive vaccines starting April 15.

Washington joins at least 38 other states that had already made vaccines available to all adults, or said they'll do so in April. New York and California, with similar political leanings as Washington, both announced last week they'd be expanding vaccine eligibility to all adults within weeks.

But moving faster on vaccine eligibility does not necessarily equate to moving faster on vaccines. Supply of vaccine from the federal government, as ever, remains the limiting factor in getting shots into people's arms.

The state had been hesitant to open eligibility too quickly, worried that with limited supply the most vulnerable would be left out in a broader rush for appointments.

"Washington remains focused on metrics that look at both risk and equity," Shelby Anderson, a spokesperson for the state Department of Health, said Tuesday. "We want to afford people in Washington who are at higher risk the chance to get the vaccine before people who are at lower risk."

Other states have also seen more vaccine hesitancy among residents, said Cassie Sauer, president and CEO of the Washington State Hospital Association.

In those states, opening eligibility can be a way to spur demand if it begins to slack.

"Washington state has been very science-based in its response and seems to be very science-based in the public's appetite for vaccine," Sauer said.

Washington, despite moving slower than many on eligibility, is among the best states in the country at getting shots out the door, with more than 90% of the first doses the state has received already in someone's arm, according to data from the federal Centers for Disease control and Prevention. Washington has given out more than 3.2 million shots of vaccine, with about 27% of the population receiving at least one dose so far, according to state data. Nearly three-quarters of Washington residents over age 65 have received at least one dose, according to state data.

Another 2 million Washington residents became vaccine-eligible Wednesday — people over 60; adults with at least two health conditions; restaurant, construction and manufacturing workers; military dependents over age 18. They join older residents, health care workers, teachers and agricultural and grocery workers.

There are now far more Washington residents (over age 16) eligible for the vaccine than ineligible.

But with eligibility qualifications getting ever-more specific and difficult to verify — what qualifies as a comorbidity again and what's a congregate setting? — some had been calling to cut the confusion and just open the doors to all.

"It's become too confusing and people are trying to figure out, do they fit, do they not fit," Seattle Mayor Jenny Durkan said on Q13 Fox last weekend. "Make every adult eligible."

Durkan said government could still try to prioritize equitable distribution by reserving certain time slots for select groups and ages. She compared it to how grocery stores had seniors-only hours earlier in the pandemic.

A national survey released Tuesday from the Kaiser Family Foundation found that 30% of people who have not been vaccinated are unsure of whether they're currently eligible to be vaccinated.

"We learned through the pandemic that it is extremely important for the public to have clear communication on what steps were being taken and what we needed the public to do," Durkan spokesperson Kelsey Nyland said. As we approach May, and as supply increases, "the mayor believes the state should consider expanding eligibility sooner to all community members to reduce confusion."

Dr. Jeff Duchin, health officer for Public Health — Seattle & King County, pushed back on Durkan's call to open the doors of eligibility. It represented one of the rare public disagreements among local leaders who have been praised for presenting a unified voice during the pandemic.

Opening up eligibility to all, right now, would "only make our situation worse," Duchin said last week, and "exacerbate the gap between supply and demand."

The state's tiered eligibility phases, Duchin said, have been aimed at an equitable distribution, to get vaccines first to people at the highest risk of infection, hospitalization and death.

"I very much support expanding eligibility as soon as we can be assured a supply that is proportional to the number eligible so that we do not add a large number of newly eligible people who will be competing with those who are currently prioritized," Duchin said Tuesday.

One concern shared by both Durkan and Duchin is cheating. The eligiblity requirements, Duchin said, at least provide some guardrails to keep the process from turning into a free-for-all.

Increasing eligibility, when demand still so far outstrips supply, Duchin said, could just make it easier for people — likely the young and well-off — to game the system.

"We know that people who have more resources and are more savvy about seeking vaccine are able to acquire it more readily and that would potentially further disenfranchise some of the communities that are already under-vaccinated," Duchin said.

On the other hand, the more complicated the rules, the more they differ from other states, the more opportunity there is to skirt them, be it intentionally or not.

"There's this whole thing, are people jumping or cheating the line," Durkan said. "There's enough confusion and there's enough differing standards from state to state that we should really focus on our job as government and to focus on prioritizing those people who are most vulnerable to disease."

In the meantime, for some ineligible people, finding a reputable way to get a vaccine has become almost a part-time job. The young(er) and the healthy queue up outside mass vaccination clinics at the end of the day, hoping for a spare dose that would otherwise go to waste.

Dave Zucker, 43, of Seattle, has been trying to volunteer at a vaccine clinic, an offer of altruism with, admittedly, a self-serving side effect.

"It seems to be fairly widely known and understood that volunteering at a vaccination site is a pretty good way to get a 'leftover' dose at the end of the day," Zucker said. "I've been trying for weeks to sign up at the Lumen Field site, with no success."

Or perhaps you've gotten one of those emails. One was going around last week. The subject line: "Fwd: Fwd: Fwd: Fwd: Fwd: Vaccine eligibility."

"Know there's a lot of ethically shady behavior happening in the general vaccine space these days, but wanted to share something," the sender wrote. His co-worker's sister works at a hospital in South King County and "apparently they were seeing 200-300 cancellations a day," the emailer wrote. "They have just decided to allow people to book appt slots proactively."

He included a link to book an appointment.

"It worked!" he wrote.

A spokesperson for the hospital said that most of the email was false. The hospital is not seeing cancellations anywhere close to 200 a day and appointments are, for now, open only to people who meet state eligibility requirements.

Beth LeValley, 25, has watched, from afar, as her parents in Iowa got the vaccine. Then four of her siblings, and their spouses, all of whom have at least booked an appointment.

Mostly, she's excited for them. She's also a little confused — "I'm wondering how the states are determining these policies on who's eligible and who isn't."

And, let's be honest, there's a little bit of envy mixed in. She sees her family sharing meals, her siblings stopping in at her parents' house.

"They are now actually getting out and doing things and can safely do that, where we're still being safer about everyone and staying home a lot of the time," LeValley, who works in marketing in Seattle, said. "It's just kind of weird to see everyone getting vaccinated and I'm just sitting here."

Still, big picture: The vaccines are a medical miracle and her turn is coming.

"I'm just excited that the vaccine is being rolled out and distributed even if I can't get one right now," LeValley said. "It's really encouraging to see others getting them."