Frustrated and caught off-guard, local public health officials plan for expanded COVID-19 vaccine eligibility

Across the state, local public health departments were pivoting their COVID-19 vaccine distribution plans on Friday, an effort that likely will continue throughout the weekend after the state abruptly announced it was expanding eligibility to include Iowans with underlying medical conditions starting next week.

Local officials say they had little warning before state officials made the announcement Thursday evening, leaving them with no time to adequately plan their strategies and putting further strain on local vaccine providers that already are feeling the pressure to meet the demand for shots while the supply still is limited.

'It is a strain,” Heather Meador, clinical services supervisor at Linn County Public Health, said on Friday. 'It's hard for all our vaccine providers when we don't know that these things are coming out and we can't do anything beforehand.

'But this is what we do at public health. We will work this weekend, we will come up with a plan and we will share it. It's not something we anticipated for this weekend, but we're going to get it done.”

Iowans aged 65 and older as well as certain essential workers, such as teachers, manufacturing workers and first responders, currently qualify for a COVID-19 vaccine.

Starting Monday, any individual aged 64 and younger that has a qualifying medical condition can receive a shot, state officials announced in a news release. Though they didn't release a specific list of conditions, the announcement pointed to a list compiled by the federal Centers for Disease Control and Prevention.

The list includes cancer, heart conditions, pregnancy, smoking, diabetes, obesity and hypertension or high blood pressure, among several other underlying conditions.

The expanded eligibility vastly increases the number of Iowans who will be able to receive a COVID-19 vaccine, accounting for a large percentage of each county population by some estimations.

And because demand for the vaccine still far outweighs the supply, some county public health departments are opting to focus on current priority populations before moving onto this new group, meaning those with qualifying health conditions may have to wait before getting a shot.

'It's hard to meet that demand when the supply is not there,” said Sam Jarvis, community health manager for Johnson County Public Health.

'Once again, we are continuing to ask for patience and we will really do our best to communicate any changes.”

In some counties, newly qualified Iowans will have to wait

Meador could not offer any details as to how Linn County - which receives 3,600 doses per week from the state - will coordinate rollout for this new population.

She did tell reporters during a news conference Friday the change will not take place until the week of March 15. Appointments already have been scheduled for older residents next week will not be affected by this announcement.

Johnson County Public Health will prioritize Iowans aged 65 and older at this time, and will continue to set aside half its weekly allocation to older Iowans and the other half to essential workers who fall under the Phase 1B tiers.

There's still hundreds left in the county who qualify under that phase, Jarvis said, who noted officials 'have made good progress.” He estimated somewhere between 60 percent and 70 percent of age-eligible residents have received a vaccine.

Jarvis said residents with underlying medical conditions can seek out vaccine appointments at retail pharmacies that receive doses from state and federal entities, including Hy-Vee, CVS, Walgreens and other retailers.

While they're not completely barring Iowans with underlying medical conditions from vaccine clinics, Jones County Public Health will continue to focus on Phase 1B 'before we start making a concerted effort on the next phase,” Director Jenna Lovaas said.

Washington County Public Health Administrator Danielle Pettit-Majewski said her department has made a similar decision. She's glad the vaccine effort can reach more Iowans, but said it will be a challenge to meet the demand while weekly dose allocations remain limited.

'We still have a lot of people aged 65 and older that still need to vaccine, not to mention the remaining three tiers,” she said. 'We're doing the best we can, and we hope our partners can help ease the burden.”

State public health officials said the move comes after 'several Iowa counties” reported they are nearing completion for vaccinating other priority population groups.

However, other local public health departments in Eastern Iowa - including Washington and Jones counties - say they're still far from that finish line.

'We're not close at all,” Pettit-Majewski said.

Jones County doesn't have a Hy-Vee or another retail pharmacy with an allocation of shots, Lovaas said, limiting options and even creating barriers for older Iowans who are unable to travel outside the county for appointments.

‘A large percentage of our population'

Including these underlying medical conditions means a huge increase in the number of Iowans who will be seeking a vaccine, ramping up demand for shots already available in very limited supply and putting more strain on county public health departments managing the distribution, local officials say.

'For all intents and purposes, this has opened it up to almost everyone in the state,” Lovaas said.

Federal officials estimate half of adults have a chronic medical condition, an Iowa Department of Public Health spokeswoman told The Des Moines Register, adding that Iowa has about 1.9 million adults aged 18 to 64.

Local public health officials only have rough estimates of the number of individuals who could receive a shot under this new state directive. Meador said accounting for qualifiers, such as anyone who has ever smoked a cigarette, that's 'a large percentage of our population,” Meador said.

'We know that this is going to be a significant population, and that's why we're asking for continuous patience,” she said.

'We know that's hard. People are tired of being patient and being told to be patient. We understand that.”

Public health officials pointed to obesity, hypertension and heart conditions as some of the more likely health conditions among Iowans who may seek out the vaccine.

It's estimated two-thirds of Americans are considered overweight, or have a body mass index of 25 and above.

According to the CDC, more than 73 percent of the adult population in the United States is overweight. At least 42 percent are considered obese, with a body mass index of 30 and above, according to the 2018 data.

Heart conditions also are common, with at least 48 percent of U.S. adults who report having some form of cardiovascular disease, according to the American Heart Association. Heart disease was the leading cause of death in Iowa in 2019, accounting for a death rate of nearly 173 deaths per 100,000 people, according to the CDC.

State public health officials informed county health departments in a call Friday that vaccine supply is expected to increase sometime in the near future, alleviating some of the demand.

President Joe Biden this week stated there should be enough COVID-19 vaccine available to offer shots to all adults by the end of May.

But until that supply increases, Iowans are asked to remain patient. Residents also should continue to wear masks, social distance and use other precautions to prevent the spread of the virus.

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