Which Essential Workers Should Get Vaccinated First? States Face A Painful Decision

When the coronavirus pandemic first started, John Costa, president of the Amalgamated Transit Union, lost sleep wondering if the bus drivers that his union represents should be pulled off the job to avoid getting sick. Nine months later, with multiple COVID-19 vaccines on the horizon, a different question keeps Costa up at night: When can his members get vaccinated?

“I understand doctors and nurses [going first]. We should be at least the next round in essential workers,” Costa told HuffPost. “We’re in a can all day driving, with hundreds of people coming in and out.”

Federal and state officials are undertaking the most ambitious and complex vaccination program in U.S. history, and promising clinical trials so far have buoyed hopes that an end to the pandemic is within sight. But difficult decisions lie ahead about which groups should get the first available doses. 

Each state will make its own final decisions on who gets priority, while looking to the federal government for advice. An advisory committee for the Centers for Disease Control and Prevention issued guidance last week saying frontline health care workers and nursing home residents should be vaccinated first. Officials must soon decide whether other essential workers and elderly people who are not in long-term care should be next in line.

The former group includes more than 55 million workers in a host of critical industries, from farm workers and bus drivers to grocery store clerks and teachers. A disproportionate number of these workers are people of color, and all of them face varying levels of exposure to COVID-19.

The Food and Drug Administration is likely to approve the first of several vaccines later this week. Late last month, Costa sent letters to all 50 governors making a case for why bus drivers should be vaccinated early, noting how critical they are to transporting other frontline workers and how much contact they have with the general public.

What’s more, his union has lost 94 members to COVID-19 around the country so far.

“Our members are getting sick at a rate that is much higher than the general population because we are continuously exposed to large crowds,” Costa wrote the governors.

Other unions representing millions of workers in essential fields, such as meatpacking, transit and warehousing, are making similar urgent pitches about the hazards they have faced on the job for months, often with little or no hazard pay.

“Each state is going to have a slightly different take on what is an essential worker,” said Josh Michaud, associate director for global health policy at the Kaiser Family Foundation, a nonprofit focused on health care issues. “Understandably, these different groups are lobbying basically to be at the front of the line.”

The CDC’s advisory committee will continue to make recommendations on how best to distribute vaccines as they become available, though states are ultimately free to adopt or ignore them. In guidance still to come, the CDC will most likely categorize different types of essential workers according to risk level, Michaud said, but it may not go so far as to create a clear road map that states should follow when vaccinating millions of workers. 

The end result could be a mix of science-based recommendations and political considerations that reflect a particular state’s economy. For instance, a state that relies heavily on tourism could decide that hospitality workers are economically critical and move them up in the line.

“There’s a lot of gray area here,” Michaud said.

The United Food and Commercial Workers Union has urged the CDC to give priority to all workers in grocery, meatpacking and food processing. At least 350 of the union’s members in those fields have died from COVID-19 so far. Meatpacking plants in particular have seen some of the worst clusters in the country.

Marc Perrone, the union’s president, said in a statement that vaccinating food-chain workers “is essential to keeping our communities safe and stopping future outbreaks.”

Last week, the CDC issued guidance that already shows some of the thorny questions states will face when deciding which essential workers to prioritize. For example, the advisory panel’s recommendations for the first round of vaccines listed emergency medical technicians but did not explicitly include firefighters. Yet, many firefighters are cross-trained as EMTs and perform frontline medical care.

The International Association of Fire Fighters, a union representing 320,000 firefighters and paramedics, sent a letter to CDC Director Robert Redfield on Wednesday, saying it was “deeply disappointed” that firefighters were not part of the initial guidance. The union asked that all firefighters be designated for the first round of vaccines.

“Doctors and nurses ― there isn’t anyone who thinks they shouldn’t be tier 1,” Doug Stern, a union spokesperson, told HuffPost. “But they have the benefit of people coming to them in the hospital where they can be protected. Our firefighters and EMTs are going out to people’s houses. … We’re the first link in the public-health chain.” 

The American Federation of Teachers, a union with 1.7 million members, has been pushing the CDC and states to prioritize teachers. The union also represents a number of health care workers and has asked the CDC to clarify that staff in congregate living facilities and emergency dispatchers are included in the early distribution.

“Our members who are 911 and 311 dispatchers are not only working under duress, but also in crowded conditions where there are very few if any mitigation strategies,” the union said in its letter to the CDC.

Even if states do manage to order workers according to priority, they may still face difficult choices within those groups. What should be done for someone who is an essential worker but also has a health condition that puts them at significantly higher risk for COVID-19?

“Does that put you ahead of people who are just an essential worker? It’s going to be a real challenge,” Michaud said. “Just thinking about this one group, you can tie yourself in knots thinking about how this will work. Then you expand that to everybody.”