California could prioritize age above all for COVID vaccine. Essential workers are upset

Jeong Park
·6 min read

José Padilla spent the last few months calling on California to prioritize vaccinating its farmworkers, who have to go to the field nearly every day and often can’t practice social distancing.

Last month, he and other advocates for farmworkers got a win when California listed essential workers such as farmworkers, teachers and grocery store clerks to be vaccinated right after those in the healthcare industry.

But as California, like much of the nation, redirects its focus to vaccinating residents 65 and older, Padilla wonders whether essential workers will be left behind.

“You cannot be changing the rules in your sixth meeting,” said Padilla, the executive director at the California Rural Legal Assistance. “That’s not fair to any of us trying to understand how equity is applied. All of a certain, the notion of equity has changed.”

For the past few weeks, California has tried to strike a delicate balance between vaccinating essential workers and older residents, whom both have been hit hard by the coronavirus pandemic that has killed more than 35,000 in the state.

But with California having trouble both getting and giving the vaccine, state officials are openly mulling prioritizing older residents ahead of all the other factors, including one’s job. That has advocates worried that essential workers, from teachers to farmworkers, will be left behind.

With state officials saying it could take until June to vaccinate all Californians 65 and older at the current pace, that could mean essential workers will have to wait until this summer to be vaccinated.

“We want it to be equitable, but you can’t compare the vulnerability solely based on age,” said Esther Bejarano, programs manager of Imperial County-based environmental justice advocacy organization Comité Cívico del Valle, at a recent meeting of the state’s Community Vaccine Advisory Committee.

Why prioritize age for COVID-19 vaccine

State officials say prioritizing age makes sense given older people have a much higher rate of hospitalization and death from COVID-19.

“We’re really thinking very seriously about focusing primarily on age and not as much on the sectors we’ve been collectively spending a lot of time on,” State Epidemiologist Dr. Erica Pan said at the committee’s meeting.

Centers for Disease Control and Prevention data shows those 85 years and over are 630 times more likely to die from COVID-19 than those aged 18 to 29. Those aged 75 to 84 are 220 times more likely to die, and those aged 65 to 74 are 90 times more likely to die than those aged 18 to 29.

Three-quarters of those who died from COVID-19 in California were 65 or older, according to data presented to the Community Vaccine Advisory Committee.

By vaccinating older adults first, the state could push down the number of those hospitalized, which could benefit the community as a whole, California Department of Public Health Director Dr. Tomás J. Aragón said at the meeting.

The state also wants to make its vaccination phases and tiers easier to understand, Surgeon General Dr. Nadine Burke-Harris said at the meeting.

“There is a great need for simplicity and clarity. We really have to look at consistency and clarity statewide as we’re looking at our vaccine rollout,” she said. “Simplifying saves lives.”

Vaccines for teachers and school reopening

Advocates don’t contest that older adults need the vaccine. But they also want essential workers to be prioritized as well.

Without vaccines for teachers and staff, many schools won’t reopen for full in-person learning, leaving students further behind, said Debra Schade, a school board member at the Solana Beach School District in San Diego County and a director at the California School Boards Association.

Age-based distribution “puts us in a situation where teachers and school employees will probably not be vaccinated until the late summer,” given the slow pace of the vaccine distribution from the federal government, she said. “It will be a heavy lifting to get those districts open... without risk mitigation that the vaccine would provide.”

San Diego County has started vaccinating those aged 75 and older, and those 65 and up can also sign up if there are doses available. But it’s unclear when teachers and school staff there would get the vaccine.

Some local governments already have started vaccinating essential workers. Long Beach began giving vaccines to food workers, with teachers to be inoculated starting in days. Riverside County on Thursday, Jan. 21, vaccinated 300 farmworkers in eastern Coachella Valley.

“We understand they’re highly exposed to this virus. But they still have to work, just like nurses and doctors… They’re just as essential,” Riverside County spokeswoman Yaoska Machado told the Press-Enterprise.

But Estella Cisneros at California Rural Legal Assistance said she is not aware of any other county vaccinating farmworkers, although many have moved onto inoculating older adults.

Noe Paramo, a legislative advocate at California Rural Legal Assistance Foundation, said without a clear guidance from the state to prioritize vaccinating farmworkers, counties could decide to let them fall by the wayside.

“We are pleased that California’s agricultural workers have been placed, and remain in, Phase 1B, Tier 1 of vaccination distribution,” Paramo recently wrote to the Community Vaccine Advisory Committee members. “However, recent pronouncements at the federal and state levels are making this prioritization illusory.”

Diana Tellefson Torres, executive director of United Farm Workers Foundation, noted a recent preprint study from University of California San Francisco, which showed agriculture workers aged 18 to 65 experienced 39% increase in deaths during the pandemic.

“What is the easiest doesn’t always address who’s at the highest risk,” she said.

Vaccine equity

State officials said they are still keeping equity in mind when it comes to vaccination.

They put forth a proposal to allocate 20% of the future vaccine supply based on ZIP codes that are among the most disadvantaged, measured by Healthy Places Index that tracks indicators such as employment, pollution and homeownership.

Anthony Wright, executive director of consumer advocacy coalition Health Access, said the place-based allocation could be one way the state can distribute vaccines more equitably even if it decides to shift to age-based distribution.

Still, distributing vaccines equitably goes far beyond who or where to prioritize, he said. California needs to address several barriers, from people not having a car to drive to a vaccine site to people not having technology to access the online appointment system, he said.

“If we want this to be as efficient and equitable rollout, equity lives in the last miles of logistics as much as prioritization of population,” he said.

In the end, the state simply needs more vaccine doses to give out as soon as possible, said Andrew Noymer, a UC Irvine disease prevention professor and epidemiologist.

“We’re kind of rearranging the deck chairs on the Titanic if we talk about vaccinating essential workers or people 65 years and older,” he said. “The fact that we have to even ask the question may be an indication we’ve failed.”