Yes, smoking 100 cigarettes qualifies you for a COVID vaccine in NC. And here’s why

Bailey Aldridge
·3 min read

North Carolina residents who currently smoke or who have smoked at least 100 cigarettes will soon be eligible to get the COVID-19 vaccine — prompting confusion and frustration from some.

But health officials say there’s a reason.

On Wednesday, North Carolina expanded coronavirus vaccination eligibility to frontline essential workers included in Group 3. These workers were originally set to be eligible starting March 10, but the availability of the new Johnson & Johnson vaccine allowed officials to move up the date.

Now, residents included in the high-risk medical conditions subset of Group 4 — which also includes essential workers and those living in close group settings — will be eligible for the vaccine starting March 24.

And current and former smokers, defined as “having smoked at least 100 cigarettes in their lifetime,” are included in the medical conditions category, according to the N.C. Department of Health and Human Services.

Their inclusion — along with the “100 cigarettes” distinction — has prompted numerous questions and comments on social media, with one Twitter user calling it “spectacularly absurd.”

“So you have between now and March 24th to pound 100 cigarettes,” one user tweeted.

“How can they prove who is a smoker or not?” another asked.

Why 100 cigarettes?

The rule is based on guidelines from the U.S. Centers for Disease Control and Prevention.

The N.C. DHHS is “aligned with CDC Advisory Committee on Immunization Practices in terms of priority order,” Catie Armstrong, a spokesperson for the department, said in an email Wednesday.

The CDC defines a current smoker as “an adult who has smoked 100 cigarettes in his or her lifetime and who currently smokes cigarettes.” It defines a former smoker as “an adult who has smoked at least 100 cigarettes in his or her lifetime but who had quit smoking at the time of interview.”

It’s unclear how health officials would know whether a person has smoked 100 cigarettes in their lifetime, but Armstrong said “individuals can self-attest to the criteria (e.g., age, job role, health status, living situation) that they qualify for eligible priority groups.”

“It is important for everyone to find their spot and take their shot when it’s their turn. Our goal is to vaccinate as many people as quickly and fairly as possible given the limited supply of vaccines,” Armstrong said.

Why are smokers a priority?

That’s also based on CDC guidelines, which say smoking “increases your risk of severe illness from COVID-19.”

The World Health Organization also says smoking increases “the risk of many respiratory infections and can increase the severity of respiratory disease.”

“COVID-19 is an infectious disease that primarily attacks the lungs. Smoking impairs lung function, making it harder for the body to fight off coronaviruses and other respiratory diseases,” the WHO says. “Available research suggests that smokers are at higher risk of developing severe COVID-19 outcomes and death.”

Smokers are included in the CDC’s vaccination Phase 1c, which says the “vaccine should be offered to persons aged 65–74 years, persons aged 16–64 years with medical conditions that increase the risk for severe COVID-19, and essential workers not previously included in Phase 1a or 1b.”

About 129 million people are included in that group, the CDC estimates.

As of 2019, roughly 18.5% of North Carolinians reported “smoking at least 100 cigarettes in their lifetime and currently smoke daily or some days,” according to a 2020 report from the United Health Foundation. That’s compared to 15.9% nationwide, the report says.

NC and tobacco

North Carolina is the country’s lead tobacco producer, putting out more than 184,000 pounds in 2020 according to Statistica. Kentucky, the next largest prodcuer, put out 107,000 pounds.

Armstrong said the “CDC may update the list of high-risk conditions as scientists learn more about COVID-19, and NCDHHS will update the list accordingly.”

“The vaccine prioritization is designed to save lives and prevent spread while vaccine supplies are limited,” Armstrong said.