Nine months have passed since I first ordered a mask online, bought hand sanitizer in bulk, and put my life on hold because of the COVID-19 pandemic. Now the vaccines from Pfizer and Moderna that might return normality to my world have started arriving in Texas, but, like most Texans, I am going to have to wait weeks, if not months, for my shot of safety.
The U.S. Centers for Disease Control and Prevention, under the guidance of an expert panel, created a list of those who should receive the vaccines first. Hospital workers, first responders, and those over the age of 75 should get top priority, followed by a second tier of police and certain other essential workers. At age 66 and able to work from my home, I was in the third group, which I will call Everybody Else. I ran the New York Times “find your place in the vaccine line” calculator, which was based on the CDC’s guidelines, and I ranked behind 118.5 million other Americans.
But Texas decided to do things differently than the CDC. While the state’s designated first tier matched that of the feds, its second tier included all Texans age 65 and older, as well as those with preexisting health conditions that make them vulnerable to severe cases of COVID-19. This approach put lower priority on police and younger essential workers, like grocery clerks or restaurant servers, many of whom were bitter about the state’s decision. Then, just before the new year, Governor Greg Abbott and his state health department changed the game further. On December 29, state health commissioner John Hellerstedt ordered providers to start vaccinating those in the second tier immediately, even though many in the first tier remained unvaccinated. Abbott backed him up in a tweet: “The state urges vaccine providers to quickly provide all shots.”
In an instant, I effectively had been moved to the front of the vaccination line. The problem was finding where that line began. Abbott had started a stampede.
There were too many eligible people chasing too little vaccine. The Texas Department of State Health Services reported that it had received 1.3 million doses. But Abbott had authorized another 8 million people to receive the vaccine even though providers weren’t anywhere near finished inoculating the 1.9 million Texans in what was supposed to be the first-tier priority group. Abbott’s declaration got too many in the state (even those under 65 and without any severe health conditions) thinking vaccines were more widely available. With few providers actually offering shots to the general public, the Hunger Games of vaccination had begun.
The Harris County Health Department had to shut down its online appointment system because too many ineligible people were signing up. Callers overwhelmed the Houston Health Department phone line. The H-E-B grocery chain informed its customers that its pharmacies had either used or committed all of its allocated vaccine and would not start vaccinating the second priority group until it had finished with the first. Memorial Hermann Health System in Houston tried to offer vaccinations to the 70,000 over-65 patients in its primary care group, but demand quickly outstripped available supply. At the same time, word got out that an Austin Regional Clinic location was running a vaccination clinic for first responders but would vaccinate anyone who showed up. Texans under age 65 with no underlying health problems started bragging on Facebook about scoring a vaccination for themselves and their family, while those with more urgent needs remained shut out.
There was an understandable logic to the Washington Post’s insinuation that political calculations had spurred this chaos. The newspaper implied that Texas’s deviation from the federal guidelines could be viewed as a reward to the state’s Republican-leaning older voters, at the expense of those in the essential-worker category, who are younger, more likely to be Black or Hispanic, and more likely to vote for Democrats. It certainly wouldn’t have been the first time Abbott’s pandemic management had bowed to politics. He had, after all, ignored his medical advisers in April in a decision to overrule local authorities and reopen many businesses across the state. His health agency also got caught gaming statistics to reflect a lower state infection rate. Not to mention his milking of the vaccines for publicity—hosting news conferences to announce how many doses had arrived, getting vaccinated himself, and promising that there would be no more business lockdowns despite worrisome increases in community spread.
Of course, these are hardly the only aspects of the vaccine rollout in Texas that have been infected by politics. Health-care workers—particularly people of color—in the Rio Grande Valley and Houston have been declining to take the vaccine. Dr. Joseph Varon of Houston’s United Memorial Medical Center told NPR that some of his staff weren’t taking the vaccine because President Trump was promoting its accelerated development, and they therefore thought it might be meant to harm them. “Most of the reasons why most of my people don’t want to get the vaccine are politically motivated,” Varon said. Similarly, Houston mayor Sylvester Turner was recently pleased that more than two thousand people had been vaccinated in a two-day clinic at the Bayou City Event Center, but was worried that there were few people of color among them because of distrust of the medical community. COVID-19 has had outsized effects on Black and Hispanic Texans, especially in terms of hospitalizations and deaths, in part because they had less access to health care going into the crisis.
Dr. David Lakey, vice chancellor of health affairs for the University of Texas System and a member of the state’s vaccine allocation panel, told me that Abbott’s transition to the second priority group could have been handled better. Still, he said, problems with the vaccine distribution are similar to what happened during the 2009 H1N1 swine flu pandemic, during which he was state health commissioner. Then, as now, the vaccine was new and there was nearly not enough to go around, with erratic deliveries from the federal government. “We would all of a sudden find out that a significant amount of the vaccine that we were expecting wasn’t going to show up,” he said. “So you had to scramble and figure out how you were going to prioritize that vaccine to those that are most in need.”
Lakey and other members of the state’s seventeen-member vaccine allocation panel to whom I spoke—Stephen Williams, who is Mayor Turner’s health director; Gerald Parker, associate dean of the College of Veterinary Medicine and Biomedical Science at Texas A&M University; state representative Stephanie Klick, a North Richland Hills Republican—said political considerations were never part of their discussions that resulted in all Texans age 65-plus being included in the second priority group. Their decision was made for epidemiological reasons—primarily because members of that age group are far more likely than younger people to need hospitalization or die if they contract COVID-19—without interference from the governor’s office.
The priority tiers were developed at the federal and state levels because months will pass before enough vaccine can be produced to inoculate all Americans. There was agreement that firefighters, EMS workers, residents of long-term care facilities, and health-care workers who tend coronavirus patients should go first. But the federal panel of experts—known as the Advisory Committee on Immunization Practices—decided the second tier should include those age 75-plus, but added front-line essential workers instead of people between ages 65 and 74. Part of that federal decision was based on the fact people of color are underrepresented among Americans age 65 and older but constitute a significant portion of the younger “essential worker” class.
Contrary to the implications of the Post article, the Texas committee adopted its second-tier recommendation three days before the federal committee adopted its recommendations. While different, both are medically justifiable. In Texas, Blacks and Hispanics account for more than 60 percent of the 27,771 people who had died of the virus by January 1, even though they make up only about 53 percent of the state’s population. Still, the Texas panel felt “the sooner we can get the 65 and older vaccinated, the sooner we’re going to, maybe, hopefully, control the most devastating aspect to this pandemic,” Parker told me.
With COVID-19 the top story on the local evening news for months on end, it’s hard to blame the vast majority of Texans for wanting a vaccination now, even if they are not in a priority group. The state is trying to calm the vaccine stampede by announcing this week that, starting January 11, there will be “mega” sites around the state that can handle up to 100,000 vaccinations a week. The bad news is the state is assigning only 200,000 doses to these hubs in the first week. This may end the free-for-all, but there still are too many people and too little juice.
With so many politically driven decisions along the way—especially those forcing local authorities to allow the reopening of restaurants, salons, gyms, and other businesses even as infections surged through the summer, and refusing to allow cities like Austin to reinstitute short-term shutdowns in the face of rising cases this winter—Abbott has set aside important tools for controlling community spread. Texas has put all its eggs in the vaccine basket, and meanwhile we watch the hospitalizations and daily death counts rise once more to frightening levels.