A vaccination clinic in Teaneck, N.J., run by Holy Name Medical Center, has the ability to administer 3,000 doses a day. But it needs more vaccine.
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Faced with soaring rates of coronavirus infection and more doses of vaccine in freezers than in arms, New Jersey officials made a calculated choice.
They opened the floodgates of vaccine eligibility on Thursday to about 4.5 million additional residents: those 65 and older and younger people with underlying health problems, including cancer, heart conditions and diabetes — diseases that can lead to severe complications from Covid-19.
As part of the expansion, New Jersey also became only the second state in the country to open vaccinations to another high-risk group — smokers. As is true for all Covid-19 vaccinations in New Jersey, no documentation of an underlying health condition is required.
The announcement came a day after the Trump administration told states to expand eligibility and to quickly use existing vaccine or risk losing future allocations.
But New Jersey’s decision to immediately adopt all of the recommendations by the Centers for Disease Control and Prevention for priority vaccination puts these groups ahead of some essential workers — including teachers. The move has contributed to a sense of confusion and anger among those who now find themselves at the back of the line for inoculation.
It has also expanded competition for shots at a time when many people in the first priority groups continue to have trouble making appointments and navigating the overburdened scheduling systems of vaccine clinics.
“The supply is not sufficient. That’s the challenge,” said Jen Kates, director of global health and H.I.V. policy for the Kaiser Family Foundation, a health policy research organization. “It has to be a calibrated balance. You want people to want to come in to be vaccinated, but you don’t want them to have to wait so long they get frustrated.”
The C.D.C. includes smoking on a list of medical conditions that it recommends be prioritized in state vaccination programs because of the higher risk of serious complications from Covid-19. But to date, only one other state, Mississippi, appears to have authorized vaccinations for people younger than 65 based solely on the criterion that they smoke cigarettes.
On Friday, Gov. Philip D. Murphy called criticism that smokers were jumping the line a “cheap shot” and a “false narrative,” noting that the state is hewing closely to C.D.C. guidelines.
Still, New Jersey is also one of only a few states that have not cleared the way for teachers to be vaccinated during the first phases of eligibility, according to an analysis released this week by Kaiser.
Steve Baker, a spokesman for the New Jersey Education Association, the state’s teachers’ union, said the group had urged government leaders to prioritize teachers. “We absolutely and consistently have advocated with the administration to make sure that educators get access to the vaccine as soon as possible, and to do everything in their power to speed up that process,” he said.
Teach NJ, a coalition of nonpublic religious schools, sent a letter to state health and education officials on Thursday also urging prioritization for educators, who, under current state policy, are not eligible for the vaccine until the next phase of the rollout.
“Prioritizing teachers and staff will ensure that schools can continue to remain open,” Dan Mitzner, the state political director, wrote.
As of Friday, New Jersey had administered less than half of the 658,800 doses of vaccine shipped to the state, according to the C.D.C., a rate that lags behind most other states in the Northeast.
And not all people included in the state’s first round of priority vaccinations, a classification that includes all health care workers and nursing home residents, have gotten the first of two required shots of either the Pfizer or Moderna vaccine.
“The process started off slowly,” said Dr. Stuart Shapiro, the interim chief executive of the Health Care Association of New Jersey, which represents many of the state’s long-term care centers. But it has picked up steam, he said, and is now “working much better.”
Enough doses have been set aside to vaccinate all residents of New Jersey nursing homes, a process that is being handled by two pharmacy chains, CVS and Walgreens. Residents of long-term care facilities account for more than 40 percent of Covid-19-related deaths in New Jersey, and outbreaks are on the rise as the virus surges anew.
The state’s health commissioner, Judith M. Persichilli, has said that no documentation is needed to receive a vaccine, likening the process to the honor system.
Elizabeth Mueller, an owner of a dance studio in Bergen County, N.J., said she wondered how health centers administering the vaccine would be able to tell who is and isn’t a smoker.
“We’re waiting our turn, doing the right thing, don’t want to take from anyone else,” said Ms. Mueller, 36, who has two children and a father with leukemia. “But they keep changing the rules and it’s just not consistent.”
Even as the decision to expand eligibility to the state’s estimated two million smokers raised eyebrows, many doctors praised the policy as an effective way to slow the spread of the virus by eliminating barriers to vaccination for the state’s most vulnerable residents and ensuring that no doses are wasted.
Dr. Annette C. Reboli, an epidemiologist and dean of Cooper Medical School of Rowan University who is also a member of a state Covid-19 advisory panel, said it would be wrong to pick and choose from the C.D.C.’s list of conditions that have been found to cause increased risk of severe illness from the virus.
“The more people we can get with shots in arms, the more lives we are going to save,” Dr. Reboli said. “It becomes dangerous when you know that something is a major risk factor and to then cherry pick off that list.”
Other states, however, appear to have done just that. New Mexico and Texas have made people with other high-risk medical conditions eligible for the vaccine, but not smokers. Alaska, Maine, Massachusetts and North Carolina include smokers, but not until later phases.
Getting on the list of people eligible for the rationed vaccine is one thing. Securing an appointment for a shot is another.
Officials running a county vaccine site in Kearny, N.J., said on Friday that they had gotten 3,500 requests within 24 hours of the state’s announcement of expanded eligibility, yet they expected to have exhausted their initial vaccine supply by Monday. They said they were hopeful of getting more doses by Tuesday.
In Bergen County, an early epicenter of the virus in New Jersey, slots for Holy Name Medical Center’s vaccine clinic were filled within hours of being made available online — even before the pool of eligible people grew.
Dr. Adam Jarrett, the chief medical officer of Holy Name Medical Center in Teaneck, N.J., said having too many people eligible to be vaccinated is better than having too few, and he praised the state’s broad expansion. Over the past month, before eligibility was expanded, the hospital sometimes found itself with extra doses of thawed vaccine at the end of the day.
No vaccine went to waste, Dr. Jarrett said, but that required effort.
“We would literally walk up and down the halls and call hospital staff members,” Dr. Jarrett said. “This vaccine is gold, and we don’t want to waste a single dose.”
Now, he said, the challenge was getting more vaccine from the federal government.
“We need to open it up,” Dr. Jarrett said. “When you get vaccinated you’re doing it for yourself, but you’re also doing it for the broader community.”
