Hillcrest vaccinations (copy)

The Pfizer COVID-19 vaccine is seen during a mass vaccination event at Hillcrest High School in eastern Idaho on Friday, Feb. 5, 2021.

Idaho COVID-19 vaccine planners have decided who to put at the front of the line for virus shots. But they are in a pickle as they decide how to structure the rest of the line.

Seniors and some frontline workers, such as pre-K-12 school staff and teachers and child care workers, are receiving shots now. Up next in Idaho’s tentative plan are essential workers and residents age 16 and up with high-risk medical conditions.

Figuring out how to establish someone actually has a medical condition that puts them at high-risk for COVID-19 complications is at the core of the debate. Some say family doctors can help, and that people who want vaccines will be honest. But having a regular family doctor or clinic isn’t economically feasible for everyone, others note.

Idaho has largely relied on “the honor system” for eligible people to receive COVID-19 shots, asking vaccine providers to only administer shots to people in current priority groups and asking people not yet eligible to wait their turn. That has led to varying interpretations by vaccine providers and state agencies.

For its part, the Centers for Disease Control and Prevention outlines high-risk medical conditions, which include things like obesity, hypertension and cancer. But estimates of the number of people with those conditions, and especially the number who used to smoke, aren’t highly accurate. Research finds age is the biggest single risk factor for COVID-19 hospitalizations; people age 45 to 64 and people age 65 and up are at more risk than people age 18 to 44, according to a study last fall.

Idaho’s vaccine advisory panel opened discussions Friday about how to open virus shot access to around 300,000 Idahoans with high-risk medical conditions and 80,000 essential workers.

The panel, which advises Gov. Brad Little, didn’t make any final calls Friday.

But a division that could color future discussions became clear as the panel made a non-binding vote on four ways to address vaccine plans: 15 panelists voted to, in some way, put people with high-risk medical conditions up first or at the same time as essential workers. A dozen others voted in favor of going to a strictly age-based approach to vaccinate the roughly 1 million Idaho adults that aren’t in priority groups already.

Stratifying vaccine access according to that plan would split up all Idahoans age 64 or below into five groups of around 200,000 each.

Beyond this preliminary, broad planning vote Friday, little is set in stone for Idaho’s next vaccine priority groups.

Who’s being vaccinated now?

Some essential workers deemed frontline in Idaho, such as first responders and jail staff, began getting virus shots in mid-January. Idahoans age 65 and older became eligible Feb. 1, a little more than a month after vaccinations started for long-term care facility residents.

Most people who have received virus shots in the U.S. have been seniors, state epidemiologist Dr. Christine Hahn said, citing national data. In total, about 291,000 Idahoans age 65 and up are eligible, 265,000 of whom live on their own.

Around 400,000 Idaho adults are currently eligible for vaccines. A quarter of the state’s estimated 1.8 million population is under age 18. No vaccines are approved in the U.S. for people under age 16.

Earlier this month, the Idaho panel rejected most proposals to put more people in current priority groups. It made similar decisions Friday on bids affecting both current priority groups and the next group, labeled 2.3. Jobs rejected for group 2.3 include Bureau of Recreation dam workers, plumbers, “on-site” apartment staff, Airbnb hosts, hotel workers and “frontline” media reporters, including journalists covering the legislative session in-person. The votes don’t indicate whether workers in those sectors will be included in essential workers as part of priority group 3, or lumped in with the general public in priority group 4.

What’s next?

Independent living seniors were classified in group 2.2 as part of Idaho’s four-step vaccine plan. Priority group 2.3 is expected to include some essential workers in several sectors — food, agriculture, manufacturing, grocery stores, Idaho National Guard, public transit, U.S. Postal Service, homeless shelter residents and some utility workers who work indoors.

The state health department estimates vaccinations for group 2.3 will open in early April, followed by group 3 in late April and group 4, the general public, in May.

Opening vaccine access to priority group 3 would serve as another test for the biggest vaccination campaign in the state’s history.

The rollout to more than a quarter-million seniors living independently earlier this month showcased the difficulties of equitably getting shots to people who aren’t all under one roof or work industry. Independent seniors complained that first-come, first-serve signup systems were swarmed, leading appointments to fill up quickly.

A total of 424 health care organizations are enrolled to administer COVID-19 vaccinations in Idaho. One public health district, in eastern Idaho, turned to a lottery system that pulls names out of a proverbial hat to assign appointment times.

Idaho’s health department announced in a Friday blog post it is working on a statewide vaccine registration tool. A previous effort for a state signup site was scrapped after state officials said it was redundant to local efforts.

Reporter Kyle Pfannenstiel can be reached at 208-542-6754. Follow him on Twitter: @pfannyyy. He is a corps member with Report for America, a national service program that places journalists into local newsrooms.