Who should be near front of line for COVID-19 vaccinations? Iowa groups make their cases

How to choose? Letters include pitches for funeral directors, people with Down syndrome, factory workers, court employees, truck drivers, water and wastewater professionals and Amazon and Uber drivers.

Tony Leys
Des Moines Register

Dozens of groups have written to a panel of Iowa experts, explaining why their members or employees should be prioritized for vaccination against the coronavirus.

The Infectious Disease Advisory Council, which is helping determine the order in which Iowans will be offered the precious shots, invited the public to share opinions. The deadline to do so was Dec. 23, and there were at least 85 responses.

The letters came from an array of groups, including those representing lab workers, grocery stores, bus systems, dentists, optometrists, and home-care nurses and health aides. They also include organizations and individuals representing Iowans with certain physical conditions, such as cystic fibrosis and kidney disease, which could leave people at heightened risk of death if they catch the virus.

A nurse administers one of first doses of the Pfizer-BioNTech COVID-19 vaccine given in Iowa on Dec. 14 on the 12th floor of the University of Iowa Stead Family Children's Hospital in Iowa City.

It will be difficult to decide who should be moved up in line, said Lina Tucker Reinders, executive director of the Iowa Public Health Association. “When you’re prioritizing one group, you’re by definition de-prioritizing someone else,” said Tucker Reinders, who serves on the state's advisory council.

She said she’s been urging the Iowa council to give strong consideration to people whose work puts them at special risk, such as employees of schools, meatpacking plants and grocery stores.

“These are groups of people who we’ve been calling essential since March,” she said. “Now, are we going to treat them as such?”

Council conducting closed-door discussions to choose groups

The council is advising the Iowa Department of Public Health, which generally plans to follow vaccination recommendations from federal experts. Iowa and other states are starting this month with vaccinations of frontline health care workers, plus staff and residents of long-term care facilities. After that, states will move on to vaccinating other priority groups.

The next in line are likely to people 75 or older and people in certain professions — such as teachers, meatpacking plant workers, police officers and firefighters — where close contact with others may be difficult to avoid. 

Iowa is considering focusing later rounds of the shot campaigns on groups such as people with chronic health conditions or physical or intellectual disabilities, people who are homeless, and those who work as "community-based spiritual workers," Department of Human Services Director Kelly Garcia said at a state news conference Tuesday. 

Federal and state leaders say the supply of shots will increase in coming months, but there probably won't be enough for everyone until spring or early summer.

Unlike national experts who are forming federal vaccination recommendations, Iowa's 25-member advisory council is meeting behind closed doors to deliberate the complicated issue. Open-government advocates have criticized Iowa's secrecy as harmful to public confidence in the process. But Garcia has said privacy is needed so the experts she tapped for the council can have "free flow of conversations."

Those conversations will include discussion of the dozens of letters from groups wanting to be considered as priorities for vaccination. 

Appeals made for funeral workers, Down syndrome community, production line workers

For example, the Iowa Funeral Directors Association says its 1,000 members deserve to get the coronavirus shots soon, because morticians routinely handle bodies of people who were infected with the virus.

“In order to protect ourselves and others with whom we need to interact, we need to receive the vaccine as soon as possible,” the association wrote to the state council. “This will ensure that the entire health care and death care systems are as protected as they can possibly be.”

Jon Peterson, a funeral director who owns funeral homes in Indianola and Carlisle, said he and his wife contracted the disease in November. The exposure could have come from his work, which includes handling bodies and interacting with grieving families, he said in an interview.

There’s no way for funeral directors to eliminate the risk, even with protective equipment and limits on funeral sizes, Peterson said. “You’re kind of on the front lines, but on the back side of it,” he said.

Vaccine hesitant?:How experts are tackling skepticism of the COVID-19 vaccine

Kay Marcel, of Urbandale, wrote to the state council asking that it prioritize people with Down syndrome and their caregivers. 

Marcel’s son, Joel, 42, has Down syndrome and two autoimmune diseases. She noted in her letter that a recent study in England estimated people with Down syndrome are five times more likely to be hospitalized and 10 times more likely to die if they're infected with the coronavirus. Researchers suspect their extra COVID-19 risks are due to immune deficiencies and physical characteristics associated with Down syndrome.

Even within a group such as people with Down syndrome, there are different risks from the coronavirus, Marcel noted in an interview. Some, like her son, have multiple chronic health conditions. Others are healthier but could face heightened exposure to the virus because they live in group homes. The experts deciding vaccination priorities will have to consider such factors.

"I appreciate the complexity and the difficulty these folks will have to weigh," Marcel said, adding that she doesn't know whether to expect vaccinations for her family next month or six months from now. 

Fact check:What's true and what's false about the COVID-19 vaccine

The Iowa Association of Business and Industry also wrote to the state council, asking it to consider vaccinations for people who work on factory production lines, where it is hard to stay far apart from others.

Mike Ralston, president of the employers' group, said in an interview that his members support having health care workers and nursing home residents get the shots first, and having other critical groups line up right behind them.

"It doesn't look like it's going to be our turn yet, and we totally get that," he said.

Factory managers will continue to take precautions, such as having plastic dividers between line workers, he said, while they hope their employees will be eligible for vaccination relatively soon. 

Other groups, companies that asked to be prioritized

Here are some of the other groups and companies that wrote to the state council, seeking to be considered as priorities for coronavirus vaccination:

  • The Iowa court system, which said its officials and employees face increased risk from the coronavirus because much of their business is done in person at public courthouses. "Judges and court employees play a key role in keeping essential functions of society running, many of which are constitutionally mandated," wrote Todd Nuccio, state court administrator. "The judicial branch is responsible for ensuring that order is maintained in our state and that disputes of the citizens of Iowa are resolved fairly. COVID-19 outbreaks among judges and court employees could easily cripple our state courts with significant impact on our state and its economy."
  • The Iowa Motor Truck Association and Truckstops of Iowa. The two industry organizations wrote that their members should be offered shots soon because they are "essential to the continued viability of our nation’s infrastructure, specifically to the front-line fuel, food, and supply distribution chains, for the duration of the pandemic."
  • Amazon, which wrote that its delivery service employees need protection from the virus. "In many ways, our essential workers have served as heroes in their communities during this pandemic as they have helped people get the products they need without having to leave their home, which, for people with underlying conditions or who are more susceptible to complications from COVID-19, is critical."
  • Water and wastewater professionals, who wrote that members of their profession must respond to emergencies, such as water main breaks or sewage backing up into homes. "By having the vaccination offered to water and wastewater utility essential service provider employees this year, we can all safely proceed with providing the best operation methods to provide Iowa citizens with safe, healthy drinking water while protecting the people and environment," wrote Kelly Graplar, deputy chief executive officer of the Iowa Lakes Regional Water utility. 
  • Uber, which wrote that its nearly 4,000 ride-share drivers in Iowa should be protected against the virus. "Over the last nine months, these workers have been a lifeline to their communities," the company wrote. "They have transported health care workers to hospitals, delivered food to people socially distancing at home, and helped local restaurants stay in business."

Tony Leys covers health care for the Register. Reach him at tleys@registermedia.com or 515-284-8449.