Estimates of the Initial Priority Population for COVID-19 Vaccination by State

On December 1, 2020, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention’s (CDC), issued an initial recommendation, adopted by the CDC director, that health care personnel and residents of long-term care facilities should be the first to be offered a COVID-19 vaccine once it is authorized or approved by the FDA (See Appendix A). The ACIP recommendation recognizes that health care workers, who are at higher risk of exposure to people with COVID-19, are essential for preserving health care capacity during the pandemic. Further, it recognizes that long-term care residents are at high risk of serious illness if infected with the virus and account for 40% of all COVID-19 deaths. States have the authority to make their own allocation decisions, although most will likely follow the ACIP guidelines for the initial priority groups.

This analysis provides new national and state-level estimates of the number of health care workers and long-term care residents who are expected to be part of the group first in line to receive the COVID-19 vaccine to gain insight into how this initial priority population varies across states. These estimates are based on our analysis of the 2019 American Community Survey (ACS) and Certification and Survey Provider Enhanced Reports (CASPER) data.

Our health care worker estimates may be lower than others because they are limited to people working in health care settings who are likely to have direct patient contact based on their occupation and who have current ties to the workforce. We include workers providing direct clinical care, such as doctors, nurses, and aides; workers providing direct patient support, such as environmental and food staff; and first-line supervisors and managers of these occupations. Moreover, the estimates are based on state of residence of the health care worker. Some health care workers may work in a different jurisdiction than where they live. For example, many health care workers in the District of Columbia live in Virginia and Maryland. Our national estimates of long-term care facility residents include individuals living in certified nursing facilities and assisted living facilities, but not others who live in other residential settings. Due to data limitations, our state-level estimates do not include people who live in assisted living facilities or in other residential settings.

Findings

Nationwide, there are 19.7 million adults working in health care settings, of which roughly 15.5 million are estimated to have direct patient contact. In addition, there are 1.2 million nursing facility residents and about 800,000 assisted living facility residents. Together, health care workers with direct patient contact and residents in either nursing facility or assisted living facilities account for approximately 17.6 million people or about 7% of the adult population in the U.S.

The number of people in this initial priority group varies widely across states. The number of adults who are health care workers who have direct patient contact or are nursing facility residents ranges from 23,800 who live in Washington, D.C. to nearly 1.7 million who live in California, while the share of adults in these groups varies from roughly 4.4% in DC to at least 8% in 7 states, with North Dakota having the highest share (10%), following by Pennsylvania (8.3%), Minnesota (8.1%) and Rhode Island (8.1%). As noted earlier these estimates do not include people who live in assisted living facilities or in other residential settings.

Discussion

The Department of Health and Human Services (HHS) has announced that about 40 million doses of vaccine could be available by the end of December 2020, enough to vaccinate 20 million people given that two doses are required for the main vaccine regiments that are furthest along in the authorization process. More recent media reports indicate the number of vaccines available for early distribution may be lower than initially projected. HHS plans to allocate vaccinations to states based on each state’s share of the total U.S. adult population but, to date, has not publicly released information on the actual number of vaccines that will be allocated to each state.

Variations in the number of health care workers and long-term care residents across states may result in uneven effects across states in their ability to immunize priority populations using their initial vaccine allotments. While some states may have an adequate supply to vaccinate their priority population, others may fall short and may need to decide who goes first among people in this initial group. Further, as states allocate vaccines down to the local level, the ability of counties, municipalities, and health care systems to vaccinate health care workers and long-term care residents could vary, depending on their supply of vaccines and the demographics of their communities. In instances where supply is insufficient to fully vaccinate the initial priority population, ACIP notes that jurisdictions may consider first offering the vaccine to health care personnel whose duties require proximity (within 6 feet) to other people and that, if vaccine supply remains limited, additional factors might be considered for sub-prioritization of health care personnel. Similarly, ACIP notes that jurisdictions might consider first offering vaccinations to residents and health care personnel in skilled nursing facilities because of the risk of COVID-19 related mortality among residents in those settings.

 Table 1: Estimated Health Care Workers and Nursing Facility Residents by State, 2019
State Total Adults Initial Priority Population
Health Care Workers with Direct Patient Contact Nursing Facility Residents Total Priority Population as a Share of Total Adults
United States* 250,235,900 15,525,100 1,246,100 16,771,200 6.7%
Alabama 3,697,300 225,300 22,700 248,000 6.7%
Alaska 526,200 33,000 500 33,500 6.4%
Arizona 5,485,500 289,300 10,300 299,600 5.5%
Arkansas 2,237,600 145,500 17,300 162,700 7.3%
California 29,920,500 1,558,100 100,000 1,658,000 5.5%
Colorado 4,377,800 263,500 16,000 279,500 6.4%
Connecticut 2,736,600 197,200 19,600 216,800 7.9%
Delaware 742,000 54,800 3,900 58,800 7.9%
District of Columbia 544,800 22,500 1,300 23,800 4.4%
Florida 16,839,200 991,500 71,200 1,062,700 6.3%
Georgia 7,832,000 405,700 22,900 428,600 5.5%
Hawaii 1,049,200 56,700 3,400 60,100 5.7%
Idaho 1,308,500 76,800 3,300 80,100 6.1%
Illinois 9,583,100 626,500 65,600 692,100 7.2%
Indiana 4,987,100 324,800 37,600 362,400 7.3%
Iowa 2,348,800 148,900 22,300 171,200 7.3%
Kansas 2,126,800 147,400 16,800 164,200 7.7%
Kentucky 3,342,400 215,200 21,500 236,700 7.1%
Louisiana 3,429,500 226,300 25,900 252,100 7.4%
Maine 1,064,800 75,000 5,800 80,900 7.6%
Maryland 4,569,400 294,400 16,500 310,900 6.8%
Massachusetts 5,323,100 390,300 34,400 424,700 8.0%
Michigan 7,664,100 516,800 37,500 554,400 7.2%
Minnesota 4,233,200 319,400 23,400 342,800 8.1%
Mississippi 2,182,700 136,300 15,900 152,200 7.0%
Missouri 4,604,900 308,900 37,300 346,200 7.5%
Montana 818,000 54,700 3,800 58,500 7.1%
Nebraska 1,409,100 100,000 10,600 110,600 7.8%
Nevada 2,350,500 101,900 5,600 107,500 4.6%
New Hampshire 1,064,100 75,400 6,400 81,800 7.7%
New Jersey 6,790,900 439,000 42,400 481,400 7.1%
New Mexico 1,576,900 101,000 5,500 106,500 6.8%
New York 14,985,700 1,103,600 89,800 1,193,400 8.0%
North Carolina 7,886,700 472,500 36,100 508,600 6.4%
North Dakota 557,200 50,400 5,300 55,800 10.0%
Ohio 8,827,900 631,100 71,900 702,900 8.0%
Oklahoma 2,893,300 183,000 17,200 200,200 6.9%
Oregon 3,287,200 201,300 4,700 206,000 6.3%
Pennsylvania 9,802,200 740,100 72,500 812,600 8.3%
Puerto Rico 2,594,600 92,300 Not Available Not Available
Rhode Island 817,600 58,400 7,600 66,000 8.1%
South Carolina 3,895,400 223,000 15,600 238,600 6.1%
South Dakota 642,400 45,200 5,600 50,800 7.9%
Tennessee 5,159,400 324,700 26,600 351,400 6.8%
Texas 20,987,700 1,202,100 90,700 1,292,800 6.2%
Utah 2,234,700 124,600 5,600 130,100 5.8%
Vermont 486,800 33,000 2,400 35,400 7.3%
Virginia 6,360,800 367,100 19,600 386,600 6.1%
Washington 5,795,500 327,800 15,100 342,900 5.9%
West Virginia 1,389,500 97,600 9,300 106,900 7.7%
Wisconsin 4,434,500 299,100 21,200 320,400 7.2%
Wyoming 430,200 25,800 2,200 28,100 6.5%
NOTE: *Excludes an estimated 800,000 assisted living facility resident; when included, 17.6 million people are part of the priority population nationally, about 7% of the adult population.
SOURCE: KFF Analysis of the 2019 American Community Survey and KFF analysis of 2019 Certification and Survey Provider Enhanced Reports (CASPER) data.
Methods

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