Missouri officials are taking decisive steps to expand eligibility for COVID-19 vaccines despite evidence suggesting that some older Missourians may be getting left behind.
This week, as the state makes half a million more Missourians eligible for vaccinations, data show that about half of Missouri seniors have yet to receive a shot.
That has concerned some health care experts, advocates and seniors themselves, including Jan Sanderson, who has been working to run down vaccination appointments for many of the older members of her Lee’s Summit retirement community.
“With another half a million people, how are we ever going to get the people on my street vaccinated?” Sanderson said.
At the end of December, Missouri kicked off vaccinations by offering shots to health care providers and residents and staff of long-term care facilities. In mid-January, officials expanded eligibility to anyone 65 and older as part of phase 1B–Tier 2.
But after more than two months of vaccinations, only 55% of Missourians ages 65-74 have received doses, according to the state’s data. Just 42% of people 75-84 and 57% of people 85 and older have received shots.
On Monday, the state activated phase 1B-Tier 3, which includes teachers and critical infrastructure workers. Officials estimate this group includes more than half a million people.
While Missouri’s vaccine distribution strategy has aimed to quickly expand eligibility to larger segments of the population, health experts say that seniors should remain the focus.
“Physician leaders from across our state of Missouri are all on the same bandwagon: we must prioritize our seniors,” says infectious disease specialist Dr. Mary Anne Jackson, dean of the University of Missouri – Kansas City School of Medicine.
COVID-19 poses the greatest threat to older people. The Centers For Disease Control and Prevention reports that people aged 65-74 are 1,100 times more likely to die of COVID-19 than people 5-17. Death is 2,800 times more likely to occur in the 75-84 age group.
But health care advocates and seniors themselves say they struggle to get the vaccine due to the complications accessing it.
Sanderson has spent the last few weeks working to get vaccination appointments arranged for her neighbors at Cedar Creek Village, a retirement community in Lee’s Summit where she moved with her husband two years ago.
Sanderson, who is secretary of her homeowner’s association, has been eager to restore the lively community that disappeared after the coronavirus hit a year ago.
“There’s just lovely people that live on this street and the other street that belong to our HOA, and we haven’t been able to socialize,” she says.
Vaccine hesitancy among Sanderson’s neighbors and most seniors appears to be a relatively minor issue. Polling conducted nationally and in Missouri show that older people are the group most receptive to getting vaccinated, probably because of their higher risk for severe illness.
“We’re in the group of people that die,” Sanderson says.
But even though most of her neighbors have been eligible for weeks, she has continued to spend hours some days navigating websites for pharmacies, hospital and health departments in search of appointments for neighbors without internet access or with limited internet skills.
Securing an appointment doesn’t guarantee a shot, however. Some of her neighbors have had appointments canceled or arrived to find lines too long for them to stand in.
For Sanderson’s neighbor Joan Haigh, who is 80, the difficulty of getting a shot has been discouraging.
“It always seems to be a headache or a hiccup along the way,” Haigh says, “You know, like, why even try?”
Data suggest that Sanderson and her neighbors aren’t the only ones in the Kansas City area who have struggled to get shots.
A Deloitte Consulting study commissioned by Missouri’s Department of Health and Senior Services showed that Jackson County had the second-highest number of vaccine-eligible people who had not received shots. Cass County was also identified as having a large number of unvaccinated eligible people.
Missouri Gov. Mike Parson acknowledged the disparities in vaccination rates when he announced in late February the activation of phase 1B– Tier 3. But he said the move was based in part on state estimates that 40% of Missourian would not seek vaccines and claimed expanding eligibility was needed to continue moving the vaccination campaign along.
“Part of why we are activating Tier 3 on March 15 is to make sure that there is a steady flow of people who are eligible and interested in getting vaccinated,” Parson said.
More recently, Parson announced a new vaccine distribution strategy that would direct more doses to areas that have higher numbers of eligible people who are unvaccinated.
Even with larger numbers of doses going to the Kansas City area, however, health care advocates argue that seniors are still at a disadvantage due to the complex system of online sign-ups and travel needed for shots.
“I think the largest challenge is that there has not been a concerted, focused effort to sit down from a consumer’s perspective and think step-by-step what will be needed to get this vaccine done,” says James Stowe, Director of Aging and Adult Services for the Mid-America Regional Council, which has a contract with the state to help seniors obtain vaccines.
Kansas City’s health department announced on Tuesday that it would focus its own vaccination efforts on residents 65 and older and prioritize this group before moving to schedule individuals from lower priority groups.
"We want no one, especially our older residents, to fall through the cracks of a backlog or in the swarm of people lined up for the vaccination,” health department head Dr. Rex Archer said in a news release.
The spread of more dangerous and transmissible COVID-19 variants makes vaccination of seniors even more urgent, says Dr. Jackson. Because of the immunity developed by people who have already contracted the coronavirus and the increasing number of people receiving vaccines, herd immunity may be achieved in many places by late May, she says. But until then, seniors may remain at high risk.
“In the meantime, what we’re trying to do is keep people out of the hospital and keep people from dying,” Jackson says. “So that’s why this particular segment of our population — and those with underlying additional medical conditions — are so important to prioritize right now.”
Sanderson estimates that around 70% of her neighbors have now received doses. But she says she’s been overwhelmed with the process of helping them and wishes they had more help than she — or the various websites and hotlines — can provide.
“I wish we had an advocate, a real advocate. Not a recording on a phone — leave your name and number, and we’ll get back to you eventually.”
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