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States put smokers in line for the Covid-19 vaccine, sparking frustration among those lower in priority

(CNN) Federal guidelines recommend that smokers under the age of 65, considered high-risk for severe Covid-19 symptoms, be eligible for the vaccine in early phases of distribution, frustrating essential workers lower in the priority line.

New Jersey and Mississippi are currently offering the vaccine to smokers under the age of 65, and several other states have included smokers among those next in line, but haven't opened the phase yet, according to a Kaiser Family Foundation analysis. 

The move to prioritize smokers over essential workers like teachers has received some criticism, though the phased rollout is in line with federal guidelines from the US Centers for Disease Control that place smoking on a list of conditions "that cause increased risk of severe illness from the virus that causes COVID-19."

The CDC's Advisory Committee on Immunization Practices advises smokers to be vaccinated in phase 1c but ultimately states can use their discretion in how they open eligibility for the vaccine to constituents.

"While ACIP makes recommendations, we understand that there will be a level of local adaptation. The phased vaccine recommendations are meant to be fluid and not restrictive for jurisdictions.  It is not necessary to vaccinate all individuals in one phase before initiating the next phase; phases may overlap," CDC spokeswoman Kristen Nordlund said in a statement to CNN.

Phase 1c includes persons 65-74 years of age, persons 16-64 years of age with high-risk medical conditions, and other essential workers. Phase 1a includes health care workers and long-term care facility residents and phase 1b includes persons 75 years of age or older and non-health care frontline/essential workers.

"This means ideally hitting a sweet spot that maximizes getting vaccine into arms while also being mindful of the priority groups -- especially because these are people who are higher risk for complications from COVID-19 or are more likely to be exposed to the virus because of their jobs," Nordlund said.

Teachers still waiting in line for the vaccine

Educators in New Jersey are disappointed and frustrated that they've been pushed back in line, Bergen County Education Association President Sue McBride told CNN.

"From what I'm hearing, it's just another round of frustration and another round of difficulty, you know, our educators and our education support professionals have working contact with the students and with their colleagues in their school buildings," McBride said.

"The idea of having a vaccine that enables to, hopefully, give some peace of mind. And some hope, and some movement in a positive direction is valued. You know, and a much anticipated thing to happen."
The New Jersey Educators Association continues to maintain the necessity of vaccine access for educators to get schools closer to a sense of normal.

"We've said from the beginning the educators should receive priority access to the vaccine. It's an important step toward a safer return to in-person learning. We have been in constant communication with state officials regarding educators' access to vaccination. We have reiterated to them the need to do whatever is necessary to expedite that access even in light of revised federal guidelines from the Trump administration and a slow federal rollout of the actual vaccine," NJEA communications director Steve Baker told CNN.

Mississippi Gov. Tate Reeves announced this week an expansion of the rollout to those with underlying medical conditions, including smokers, but said essential workers like teachers are next.

"And just be very clear to our emergency first responders, to our police officers, to our firefighters, and to our teachers, you're on deck. The next time we have an update, I expect it will be to announce that the vaccine will become available to you," Tate said at a press conference Tuesday.

CNN did not immediately hear back for comment from the Mississippi Department of Health.

New Jersey Gov. Phil Murphy has defended the decision, saying it wouldn't be a matter for conversation if the federal government provided states with more vaccine doses.  

"I get it, I understand the optics here, and that attacking folks who took up the habit of smoking and are now addicted may be politically expedient," Murphy said at a news conference Friday. "But at this time we are stuck in a position where we have to prioritize a limited federally distributed vaccine doses based on medical fact and not on political want. We need to save lives. And we need to protect our hospitals, by the way, from a patient surge."

Murphy added that "teachers are in the on-deck circle" and any teachers younger than 65 with chronic health conditions are currently eligible for the vaccine.

Teachers are also included in the next eligible sub-phase, New Jersey Department of Health spokeswoman Donna Leusner told CNN, but smoking is understood by health officials to be a health risk for state residents.

"Yes, the issue has been raised. Nicotine is one of the most powerful addictions. Smoking put individuals at higher risk for more severe disease. If an individual who smokes gets COVID, they get sicker much quicker.  Our goal is to save as many lives as possible and to promote vaccination among the highest risk groups. Smoking is the leading cause of preventable death in the US as well as in NJ (except for Covid 19). We encourage anyone who smokes to quit," Leusner said in a statement to CNN.

Smoking and Covid-19 from a public health standpoint

An estimated 2 million smokers in New Jersey make up the largest population qualifying for the vaccine under the list of underlying medical conditions, New Jersey Health Commissioner Judy Persichilli said at a news conference Wednesday.

Prioritizing smokers is a matter of public health, not a judgment of personal choices, said Dr. Albert Rizzo, the chief medical officer of the American Lung Association.   

"It's a population that we know is at risk, whether it was a good choice, or a bad choice to become a smoker. They are smokers, they're at risk of getting sick, and needing medical services, so if we can keep them healthy that helps society in general," Rizzo told CNN. 

Rizzo, a pulmonologist in the Christiana Care Health System in Delaware, says it's difficult to rule out all smokers in favor of smokers who have additional diagnosed respiratory diseases.

"We can make arguments on either side, but we do know that smoking by itself, whether you have chronic bronchitis, but no COPD, or really just have a cough but no shortness of breath, put you still at risk," Rizzo said. "And I think most people from a scientific standpoint says if you inhale, tobacco vapors and nicotine and tar, all those things inflame your airway and put you at risk whether or not you've reached the point of developing COPD or not."

The World Health Organization launched a "Commit to Quit" campaign in December, cautioning smokers around the world of the risks related to the pandemic and offering resources to encourage people to quit.