Maine makes age the vaccine metric that matters

The Baker administration says it will consider that approach.

Helen Thibeau of Pittston, Maine, arrives at the COVID-19 vaccination site at the Augusta Civic Center, Feb. 26. Gov. Janet Mills said Mainers ages 60 and older may get the vaccine starting Wednesday, March 3.Robert F. Bukaty/Associated Press

Janet Mills, the governor of Maine, is an unflappable hand at the helm, one who worries more about getting the policy than the politics right.

So when Mills announced a new approach to delivering COVID-19 vaccines last week, it caught my eye. Henceforth, Mills said, the state will vaccinate according to age. On Wednesday, those 60 and older become eligible. In April, vaccine eligibility will extend down to 50, in May to 40, and so forth. By July, everyone will be eligible.

Maine, like many other states, had factored occupation and individual medical conditions into its vaccination plan. So why the change? For Mills, it came down to the question of “who is most likely to die” if they come down with COVID-19. Age is the strongest predictor both of dying if one contracts COVID as well as of suffering serious effects. Further, age is closely associated with the health problems — comorbidities — that make contracting the coronavirus especially dangerous.

“This way of doing things is going to get more people vaccinated sooner and will benefit the most people in the fastest way possible,” Mills told me.

Which raises this question: Will the Baker administration, whose Massachusetts vaccination effort was star-crossed in the early going, take a look at the Maine scheme?

Tim Buckley, senior adviser to Governor Baker, makes an energetic case that the state has steadily rebounded from its initial stumbles, noting, correctly, that the Commonwealth is now number one in administered first doses per capita among the 24 states with more than 5 million people and sixth overall in first doses per capita. (The state has also moved up from an F to a B on the attention-getting Harvard Belfer Center/Kennedy School report card.)

With that said, Buckley added that the administration “will always consider any good idea, including that one, to further improve or simplify the vaccination process for the people of Massachusetts.”

Every policy, of course, has trade-offs and, sadly, winners and losers. Maine’s new approach focuses on the risk of dying from COVID should one contract it rather than the risk of becoming infected with it in the first place. Still, this plan has several advantages to recommend it.

In Maine, 98 percent of those who have died from COVID have been 50 or older. According to statistics from the Centers for Disease Control and Prevention, the risk of dying after having contracted COVID-19 increases rapidly as you ascend the age ladder. As an example, those 65 to 74 perish at 90 times the rate of those 18 to 29.

Second, using age will allow the vaccination process to move “much faster,” predicts Mills. Age, after all, is far easier to verify than occupation or health conditions. As a corollary, it will obviously make line-jumping more difficult.

Further, an age-based vaccination order means policy makers don’t have to make judgments between different occupational groups. That wasn’t an issue when inoculation efforts were focused on doctors and nurses or first responders or others whose jobs bring them in close and regular contact with COVID patients.

But it is now. Mills says she and her team were being lobbied hard for vaccine priority status by groups ranging from veterinarians to grocery workers to transportation sector employees to funeral directors to ski patrollers (!) to those with various health conditions.

“Everybody makes a good case,” she said, perhaps a bit diplomatically. Choosing among them is inherently at least somewhat subjective. Using age avoids that subjectivity while assuring that the most vulnerable cohort in all occupations will be vaccinated in the same approximate period.

Maine is the only state using age alone, though Connecticut (first dose, 19.5 percent) has a new schedule based primarily on age, with a special exception for teachers. The Mills administration is not prioritizing teachers as an occupation but has promised an effort to make sure all educators are vaccinated when their age group becomes eligible.

Now, Maine is an older state and an overwhelmingly white one, so what works there may not be the right solution elsewhere. Still, Mills’s plan strikes me as both sensible and easy to administer — and one that thus deserves a close look as other states grapple with how to prioritize the next tier of vaccine recipients.