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The floodgates have opened for people seeking COVID vaccines

People who are even a few pounds overweight or former smokers now eligible

People entered the Hynes Veterans Memorial Convention Center COVID-19 vaccination site in Boston.Jessica Rinaldi/Globe Staff

New state eligibility rules for COVID-19 vaccinations effectively flung the doors wide open to the vast majority of residents, allowing immediate shots for people who are even slightly overweight or smoked as few as 100 cigarettes in their lifetimes.

The rules, which took effect on Monday, allow anyone who suffers from a single co-morbidity, such as being overweight or a former smoker, to immediately seek an appointment regardless of age — a full two weeks before the general public was scheduled to become eligible.

Nearly three-quarters of adults qualify as overweight or obese under federal guidelines adopted by the state late last week, including any person who is 5 feet 10 inches and weighs more than 174 pounds.


That describes Dave Powers, a 31-year-old Web developer in Somerville, who was able to snag an appointment for next week because he just squeaked in under the new rules with a body mass index, or BMI, of 25.1. For Powers, who is about 5 feet 10 inches, that translates to 175 pounds.

“It was a pleasant surprise being eligible a couple weeks sooner than I expected to be,” said Powers, who has been scouring the state’s eligibility list each time it’s updated to see if something, anything, would put him in line sooner.

The state has been steadily making new population groups eligible for a COVID vaccine as the pace of vaccinations quickens — so far, more than one third of Massachusetts adults have received at least one dose and 21.6 percent are fully vaccinated, according to state figures.

Under the criteria that took effect Monday, people 55 and older and those 16 and older with one qualifying health condition are able to book appointments. Last Friday, the state expanded the list of qualifying health conditions to include type 1 diabetes, HIV, and having a substance use disorder, aligning the state with recommendations from the federal government.


The new rules expand the pool for who can get shots by more than 1 million people, according to the state COVID-19 Response Command Center, which issued a statement saying they are just following the guidelines from the Centers for Disease Control and Prevention. However, based on the percentage of people who are overweight or obese, the number could be much larger than one million.

The biggest issue, state officials said, is having enough vaccine doses to give everyone their shot.

“The Commonwealth followed CDC guidance and updated its list of medical conditions to align with the CDC’s updated list and definitions,” the statement said. “By Patriots’ Day, all residents 16 and older will be eligible for the vaccine, earlier than the Biden-Harris Administration’s directive of May 1, but the vaccine rollout can only move as quickly as the federal government distributes vaccines to states, and the Commonwealth continues to urge the federal government to increase the state allocation to Massachusetts.”

On April 19th, Patriots’ Day, the general public ages 16 and over will be eligible, adding about 1.73 million additional individuals, the statement said.

But Monday’s eligibility changes caught many people by surprise as they learned that they could get their shots now instead of waiting for April 19.

Just the new weight criteria, along with another health condition that makes former smokers eligible, opens the door to a wide swath of the population, physicians say. The state is using the CDC guideline of a former smoker as an adult who has smoked at least 100 cigarettes in his or her lifetime but who had quit smoking. Nationally, 21 percent of all adults are former smokers, according to the National Center for Health Statistics, but they may face continued health risks from their past.


“About 40 to 50 percent of patients we see in emergency departments are current or former smokers,” said Dr. Ali S. Raja, executive vice chair of emergency medicine at Massachusetts General Hospital.

Raja said that any prior history of smoking — even just a few packs — carries a higher risk for complications from COVID-19, which is why the CDC and Massachusetts are using that criteria.

“It’s a very conservative cut off,” he said. “And I think it’s a great thing. I want us to include as many people as possible because we are seeing a surge [of infections] in younger people as well and I really want to see them vaccinated.”

The new weight criteria intensified an already turbo-charged race to sign up for a vaccine, with many younger, digitally savvy people, including Powers, hopping on Web aggregating sites and Twitter accounts Monday that continuously search and spit out Web links to locations with available appointments.

“I was able to register for an appointment for next week at Tufts,” he said. “I will see if anything comes up sooner. But I’m glad to have something in my pocket.”


The new weight rules have also reignited a long-simmering debate about how accurately body mass index predicts increased health risks. The state is following CDC guidelines, which sets BMI benchmarks to determine who is overweight or obese. The CDC benchmark for overweight is a BMI of 25 to 30. Over 30 BMI is considered obese, which the CDC says includes about 43 percent of Americans.

“For athletes, the BMI is rough, it’s a crude measure of body fat,” said Dr. Caroline Apovian, co-director center for weight management and wellness at Brigham and Women’s Hospital. Some athletes who have a lot of muscle, for instance, might have a BMI that ranks them as overweight or even obese, even if they are in good health.

Apovian also noted that the BMI is not calibrated well for different racial and ethnic minority groups and how at risk they might be for other health problems tied to weight, such as heart disease and diabetes.

For instance, Apovian said, Black people may be at higher risk of diabetes at a lower BMI.

“They have a higher prevalence of diabetes, controlling for BMI, than whites or Hispanics,” she said.

But Apovian sees a “silver lining” in the addition of the overweight BMI category to the state’s list.

“This is a good thing because we are becoming more aware of weight and our BMI and how it leads to disease — more than just leading to a shot,” she said.

Anissa Gardizy and Steve Annear of the Globe staff contributed to this report.


Kay Lazar can be reached at Follow her @GlobeKayLazar.