Who Qualifies as High-Risk for COVID-19 Vaccine Eligibility?

As global COVID-19 vaccination efforts continue, more places are starting to offer the vaccine to people with health conditions deemed "high risk" regardless of their age. But what exactly is considered "high risk," and is the definition the same everywhere?

States Have Different Standards

The lack of federal unification in the United States means that each state is left to determine which conditions to prioritize for COVID-19 vaccination. Rich Parker, MD, chief medical officer for Arcadia, a health management platform, tells Verywell that most—but not all—states are using the Centers for Disease Control and Prevention (CDC) guidelines to inform their classifications.

"The CDC does offer guidance about who should go first, but states aren't obligated to follow that guidance," Parker says. "In Florida, Governor DeSantis said 'I'm giving the vaccine to everyone over 65, regardless of job function.' Each state relies on their Department of Health to make those recommendations, then politics gets thrown in, and it ends up being very arbitrary."

Parker says that the different standards mean that some people are able to access the vaccine more quickly than others.

"In Washinton state, you can get the shot if you live there or if you work there," Parker says. "In Kentucky, you can get it if you're a resident or provide health care in that state, but not any other job. It's totally variable."

What Is Considered High-Risk?

In some states, conditions that would typically be categorized as extremely high-risk are still not eligible for the vaccine. "If you're in Massachusetts and have HIV, that doesn't count. That's crazy," Parker says. "Certain cancers don't count."

Rare Conditions Left Out

Advocates from the rare disease community are calling for inclusion in higher-risk tiers. In February, the Tuberous Sclerosis Alliance joined with 70 biotech firms and advocacy groups to petition the National Governors Association to consider conditions that don't fall within the broad categories that were used to create the current standard.

"Due to the complexity of such diseases like TSC, rare disease patients are at an increased high risk for neurological and organ damage if they are infected with COVID-19," Kari Rosbeck, president and chief executive officer of the TS Alliance, said in a statement at the time of the petition letter.

The advocates also say that the caregivers of people with rare conditions need to be prioritized for vaccines as well. In their statement, Rosbeck pointed out that if "caregivers are exposed and forced to quarantine, it adds additional concerns for irreversible outcomes associated with lack of care and potentially catastrophic consequences for those with rare diseases."

More Common Conditions Deemed High-Risk

While people with rare diseases are still waiting for their turn for a vaccine in many states, some people with more common conditions that have been deemed high-risk have already been vaccinated.

Rebecca Feldhaus Adams, the news director at WFPL in Louisville, Kentucky, has asthma and is currently pregnant. She received the COVID-19 vaccine where she lives in Virginia Beach, Virginia.

According to the Virginia Department of Health, the conditions considered to be "high risk" are constantly being reevaluated as scientists learn more. According to the state's guidance, Feldhaus Adams' most acute condition was pregnancy, and asthma was secondary.

"I had signed up through the Virginia Beach registration site, not expecting to get the call until after I gave birth," Feldhaus Adams tells Verywell. "When I got the call that I had an appointment, I called every healthcare professional I know and asked, 'Are we sure about this?' My husband works in a hospital too, so all of the people I spoke to thought I was a good candidate for the vaccine."

Little Documentation Required

Although many people are now eligible for a vaccine under the changing tiers, the requirements for proving that they qualify for a vaccine for a medical reason are low.

Parker says that little to no documentation is required to prove medical conditions, partially because of the strain it would put on the system. "It's all on the honor system," Parker says. "And the reason for it is if we required people to give proof, we would just bog the whole system down. Doctors would go crazy, trying to document for everybody to deal with that."

In most places, identification is requested, but if people wouldn't be turned away if they don't present it. Feldhaus Adams says that she was not required to produce proof of her asthma diagnosis when she registered with Virginia Beach nor when she received the vaccine.

Vaccinating as Many People as Possible

Parker says that while the seemingly arbitrary nature of the classification of medical conditions for vaccines is frustrating, the result should still be kept in mind.

"There's an ethical question about jumping the queue. You could be depriving a more vulnerable person of the vaccine, and that's problematic," Parker says. "On the other hand, you could argue that the same person jumping the line may be breaking other rules, like wearing masks and not socially distancing. We want to get people like that vaccinated as soon as possible to be less of a risk to others. From a completely utilitarian perspective, it's important to get as many people vaccinated as possible."

As more states open up lower tiers for vaccinations, public health experts are expecting to see more vaccine tourism as people with conditions that are not included in standardized tier structures cross state lines in search of a vaccine.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.