When AJ McCulloch received a first dose of Covid-19 vaccine, she said a wave of emotions overcame her – but the strongest was relief.
McCulloch, 27, lives with type 1 diabetes, as do her twin sister and father. The disease puts them at an increased risk for severe illness if they get Covid-19.
“One of the first things my dad ever told me when I was diagnosed was that I was going to have to fight for myself and my health my whole life,” McCulloch told CNN. “So when I walked in and was able to get the vaccine … I felt such a sense of relief.”
About two months have passed since the Pfizer/BioNTech and Moderna Covid-19 vaccines were authorized for emergency use in the United States and states began to administer doses, vaccinating health care workers and long-term care facility residents first.
Since then, many states have moved on to vaccinate the next prioritized groups, such as other essential workers, older adults and – most recently – people with comorbidities or underlying medical conditions that put them at an increased risk, such as diabetes.
“At the end of the day, 40% of all the deaths from Covid-19 are among those with diabetes, not just type 1, but type 2 as well,” said McCulloch, a project manager at the American Diabetes Association. Although, according to the association, diabetes affects just about 10% of the US population.
But the move to vaccinate people with diabetes and other certain conditions has not been uniform nationwide. In some states, people with comorbidities are not eligible to receive the vaccine yet – and in states where they are eligible, there’s variation on what conditions make someone eligible for a vaccine, and whether paperwork is required to confirm that condition.
The underlying conditions that qualify
Most of the states that are vaccinating people ages 16 to 64 with certain comorbidities are defining the eligible conditions by the US Centers for Disease Control and Prevention guidance on which conditions are associated with an increased risk for severe illness from Covid-19 infection.
The CDC notes that adults of any age with the following underlying conditions are at an increased risk of severe Covid-19: cancer, chronic kidney disease, COPD, Down syndrome, heart conditions, obesity and severe obesity, sickle cell disease, smoking, and type 2 diabetes. The list also includes people with a weakened immune system from solid organ transplantation and pregnancy.
Some states include just some of those conditions on its list of eligible conditions, while others may require that a person lives with two or more of those conditions to be eligible.
In New Hampshire, for instance, having two or more conditions qualifies you for the vaccine under Phase 1b, if your conditions are verified by a medical professional, but having just one condition puts you into Phase 3A, which has not started yet.
In Ohio, those with a developmental or intellectual disability plus certain congenital, developmental or early onset and inherited conditions are eligible for vaccination, according to the state’s Department of Health website.
The state of Colorado, where McCulloch lives, has not started vaccinating people with certain comorbidities or underlying health conditions, such as cancer, heart conditions or diabetes.
McCulloch was able to receive a first dose of the Moderna vaccine because a local pharmacist who vaccinated McCulloch’s mother mentioned that the pharmacy had some extra doses of vaccine that it needed to administer quickly. Otherwise, the doses would expire and could not be used.
“They had asked her if she had anyone that she knew that was living with diabetes, heart disease, all of those things – and she actually said that her husband and her two daughters were both living with diabetes,” McCulloch said. “So I was able to go.”
When McCulloch arrived at the pharmacy to receive the vaccine, the pharmacist asked for proof that McCulloch lives with diabetes. McCulloch said that she showed the pharmacist a glucose-monitoring sensor on her arm, some of her medical data that she tracks on an app and her health insurance information.
“Just being in the right place at the right time, I was able to kind of jump in line and grab my first dose,” McCulloch said. She is due for her second dose on February 15.
“I recognize that I have a very privileged stance, because of the way that the rollout was done, and due to my mom being a special education teacher,” McCulloch said.
“For example, my dad and my twin sister have not gotten their vaccine quite yet,” she said. “That’s part of the problem right now – is that states’ rules vary so greatly, and at the end of the day, people with comorbidities, they deserve to receive the vaccine just as much as other people.”
Where people with comorbidities are eligible
People with certain comorbidities and underlying conditions currently are eligible to sign up for Covid-19 vaccinations in nearly a dozen states: New Hampshire, New Jersey, Pennsylvania, Texas, New Mexico, Virginia, Mississippi, Ohio, Missouri, Nebraska and Montana, according to a CNN analysis of public health department websites.
Some of those states have started vaccinating this group while others are only starting pre-registration. Within a state, it might vary county by county.
In a couple of other states, vaccinations are set to start soon this month.
In New York, people with comorbidities and underlying conditions can sign up for vaccination appointments starting Sunday and vaccines are expected to begin for this group on Monday.
“As the state’s effort to vaccinate health care workers nears completion this week, we are now shifting those doses to prioritize those New Yorkers with comorbidities and pre-existing conditions - a group which has felt the brunt of COVID’s destructiveness first-hand,” New York Gov. Andrew Cuomo said in a news release this week.
In Illinois, the state plans to expand eligibility for the vaccine on February 25 to include people with comorbidities, underlying conditions and disabilities.
On Wednesday, Illinois Gov. JB Pritzker said in a news release, “As quickly as we receive enough vaccine supply, we need to waste no time in protecting a broader section of our most vulnerable population.”
‘Some … are going to be on the honor system’
But how individuals confirm their underlying conditions is different from place to place.
In some states, such as New York and New Mexico, documentation is required at vaccination appointments to prove that you have an underlying medical condition. For instance, New Yorkers must provide either a doctor’s note, medical records or signed certification.
In New Mexico, the state’s Department of Health notes, “Individuals should be prepared to verify medically qualifying conditions. To do so, individuals may provide a note from a provider, emergency department or hospital discharge summary, prescription bottle, prescription, or other form of validation.”
In some other states, such as New Jersey, Texas and Virginia, no documentation is required.
Lara Anton, a spokesperson at the Texas Department of State Health Services told CNN in an email on Thursday, “We don’t want to create barriers that would prevent people from getting vaccinated. To confirm chronic medical conditions, providers should refer to the person’s medical history. If a provider doesn’t have access to the person’s medical history, the person can self-disclose their qualifying medical condition. They do not need to provide documents to prove that they qualify.”
Each state is different “and some of these vaccine registration processes are going to be on the honor system,” said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials, known as NACCHO.
As someone living with high blood pressure, Freeman said that she pre-registered for a vaccine on an online waitlist in her community of Prince William County, Virginia, in the category of underlying health conditions. Covid-19 vaccines will be administered to that priority group once the county moves into its next vaccination phase.
“In the case of my own jurisdiction, the preregistration for those with underlying conditions is based on an honor system to tell you truth,” she said. “I did not have to provide proof of medication, a diagnosis of the underlying condition, or anything like that.”
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Freeman said that there are various ways residents might learn about their eligibility for a Covid-19 vaccine, such as through their local health department, community organizations or the faith community.
McCulloch, who has received her first dose in Colorado, certainly looks forward to when her twin sister and father will be eligible to get vaccinated in their communities.
“I believe in health care, and I believe in science,” McCulloch said. “This is critical for the health and safety of our population.”
CNN’s Ashley Ahn contributed to this report.