ROCHESTER, Minn. — Mayo Clinic Rochester says it has embarked into a final category of health care workers permitted to receive the COVID-19 vaccine early.

When this group has been administered shots, Mayo will have offered the doses to more than 33,000 — or 92% — of its 39,000-person staff.

That leaves just 8% of the workforce for the state's largest private employer considered ineligible to receive vaccine early.

The figures come alongside news of favoritism within some large health care institutions across the country: Reports published over the weekend in The New York Times say that vaccine has been administered at academic hospitals to nonpatient-facing health care professionals, including researchers and administrators. The academic hospitals include Columbia University, Harvard, NYU and Vanderbilt, according to the Times.

With scarce, early doses meant for the prevention of sickness and preservation of societal function, giving vaccine to nonessential hospital administrators and others facing no contact with doctors or nurses was depicted in the article as equivalent to cutting in line, according to those who wrote the early vaccine guidance.

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Mayo says it has avoided that scenario.

"In Southeast Minnesota we've moved to third priority," said Melanie Swift, an occupational medicine specialist in charge of the COVID vaccination program at Mayo Clinic Rochester. "It includes people who are part of the health care team, and they're on site ... It's important to vaccinate them as part of that team that's physically together supporting the care of patients."

Swift said this group does not include researchers with no patient contact, employees who will presumably qualify for vaccine at a later date as do much of the general public — based on their age and health status.

"Here at Mayo Rochester, we have not extended the invitation for vaccination to those groups," Swift said, "... those researchers, those teleworkers."

Dr. Melanie Swift. Submitted photo.
Dr. Melanie Swift. Submitted photo.

Swift said Mayo developed its list for health care workers allowed early access after an exhaustive internal assessment by supervisors of each employee's exposure, according to a set list of variables. The clinic undertook this project in early December, before the state released its guidance, and will soon publish it in the New England Journal of Medicine.

"The two groups not (allowed early vaccine) are people who may be physically onsite, but their work does not support clinical care," Swift said. "That would include people who do solely nonclinical research, who are not working with COVID samples, who are not working directly with patients. It includes people who support education but not the clinical enterprise, and people who exclusively telework."

Following Federal vaccine prioritization plan

In late December, the Centers for Disease Control and Prevention created guidelines outlining a prioritization process for distributing early, limited doses of vaccine. States were free to fine-tune these advisories. In Minnesota, the result was a plan demarcating the vaccine-seeking public into three early phases, Phase 1a, 1b and 1c.

Phase 1a was designated for health care workers and residents of long-term care, Phase 1b included those older than 74 and essential workers, while Phase 1c served those with underlying conditions and over 64.

With its large health care sector, Minnesota is estimated to have 500,000 residents in Phase 1a alone, and health officials believe all of January will be needed to vaccinate them all.

This has necessitated dividing Phase 1a into three tiers, with a first tier doses within 1a reserved for those working with COVID patients or lab samples. The state is now in the second tier of Phase 1a, one in which all health care workers providing direct patient care are eligible for vaccine.

Tier three of Phase 1a, where Mayo arrived last week, is meant to serve vaccine broadly among all medical staff onsite within a health care organization. Asked if this guidance allows administrators with no patient contact to receive vaccine, in an email, Kris Ehresmann, Minnesota Department of Health Infectious Disease director, wrote, "tier 3 of Phase 1a ... is in reference to workers with direct patient interaction or who could be exposed to infectious agents that can be transmitted in the health care setting."

The language on the MDH webpage appears to go even farther, including in this final group "all remaining HCP (health care personnel) not included in the first and second priority groups that are unable to telework.

"Their Phase 1a is large," Swift said. "But we believe we are aligned with the intent of it."

M Health Fairview, with 34,000 employees, also says it has not allowed administrators, student researchers and others with no patient contact to get COVID-19 vaccine, according to spokesperson Jill Fischer.

During a news conference Tuesday, Jan. 12, Ehresmann said "we are aware of several systems that have made decisions on their own," about which health care workers qualify for vaccine. "There are some situations in which you are vaccinating quickly to avoid wasting doses," she said. "But what is challenging is when decisions are made that are planful about not following guidance."

Counterpoint: Rigid apportioning of doses is slowing rollout

Ironically, concern has shifted away from the question of whether some may be getting early vaccine without justification, to the question of whether rigid adherence to prioritization guidelines has caused health systems to slow the delivery of vaccine.

Currently, just a third of the vaccine delivered to the nation's states has been administered. This lag led the White House on Tuesday, Jan. 12, to say it may shift away from allocating vaccine by population. Instead, more vaccine would be given to states that are using more, and by their percentage of population over 65 — who it says should begin getting vaccine now along with those with elevated health risks.

Ehresmann said the announcement came as a surprise to state health officials, and will cause them to delay their planned announcement next week of which essential workers and older Minnesotans gets vaccine under Phase 2a, slated to begin next month. She added that the change may not last, as it would not take effect until after Jan. 20, when Joe Biden is inaugurated as president.

"If you are tracking the date, there will be a new administration at that point," Ehresmann said. "We have appreciated the pro-rata (population-based) approach, and will wait to see what they have to say. The only information we have is what we saw in that announcement today."

Ehresmann said systems should consider giving any excess vaccine during the health care prioritization window to health care workers outside of their systems.

Asked if it was possible that highly placed executives who would never be thrust into patient contact might have received vaccine, Swift said "I can tell you that we built a process that assesses people for their individual risk level, and that we have not allowed people to self-assess their risk.

"We have tried to fine-tune it as much as possible. Is it going to be 100% perfect? No, probably not. But it's a good faith effort to make sure the vaccine is being allocated where it's intended to go. ... We just need more vaccine as soon as possible to get to the next phase of vaccination," she said. "We have no trouble getting vaccine delivered once we receive it."