Prioritization of pregnant individuals in state plans for coronavirus disease 2019 vaccination.

Objective

The US Centers for Disease Control and Prevention (CDC) considers pregnant people to be at high-risk for severe disease and death from coronavirus disease 2019 (COVID-19), and the Advisory Committee on Immunization Practices (ACIP) recommends that pregnant individuals should be prioritized for vaccination in Phase 1c of vaccine allocation. However, various state vaccination plans have not been uniform in the adoption of the ACIP priority group recommendations. Prior research found 15 states included pregnancy among other COVID-19 priority groups, but planning has been highly dynamic in recent weeks. The objectives of this study were to determine how many states prioritize pregnant individuals for COVID-19 vaccination and assess the current eligibility of pregnant people to receive COVID-19 vaccinations across the United States.

Study Design

We searched for information about the priority groups for COVID-19 vaccinations from all 50 states in the United States and the District of Columbia on March 6, 2021. Our analysis included information from official government websites. This study did not require institutional review board approval because it examined data from publicly available sources and used no patient information.

Results

As of March 6, 2021, most states (36 of 51; 73%) classified pregnant individuals as a priority group for COVID-19 vaccination; in just under 50% of the states (24 of 51), pregnant people are currently eligible for vaccination (Table ). The 36 states prioritizing pregnancy encompass 76% of the US population. Of these states, 23 refer to the CDC’s classification of pregnant people as being at an elevated risk for severe COVID-19 illness. Several states (9 of 51; 18%) prioritize groups at elevated risk for severe COVID-19 illness because of preexisting health conditions but have not specifically enumerated pregnant people as a priority group. Four states have designed their prioritization plan around an age-descending strategy, and 2 states list only current or near eligible groups, and pregnant people are not included.

Table

State prioritization of pregnant individuals for coronavirus disease 2019 vaccination

State	Priority (phase)a	Current eligibilityb	Populationc	Source
Alabama	Yes (1c)	No	4,903,185	https://www.alabamapublichealth.gov/covid19vaccine/distribution.html
Alaska	Yes (1b)	Yes	731,545	http://dhss.alaska.gov/dph/epi/id/pages/COVID-19/vaccine.aspx
Arizonad	No	No	7,278,717	https://azgovernor.gov/governor/news/2021/03/state-adopts-unique-hybrid-model-covid-19-vaccine-prioritization
Arkansas	Yes (1c)	No	3,017,804	https://www.healthy.arkansas.gov/programs-services/topics/covid-19-vaccination-plan
California	Yes (1c)	No	39,512,223	https://covid19.ca.gov/vaccines/#California's-vaccination-plan
Colorado	Yes (1b)	Yes	5,758,736	https://covid19.colorado.gov/for-coloradans/vaccine/vaccine-for-coloradans
Connecticut	No	No	3,565,287	https://portal.ct.gov/vaccine-portal/COVID-19-Vaccination-Phases
Delaware	No	No	973,764	https://coronavirus.delaware.gov/vaccine/vaccination-timeline/#phase-1b
Florida	No	No	21,477,737	https://floridahealthcovid19.gov/covid-19-vaccines-in-florida/
Georgia	No	No	10,617,423	https://dph.georgia.gov/covid-vaccine
Hawaii	No	No	1,415,872	https://hawaiicovid19.com/vaccine/#first-vaccines
Idaho	No	No	1,787,065	https://healthandwelfare.idaho.gov/covid-19-vaccination
Illinois	Yes (1b+)	Yes	12,671,821	https://www.dph.illinois.gov/covid19/vaccine-distribution
Indiana	No	No	6,732,219	https://www.coronavirus.in.gov/vaccine/index.htm
Iowa	Yes (1b)	Yes	3,155,070	https://idph.iowa.gov/Emerging-Health-Issues/Novel-Coronavirus/Vaccine/Information-for-the-Public
Kansas	Yes (3)	No	2,913,314	https://www.kansasvaccine.gov/157/Availability
Kentucky	Yes (1c)	Yes	4,467,673	https://govstatus.egov.com/ky-covid-vaccine
Louisiana	Yes (1b)	Yes	4,648,794	https://ldh.la.gov/index.cfm/faq/category/138
Maine	No	No	1,344,212	https://www.maine.gov/covid19/vaccines/phases
Maryland	No	No	6,045,680	https://covidlink.maryland.gov/content/vaccine/
Massachusetts	Yes (2)	Yes	6,892,503	https://www.mass.gov/info-details/covid-19-vaccinations-for-individuals-with-certain-medical-conditions
Michigan	Yes (1c)	No	9,986,857	https://www.michigan.gov/documents/coronavirus/MI_COVID-19_Vaccination_Prioritization_Guidance_2152021_716344_7.pdf
Minnesota	Yes (1b)	No	5,639,632	https://www.health.state.mn.us/diseases/coronavirus/vaccine/phase1b1c2.pdf
Mississippi	Yes	Yes	2,976,149	https://msdh.ms.gov/msdhsite/_static/14,22816,420,976.html
Missouri	Yes (1b)	Yes	6,137,428	https://covidvaccine.mo.gov/priority/Phase1b/#phase1b-2
Montana	No	No	1,068,778	https://dphhs.mt.gov/publichealth/cdepi/diseases/coronavirusmt/covid19vaccineavailability
Nebraska	No	No	1,934,408	https://dhhs.ne.gov/Pages/COVID-19-Vaccine-Information.aspx#SectionLink2
Nevada	Yes	Yes	3,080,156	https://www.immunizenevada.org/county-specific-covid-19-vaccine-plan
New Hampshire	Yes (1b)	Yes	1,359,711	https://www.dhhs.nh.gov/dphs/cdcs/covid19/documents/covid19-vaccine-allocation-plan-summary.pdf
New Jersey	Yes (1b)	Yes	8,882,190	https://covid19.nj.gov/faqs/nj-information/slowing-the-spread/who-is-eligible-for-vaccination-in-new-jersey-who-is-included-in-the-vaccination-phases
New Mexico	Yes (1b)	Yes	2,096,829	https://cv.nmhealth.org/wp-content/uploads/2021/02/2021.1.28-DOH-Phase-Guidance.pdf
New York	Yes (1b)	Yes	19,453,561	https://covid19vaccine.health.ny.gov/phased-distribution-vaccine#phase-1a---phase-1b
North Carolina	Yes (group 4)	No	10,488,084	https://covid19.ncdhhs.gov/vaccines/providers/covid-19-vaccine-management-system-cvms
North Dakota	Yes (1b)	Yes	762,062	https://www.health.nd.gov/covid-19-vaccine-priority-groups
Ohio	Yes (1c)	Yes	11,689,100	https://coronavirus.ohio.gov/wps/portal/gov/covid-19/covid-19-vaccination-program
Oklahoma	No	No	3,956,971	https://oklahoma.gov/covid19/vaccine-information.html
Oregon	Yes (1b)	Yes	4,217,737	https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le3527A.pdf
Pennsylvania	Yes (1a)	Yes	12,801,989	https://www.health.pa.gov/topics/disease/coronavirus/Vaccine/Pages/Distribution.aspx
Rhode Island	Yes	No	1,059,361	https://health.ri.gov/publications/guidelines/COVID19-underlying-conditions.pdf
South Carolina	Yes (1b)	No	5,148,714	https://scdhec.gov/covid19/covid-19-vaccine
South Dakota	Yes (1d)	Yes	884,659	https://doh.sd.gov/documents/COVID19/Vaccine/COVIDVaccineAvailability_Distribution.pdf
Tennessee	Yes (1c)	No	6,829,174	https://covid19.tn.gov/covid-19-vaccines/vaccine-phases/#1c
Texas	Yes (1b)	Yes	28,995,881	https://www.dshs.texas.gov/coronavirus/immunize/vaccine.aspx#eligible
Utah	No	No	3,205,958	https://coronavirus.utah.gov/vaccine-distribution/#eligibility
Vermont	Yes (5A)	No	623,989	https://www.healthvermont.gov/covid-19/vaccine/about-covid-19-vaccines-vermont#conditions
Virginia	Yes (1b)	Yes	8,535,519	https://www.vdh.virginia.gov/covid-19-vaccine/#phase1b
Washington	Yes (1b)	No	7,614,893	https://www.doh.wa.gov/Emergencies/COVID19/VaccineInformation/AllocationandPrioritization
Washington D.C.	Yes (1c)	Yes	705,749	https://coronavirus.dc.gov/vaccine
West Virginia	Yes (2a)	Yes	1,792,147	https://dhhr.wv.gov/COVID-19/Pages/Vaccine.aspx#timeline
Wisconsin	No	No	5,822,434	https://www.dhs.wisconsin.gov/covid-19/vaccine-about.htm
Wyoming	Yes (1b)	Yes	578,759	https://health.wyo.gov/publichealth/immunization/wyoming-covid-19-vaccine-information/

Results of the review of state prioritization planning for pregnant individuals. Data were collected on March 6, 2021, and may not represent recent changes in planning or eligibility.

COVID-19, coronavirus disease 2019.

Crane. Prioritization of pregnant individuals in state plans for coronavirus disease 2019 vaccination. Am J Obstet Gynecol 2021.

Phase listed refers to the first phase or subphase in which pregnant individuals are prioritized for vaccination. These have been rounded to the nearest subphase when divided into subphase tiers. States which do not follow a clear, phased approach to vaccination but still prioritize pregnant individuals are listed only as “Yes.” When pregnant individuals are prioritized across multiple phases, they are listed here under the earliest phase in which they are enumerated

Eligibility varies in some states at the county level. Results here refer to eligibility of pregnant individuals in at least some counties within a state, even if there are additional requirements such as multiple, high-risk health states or an age threshold. States were not enumerated if they rely on reference from a physician to determine vulnerability to COVID-19 without specific mention of pregnancy

Population counts obtained from 2019 US Census Bureau Data (https://www.census.gov/newsroom/press-kits/2019/national-state-estimates.html)

At the time of plan analysis, Arizona was transitioning toward an age-based approach to COVID-19 vaccine eligibility and not all government resources had been updated to reflect this policy adjustment. Our analysis reflects the anticipated age-based approach.

Conclusion

Most states classify pregnant individuals as a priority group for initial COVID-19 vaccinations, and in almost 50% of the states, they are currently eligible to receive vaccines. These results differ substantially from previous findings published in early February 2021, which found that 15 of the 51 jurisdictions had prioritized pregnant individuals. The increased prioritization of pregnant people for COVID-19 vaccination marks important progress—it is both ethically imperative and supported by recommendations from professional US obstetrics societies and the CDC. , Continued efforts to ensure equitable access to COVID-19 vaccines for pregnant people require, at minimum, that all states prioritize pregnancy as equal with the CDC-listed, high-risk health conditions based on the available, objective data.

Even where pregnant people are eligible for COVID-19 vaccinations, personal decision making is complicated by the overall lack of pregnancy-specific safety data. Vaccine studies among pregnant people are underway and early registry data are reassuring. To date, pregnancy outcomes among nearly 2000 vaccinated pregnant people are no different from those in the general population, suggesting that the messenger RNA vaccines have no adverse effects on pregnancy. Pregnant people deserve the clearest possible guidance from public health agencies about their eligibility for COVID-19 vaccinations and whether the likely benefits of vaccination during pregnancy outweigh the risks.