MILWAUKEE — As COVID-19 vaccines keep rolling out across the Badger State, officials are still trying to figure out who exactly should be next in line for the shots.

Wisconsin is for now focusing its doses on Phase 1A — health care workers and long-term care facilities. But the next wave, Phase 1B, is right around the corner.

On a national level, a Centers for Disease Control and Prevention committee published its guidance in December. The CDC group recommended that Phase 1B should include adults 75 and older, people with high-risk medical conditions, and certain essential workers. 

And the Trump administration released new guidance Tuesday that would bypass the earlier CDC list, recommending the vaccine for people 65 and up or with underlying health conditions. 

But the nationwide guidelines aren’t binding — states have final say over where they send their doses. 

In Wisconsin, a subset of the State Disaster Medical Advisory Committee has been meeting regularly to hash out what the state’s phases should look like. Experts on this SDMAC vaccine subcommittee voted Tuesday to send their Phase 1B plan out for public comment. 

Their recommendations, which stray slightly from the CDC’s guidance, would bring several new groups into the mix for the next phase of vaccination. Here, we break down who will likely be included, based on the SDMAC's discussions.

Older adults ages 70 and up

In Wisconsin, the majority of COVID-19 cases have stemmed from young adults and middle-aged residents. But older adults have faced the most severe consequences: Patients 70 and older make up 79% of deaths related to coronavirus, according to DHS data.

Wisconsin is a relatively old state, and around 682,000 residents would fall into the 70 and up range, according to the SDMAC draft. Of course, as the draft points out, a good number of these residents live in long-term care facilities and are already covered by Phase 1A.

The guidance would shift the age cutoff down from the CDC’s original range, which draws the line at 75 years. 

UW-Madison’s Jonathan Temte, co-chair of the vaccine subcommittee, said this is in part a question of data collection: Wisconsin shares its coronavirus age information by decade. Plus, he pointed out, pulling the range down a bit could help bring in more Wisconsinites with underlying risk factors.

“There are a lot of relatively healthy people in their upper 60s,” Temte said at a subcommittee meeting last week. “People hit 70, and we start having a higher preponderance of comorbid conditions.”

Congregate living settings

The SDMAC guidance includes a major addition that’s not in the CDC outline: Congregate living staff and residents. 

This means Phase 1B could send vaccines into group homes for the disabled, homeless shelters, jails, and prisons, among other locations. (College dorms would still be excluded, the draft specifies, since adding them in would make 1B too wide.)

In all of these settings, residents take on extra exposure risk as they are often unable to follow social distancing guidelines. 

Plus, many of those in family care — like the state’s IRIS program — are low-income, have underlying health conditions, and require face-to-face medical care, as some subcommittee members pointed out. According to DHS data, there have been 142 COVID-19 deaths among group housing residents, excluding long-term care facilities. 

Jails and prisons across the state have also seen major COVID-19 outbreaks over the course of the pandemic. More than 10,500 inmates have tested positive in total, according to a Department of Corrections dashboard, and at least 25 have died; the COVID-19 mortality rate among inmates is more than twice as high as in Wisconsin overall.

Subcommittee member Mary Muse, director of nursing for the Wisconsin DOC, said excluding incarcerated people would be “a disparity on top of a disparity.”

“I understand we want to be efficient; I understand we want to get this vaccination out,” Muse said. “But you cannot ignore this population. You cannot push them back.”

Public-facing essential workers

Specific groups of essential workers will also likely be part of Wisconsin’s 1B population, according to the SDMAC draft. 

Non-EMS first responders, including police and firefighters, are part of this list. State officials announced this week that police and firefighters would actually be the first 1B group eligible for the vaccine, and could start getting their shots as early as next week. 

At a media briefing, DHS deputy secretary Julie Willems Van Dijk said this was an effort to create a “seamless” transition between the two phases, getting started on the next round while still finishing up 1A groups.

“Our goal is to never stop vaccinating,” Willems Van Dijk said.

Those in education and childcare — from preschool all the way through higher education — are part of the draft 1B recommendation as well. Getting kids back to school has been a huge concern during the pandemic, since, as the draft says, in-person instruction can lead to better learning outcomes for students and let their caregivers get back to work.

Non-frontline health care workers are also a potential 1B category.

Though they may not be taking care of patients directly, these types of employees — like those focused on supply chain, food service, and cybersecurity — are important to keep health infrastructure up and running, subcommittee members said. However, some members were unsure about the category, since these employees may be able to work remotely and not take on direct exposure risk.

Finally, the SDMAC draft calls out a small and specific group: Mink husbandry workers. The main goal for this group, which represents an estimated 300 Wisconsinites, is to avoid viral jumps between humans and animals, which could lead to dangerous mutations. 

Research has shown that the virus can move from infected farm workers to mink and then back into humans. Though no concerning mutations have been found yet from these species jumps, the possibility has raised concern — in Denmark, the government went so far as to cull all 17 million of its farmed mink.

What happens next?

At the end of its Tuesday meeting, the SDMAC vaccine subcommittee voted unanimously to move the draft — with some amendments — into a public comment period. Once the revised draft is posted, members of the public will have a week to submit comments about the proposed 1B groups. 

After public comment, the subcommittee will send an updated version through the whole SDMAC group, and finally submit their recommendations to DHS.

Of course, while these discussions continue, the state is in the thick of its ongoing vaccine distribution efforts. Officials said Monday that around 30% of Phase 1A residents had already gotten their shots, and that the DHS would keep managing the constant “treadmill” of distribution while working through the decision-making process for future phases. 

“We’re balancing their good and scientific counsel to us with vaccine supply and keeping the system moving,” Willems Van Dijk said.

And the subcommittee’s work is not done yet: Its experts are also tasked with creating guidelines for Phase 1C. This phase is still under discussion, but may add more older adults, high-risk patients, and essential workers in public transit, manufacturing, and agriculture.

Temte reminded subcommittee members that, while no decision would please everyone, the task of getting vaccines out is one of life-saving significance.

“We need to make progress with the realization that whatever we do is going to be far from perfect, and that’s OK,” Temte said. “The important thing is to get as much vaccine into as many people as possible.”