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As states continue fine-tuning their plans for prioritizing scarce doses of COVID-19 vaccines, some in higher education who expected to be vaccinated along with other educators have found themselves pushed farther back in line.

About half of all states are already vaccinating K-12 teachers. But while some states are treating college educators the same as teachers for prioritization purposes, many are not. Some states are prioritizing K-12 workers first and scheduling higher education workers for later vaccination phases, while other states are seemingly not giving any prioritization to higher education workers and are instead leaving them to be vaccinated according to wherever they fall in line among the general population.

Bioethics experts disagree on the fairness of prioritizing individuals for vaccine distribution by virtue of their occupation. But for those states that have chosen to give educators early doses of the vaccine -- a choice that's in line with the recommendations of an influential federal advisory group -- the variety and still-evolving nature of approaches has created frustration and raised equity concerns.

Across states there are a patchwork of approaches. Some states, such as Alabama, California, Nebraska, South Dakota, West Virginia and Wisconsin, explicitly reference higher education staff and faculty in their vaccine allocation plans and give them equal priority as K-12 teachers and staff.

Some states have designated higher ed workers for a later phase than pre-K-12 workers. For example, Virginia and Washington, D.C., have both assigned higher education workers to a later phase than K-12 teachers and staff. The state of Oklahoma includes pre-K-12 teachers and staff in Phase 2 and workers in other educational settings in Phase 3.

Massachusetts prioritizes early education and K-12 workers for an earlier phase but indicates higher education workers will be eligible when the vaccine is available to the general public. Some states, such as Colorado and Tennessee, list K-12 educators as receiving priority for the vaccine but do not list higher education workers as having any special priority.

Priority for K-12, but Not Higher Ed

In Colorado, where pre-K-12 educators and childcare workers are eligible for vaccination right now, some college leaders have been advocating for college faculty and staff to be moved up the line.

"The sooner that higher education employees are vaccinated, the sooner we can expand our students' in-person learning experience," Michelle Marks, the chancellor of the University of Colorado Denver, said on Twitter. "This, in turn, helps to get our state’s economy back on track and boost the workforce."

Andy Feinstein, president of the University of Northern Colorado, said on Twitter that he lobbied state leaders "for elevating the vaccination priority of @UNC_Colorado ’s faculty -- especially those who are teaching in-person in our classrooms, labs, and studios right now.

"We agree: K-12 teachers, re-opening schools are priorities. Our faculty should be, too. Many college students struggle with learning online. I worry about students who stop out or are struggling in silence," he wrote.

In a recent press conference, Colorado governor Jared Polis outlined the reasoning behind prioritizing pre-K-12 over higher education workers, explaining that elementary-aged children, in particular, "have difficulty getting the academic mastery they need through online education."

Polis added that the need for parents to support their children in learning online has "led to many parents having to drop out of the workforce, cut back their hours and put their economic security at risk. We already have seen that remote learning in pre-K-12 has already hurt participation of women in the workplace as well. It has negative effects on the mental and physical health of children."

"And of course to some extent all of these same issues affect higher education, but we do know that a 20-year-old is able to safely learn from home by themselves in a way that a 7-year-old simply can’t," Polis said.

Matthew Harvey, director of legislative affairs for the University of Colorado Boulder's Graduate and Professional Student Government, said that Polis's explanation "fails to consider some key points about higher education in the state of Colorado. Firstly, that the university system is continuing to promote a return to in-person instruction later this month, and will be returning undergraduate students to on-campus housing.

"As we return to in-person instruction, the burden for providing in-person instruction will fall on graduate student workers and pretenured faculty who have minimal job security, little to no bargaining power or union representation, have large teaching loads that create high work volumes and multiple classrooms (i.e., possible infection sites), and relatively little health insurance coverage should they contract severe infection," Harvey said.

Monica Fuglei, the chair of the English department at Arapahoe Community College in Colorado, believes higher education workers who have to work on campus deserve the same protections the state is giving K-12 educators.

"I think the initial perception was that higher education can move to a remote learning environment and can do so easily, but if you look at the degrees and certificates that my school provides, it's incredibly difficult for some of our students to move to a remote learning environment," Fuglei said.

"That perception that what we do we’re always able to do from a distance includes the belief that all of our students have internet, that all of our students have computers, that they don’t have needs that are difficult to attend to through the internet, that they’re not hungry, that they're not homeless," Fuglei said. "Our students are those things. They struggle with internet, they struggle with access, they struggle with online classes, they struggle with food, they struggle with housing, and all of those things have gotten worse during the pandemic, and so for us to serve students has become very difficult."

Hard Choices and Questions of Privilege

With quantities of COVID vaccines remaining highly limited, and viral transmission remaining at very high levels throughout the country, individual states have had to make hard choices about who gets vaccinated first.

The Advisory Committee on Immunization Practices, a body that advises the Centers for Disease Control and Prevention, recommends including educators, including those in higher ed, in the second phase of vaccination, Phase 1B.

But not everyone agrees educators should be prioritized for the early doses. Daniel P. Sulmasy, the André Hellegers Professor of Biomedical Ethics and director of the Kennedy Institute of Ethics at Georgetown University in Washington, D.C., argues that teachers and professors should not get special priority because of their occupations.

"Our priority ought to be on protecting the most vulnerable, those at highest risk for becoming critically ill and dying," Sulmasy said. "Within that there are some teachers who are in those categories -- they either have pre-existing conditions that put them at higher risk or they’re over 65 -- and they like the rest of the population in my view should get vaccination priority."

"It seems to me that there are plenty of states in which a 25-year-old first-grade teacher who’s perfectly healthy is getting priority over a 64- or in some cases 74-year-old with diabetes and hypertension and congestive heart failure and asthma," Sulmasy said. "There’s something to me that’s wrongheaded about that kind of a position because this virus selectively affects people in terms of the intensity of the illness. We ought to be following the course of the differential effect of the virus on particular populations, rather than prioritizing people because of their chance of being infected."

Steven W. Thrasher, a professor at Northwestern University in the Medill School of Journalism and author of the forthcoming book The Viral Underclass: How Racism, Ableism and Capitalism Plague Humans on the Margins, penned a recent essay in Scientific American in which he urged those who have had the luxury to work from home -- including professors -- to wait to be vaccinated.

"On the academic side of my life, I have noticed that by far, the largest group of people I see getting vaccinated in my social media feeds are other professors who are also working from home," Thrasher wrote. "This is somewhat expected, given whom I know. But they -- or rather, I should say we -- are highly educated people adept at navigating complex technical systems. People like us have kept our jobs even as custodians and food workers on our campuses have lost theirs."

Thrasher noted that a recent map of Chicago "that tracks who is dying of COVID and who is getting vaccinated against it alarmingly showed almost inverse populations.

"All of this makes me afraid that, because the rules have been catered to us, those of us least likely to get COVID are the most likely to get vaccinations first (and to even feel like we deserve it because we figured it out), when we should be getting them last because we’ve had other forms of protection," he wrote.

Thrasher said in an interview that while those who have had the privilege to work from home should wait, faculty and staff who have no choice but to work on campus should be eligible for vaccination on the same terms as K-12 educators.

“I think university administration of course should be mindful of this as well," Thrasher said. "They should not be forcing people into the classroom if they’re going to get vaccinated in a month. We need to be flexible and not force something when we’re very close to much safer conditions."

Matthew A. Crane, a visiting scholar at the University of Southern California's Schaeffer Center for Health Policy and Economics, said that the degree to which states choose to prioritize educators for early vaccine doses "is going to be a reflection of how they’re trying to get society reopened."

"There are clear arguments for getting students back in classrooms," said Crane, who is also a medical student at Johns Hopkins University. "There are also strong arguments in going straight for age and focusing on reducing mortality as quickly as possible. A lot of that will just depend on where the states’ priorities are for reopening at the moment and what their disease situation looks like as well."

Crane said in his view it does make sense to prioritize K-12 over higher education workers "given a lot of the discussion in the medical community has been centered on the possible irreversible damage of education to students and educational setbacks you might see in the pandemic" among younger children. "It’s just a different population that you’re dealing with."

The American Academy of Pediatrics has stressed the importance of resuming in-person K-12 schooling, citing educational reasons as well as health and safety concerns.

"Disparities in school funding, quality of school facilities, educational staffing, and resources for enriching curricula among schools have been exacerbated by the pandemic," the group says. "Families rely on schools to provide child care; a safe, stimulating space for children to learn; opportunities for socialization; and access to school-based mental, physical, and nutritional health services."

Apart from the K-12-versus-higher education distinction, at least one state, New York, has drawn a distinction among types of higher education employees as well. In-person college faculty and instructors -- but not other higher education employees -- are eligible for New York's current vaccination phase.

New York governor Andrew Cuomo's office did not return a request for comment about the reason for prioritizing in-person college faculty and instructors over other college employees, a decision that has been criticized on equity grounds. The state makes no similar distinction at the pre-K through 12th-grade level, where teachers, administrators, support staff and contractors, including bus drivers, are all currently eligible for the vaccine.

"It has proven to be really frustrating," said Frederick E. Kowal, president of United University Professions, a union that represents faculty and professional staff at 29 State University of New York campuses. "Especially in areas like residential life, they are dealing with students on a day-to-day basis. I’m hearing from our professional members every day who are concerned, frightened and disappointed."

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