A woman wearing a protective face mask smokes a cigarette on June 7, 2020. Ely Pineiro/Getty Images

New Jersey announced Thursday it would start vaccinating people age 65 and older and people with underlying health conditions against the coronavirus.

One of those health conditions that now bumps New Jerseyans to the front of the line is smoking.

Only people age 75 and older and essential workers were recommended to be next in line, but US officials recently urged states to expand eligibility.

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Officials are scrambling to speed-up COVID-19 vaccinations across the US, but a complicated set of guidelines regarding who should get priority have stymied states’ efforts to maximize the number of shots in arms.

In order to accelerate the rollout, Health and Human Services Secretary Alex Azar said Tuesday that states should expand the pool of people who have priority access. That pool should now include Americans between the ages of 16 and 64 who have certain underlying health issues that increase the risk of developing severe COVID-19, he said.

As a result, New Jersey governor Phil Murphy announced that the state will extend vaccine eligibility per Azar’s recommendations starting Thursday.

The decision will bump the state’s two million cigarette smokers to the front of the vaccine line, alongside people with other high-risk medical conditions, including obesity, Type 2 diabetes, and heart disease.

“Nicotine is one of the most powerful addictions. Smoking put individuals at higher risk for more severe disease. If an individual who smokes gets COVID, they get sicker much quicker,” Donna Leusner, director of communications for the state department of health, said in a statement Thursday.

“Our goal is to save as many lives as possible and to promote vaccination among the highest risk groups,” she added.

In NJ, smokers can get vaccinated before teachersNew Jersey Governor Phil Murphy, watches as Maritza Beniquez, RN, reacts to receiving a COVID-19 in Newark, New Jersey. Kirsten Luce/Pool via Reuters

New Jersey’s decision to expand its vaccine priority pool means that smokers are now eligible to get vaccinated alongside healthcare workers, police officers and firefighters, and residents age 65 and older.

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The move also catapults people with a history or current practice of smoking cigarettes ahead of teachers and public transportation employees in the state.

Per CDC guidelines, essential workers should be among those next in line, though ultimately individual states decide how to distribute their vaccine allotments. States like New York are already vaccinating teachers.

Governor Murphy’s announcement sparked an outcry on social media, with people pointing out that smokers now have elevated priority over essential workers, who are disproportionately people of color.

According to Kristen Ehresmann, director of infectious disease epidemiology, prevention, and control for the Minnesota Department of Health, expanding the priority pool may be more trouble than it’s worth.

“There would be some gains in efficiency, but there would be significant losses” in terms of vaccine equity and racial justice, she told STAT.

No proof requiredSandra Lindsay, director of critical care at the Long Island Jewish Medical Center in New Hyde Park, New York, was the first hospital to role out the COVID-19 vaccine in the US. Mark Lennihan/Pool via REUTERS

NJ Department of Health Commissioner Judy Persichilli said in a press conference Wednesday that the state will not ask for proof that people smoke if they show up for a shot.

“No documentation of the medical condition or your age will be required,” she said.

Twitter users joked that the lax guidelines surrounding New Jersey’s new vaccine eligibility presented an easy opportunity to get vaccinated.

The expanded priority pool means four and a half million New Jersey residents – about half the state’s population – are now eligible for a vaccine.

In addition to the state’s two million smokers, that group includes one and a half million residents age 65 and older, and up to one million people with other health conditions, according to Persichilli.

New Jersey has only administered about 288,000 doses as of Thursday – about 6.5% of the now eligible population – and the state has only been allocated 731,000 doses, according to the Washington Post.

States can’t vaccinate everyone who is now eligible

While not all states have followed Azar’s recent instructions (Florida and Texas opened up vaccinations to residents older than 65 at the end of December), this expansion of America’s vaccine priority pool means it’s unlikely that any state can vaccinate all of its eligible residents in the near future.

Hundreds wait in line in Florida to receive the COVID-19 vaccine on December 30, 2020. Andrew West/The News-Press/USA Today Network via Reuters

There are 24 million healthcare workers and resident of long-term care facilities, who are part of the first priority group. Americans older than 74 and frontline essential workers, which constitute about 49 million people, make-up group two, followed by the 129 million Americans who were either older than 64 or had underlying health conditions.

Given Azar’s Tuesday announcement that all three groups should be bumped to the front of the vaccine line, that’s more than 200 million Americans who now have claim to a shot.

According to Moncef Slaoui, chief advisor of Operation Warp Speed, only half that many people will get vaccinated by March.

Operation Warp Speed chief Moncef Slaoui. MANDEL NGAN/AFP via Getty Images

The speed of US’s roll out is already significantly behind Slaoui’s predictions.

He predicted last month that 50 million Americans would be vaccinated by the end of January. With just 17 days left until that deadline, only 11.1 million doses have been administered and just 30 million doses have been distributed, according to the CDC.

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