Twenty-five year old Marie Eriel Hobro wasn’t expecting an invitation to get a COVID-19 vaccine, but when she did, the Oahu photojournalist and substitute teacher felt both eager and guilty. Thoughts of her older family members who had health conditions made her almost decline the invitation.

“I was really happy to get that notification because I have severe anxiety and OCD (obsessive compulsive disorder) and it’s pushed my mental health to dangerous limits at times,” she said. “At the same time there are people who are dying and have severe health risks. I felt like I didn’t deserve it yet.”

More than 189,000 doses of COVID-19 vaccines have been administered in Hawaii to medical workers, seniors 75 years old and older, and most recently, essential workers, or people who work in sectors officials have deemed critical.

So far, demand for the vaccine in Hawaii has exceeded the supply. As of Thursday, Hawaii had delivered approximately 80% of its vaccine supply, according to Lt. Gov. Josh Green.

The tight supply has some questioning the prioritization of certain groups — especially Hawaii’s decision, among a minority of states, to limit vaccine eligibility to those 75 and older instead of 65.

“We’re hearing from people who are 65 through 74 who have underlying chronic conditions that increase the risk factor for them, and they are eager to be vaccinated and don’t understand why they aren’t able to get in line now,” said Keali‘i Lopez, AARP’s Hawaii state director.

The first phase of Hawaii’s rollout — 1a — targeted long-term care residents and health care workers. The next, 1b, scheduled to continue into March, includes those 75 and older and front-line essential workers. Not until the third phase scheduled to continue from March to May, 1c, are those 65 and older included, along with other essential workers and those of all ages with underlying conditions.

Critics of Hawaii’s rollout say certain essential workers who may not really be at high risk nor likely to have severe illness  — such as a young government worker or others working remotely — are ahead of those who have the highest likelihood of illness and death.

But state officials say their plan is in line with the original federal guidance and that everyone must wait their turn.

“It’s not about lining people up in a particular order,” Dr. Sarah Kemble, acting state epidemiologist, said. “It’s really about how we keep doses moving so that we move through this whole swath of 1b and on to 1c. Everyone will get their turn if they want a shot.”

Kupuna Or Essential Workers?

States can decide vaccine eligibility, but last month, both the Trump and Biden administrations suggested states revise their vaccine plans to place a higher priority on people 65 and older because of their risk of illness and death.

Many states have updated their plans accordingly. More than 30 states have placed people 65 and older either before or alongside essential workers.

“Truth be told, we’re still deep in kupuna (75 and older) because there are only so many shots,” Green said. “Now, any state can say they’re vaccinating 70 and up, 65 and up like California, but can they actually do it? The answer is no.”

The decisions on vaccine rollout came after “hundreds of hours” of deliberations, weighing federal recommendations against Hawaii’s unique demographics, Green said.

Part of the rationale for prioritizing essential workers, he said in a Thursday interview with Civil Beat, is that it will keep the economy open and help the community reach herd immunity.

But on Saturday, Green said he asked the vaccination planning team to consider launching the 1c phase that includes the 65-and-older cohort on March 1, which he said coincides with the state getting a bigger supply of vaccine.

Department of Health officials would not provide any information about how many kupuna have been vaccinated compared to essential workers. Nor did they disclose details about what categories of essential workers are now getting shots and why they were chosen.

“We’re really focusing first to make sure we’ve made adequate progress on 75-plus and then we’ll move on to 65 and older,” Kemble said at a Friday press conference. “We aren’t approaching this as a one-at-a-time thing. There are multiple sites going up all at once. I want to discourage people from thinking of this as, ‘Oh, I got put in front of this person or behind that person.’”

The Department of Health’s vaccination plan was first drafted in November. The department has yet to release a complete copy of its revised plan, which is still undergoing revisions to address approximately 600 comments, DOH spokeswoman Janice Okubo told Civil Beat. An executive summary is available online.

Department of Health spokesman Brooks Baehr said numerous categories of essential workers are eligible for vaccinations as part of both Phase 1a and 1b, including teachers, judges, certain Board of Water Supply workers, public health nurses, adult correctional officers, deputy sheriffs and transportation workers, among others.

“It is a long list,” he said. “We do not have a count of how many people in each category have already been vaccinated.”

Lopez said she’d like to see more transparency.

“What’s unclear is how many of those (vaccinated so far) are kupuna versus frontline essential workers,” Lopez said. “We’d encourage the state to think very hard about moving into providing vaccinations to those 65 and older as soon as possible.”

Data from the Centers for Disease Control and Prevention show people in the 65 and older cohort have had the highest death rate. Hawaii’s experience reflects that as well, with 82% of the 416 deaths to date among people 60 and older as of Friday.

Approximately 109,000 people in Hawaii are 75 or older. Another 148,000 are between the ages of 65 and 74.

According to the state’s plan, vaccines within each phase will be prioritized to the eldest first, then by descending age order as more vaccines become available.

Debby Regidor, 69, a recently retired epidemiologist who worked for one of the state’s largest health organizations, has followed the national rollout since she retired last year. She wonders why Hawaii hadn’t opened up vaccinations to those 65 and older, especially with its large elderly population.

She said that the essential workers being vaccinated work in sectors that are not in danger of collapse. So why, she asks, put those people ahead of the most vulnerable?

In Oahu’s neighborhood of Kalihi, Emmanuel Kintu, the CEO and executive director of Kalihi Palama Health Center, has wondered the same thing. He said the clinic’s doctors do not intend to turn away certain at-risk patients, especially those who don’t often come to the clinic. He questioned the logic of limiting the vaccine to those 75 and over when in his neighborhood, hard hit by the pandemic, the average age may be below that.

“These are things that we don’t normally think about,” Kintu said.

Civil Beat reporter Anita Hofschneider contributed to this report.