BISMARCK — After a federal advisory board recommended new guidelines for the distribution of COVID-19 vaccines over the weekend, North Dakota’s own ethics panel workshopped its plan to better fit the national rollout in a few key priorities.

The state’s COVID-19 Vaccine Ethics Committee on Monday, Dec. 21, established a high priority group for all North Dakotans ages 75 and older for the next wave of vaccinations, known as Phase 1B. They also elevated a few categories of essential workers into a lower tier of this phase, targeting pre-school and K-12 teachers, child care workers and school operations workers like bus drivers into Phase 1B.

These recommendations track with the guidance released by the CDC’s Advisory Committee on Immunization Practices in its meeting over the weekend, though the North Dakota plan still diverges from the federal guidance in several other specifics.

After the North Dakota ethics committee put a large bracket of 55 and ups ahead of essential workers in last week’s draft, they axed that priority group on Monday out of concern over its size. Interim Chief Health Officer Dirk Wilke advocated for the higher prioritization of teachers and child care workers among a larger category of essential workers.

The state began the vaccinations of Phase 1A after the first shipments of the new Pfizer vaccine arrived in North Dakota last week. Front-line health care workers were the first to get vaccinated last week, and the other top priority group, nursing home residents, are expected to begin receiving their first shots in the next few weeks.

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North Dakota's latest recommendations for Phase 1B now include a top tier of people ages 75 and up, people between 65 and 74 with multiple underlying conditions, as well as residents and staff of prisons, group homes and homeless shelters. The second tier covers anyone 65 and older with a single underlying condition, and the third tier includes the rest of the 65 and up population, anyone 16 and older with multiple underlying conditions and school employees.

This marks a break from the CDC recommendations, which hold off on vaccination of the 65 and up and multiple underlying condition groups until Phase 1C. In another noteworthy difference, the CDC included postal service, manufacturing, public transportation, food service and grocery workers in its Phase 1B, groups that remain in 1C of the North Dakota plan.

Recommendations from the ethics committee will now go before the state’s Unified Command, a multi-agency team coordinating pandemic response, for final approval. Among the key decision-makers on Unified Command are Gov. Doug Burgum, Chief Operating Officer Tammy Miller and Adjutant General Alan Dohrmann of the North Dakota National Guard.

With the shifting distribution plan and some differences between the CDC and North Dakota-specific guidance, members of the committee expressed concern Monday that it may be challenging to ensure clear public messaging of their priority list. This has posed a particular challenge when it comes to the prioritization of various types of essential workers, many of which currently fall in North Dakota’s Phase 1C.

State Immunization Program Manager Molly Howell noted that the health department has fielded many calls from residents wondering where they fall in the hierarchy, with some arguing that their job should qualify them for earlier vaccination.

“As we try to chop these into really narrow categories for the purpose of trying to narrow the amount of people who get the vaccine before we move on to the next group, we are having sort of an opposite effect on how we’re communicating to the public,” Wilke said.

“It’s going to be a mess. That’s my comment,” Howell added of the messaging effort as more groups become eligible for vaccination.

While the health department hashed out the details of later distribution phases, vaccine rollouts continued around the state on Monday, with the majority of North Dakota's tribal nations receiving their first shipments of COVID-19 vaccine.

The Turtle Mountain Band of Chippewa, the Standing Rock Sioux Tribe and the Sisseton Wahpeton Oyate Sioux Tribe received their first shipments of the newly approved Moderna vaccine through the Indian Health Service on Monday. The Mandan, Hidatsa and Arikara Nation and Spirit Lake Nation, who both opted to participate in North Dakota's distribution plan, are expecting to administer their first doses to front-line health care workers later this week.

The state vaccine ethics committee also began workshopping hierarchies within Phase 1C, which includes a huge swath of essential workers, on Monday, prioritizing some categories of workers ahead of others. The committee indicated that it will continue to discuss 1C and any breakdowns in essential worker groupings at their meeting next week.

Forum News Service reporter Michelle Griffith contributed to this report.