On Tuesday morning, thousands of Minnesotans logged onto the state’s COVID-19 vaccination website to register themselves, a friend or a family member for a chance at a limited number of vaccine appointments for people ages 65 and older.

The lottery system, announced Monday, is designed to give more Minnesotans age 65 and older a more fair chance at getting a vaccine, after long waits and confusion that stemmed from last week’s first-come, first-served effort. This week, anyone eligible has 24 hours to register for a spot in the vaccine lottery ending at 5 a.m. on Wednesday, after which the state will draw roughly 8,000 names.

That’s just a small fraction of the estimated 920,000 Minnesotans who are age 65 or older.

Some in this age group have already been vaccinated against the virus through long-term care programs, work or in other states.

And while others are starting to gain access to vaccinations via limited doses available through the lottery, community clinics and health care providers, a great many in this age group — the most likely to be hospitalized or die due to COVID-19 —  still don’t know when they’ll get a vaccine.

Confusion all over

Minnesotans in this situation are not alone. Last week, a survey by the Henry J. Kaiser Family Foundation found nearly six in 10 older adults in the U.S. who have yet to receive a COVID-19 vaccine don’t know when or where they’ll be able to get one.

That finding wasn’t necessarily surprising given the trajectory of the vaccine rollout, said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

“The data in the survey quantify the confusion that’s out there, but there’s a lot of additional anecdotal evidence that people are just confused,” Tolbert said. “Part of it is that we’re in an ever-changing landscape. Even the federal guidance around who should be vaccinated changed fairly recently.”

As vaccines for the novel coronavirus began to be developed last year, states started making plans to administer them.

Many states, Minnesota included, adhered closely to guidance set out by a Centers for Disease Control committee charged with making recommendations about immunizations.

Following those guidelines, Minnesota announced that health care workers plus long term care residents and employees, in group “1A,” would get the first vaccines available. Then, it would go to essential workers and those 75 and older, “1B,” followed by those 65 and older and younger people with underlying health conditions that put them at risk of severe COVID-19 complications, “1C.”

In mid-January, Minnesota was part-way through 1A when the federal government, under pressure to speed up the vaccination effort, announced that anyone age 65 and older and younger people with underlying health conditions that put them at risk for severe COVID-19 complications should be made eligible.

Some states, Florida and Texas among them, were already making vaccines available to those 65 and older, either due to including them in their 1A group (Florida) or vaccinating 1A and 1B concurrently (Texas).

But for others, the new federal guidance brought a quick change in plans.

Going from having a targeted number of people eligible to receive vaccinations through specific settings — work in the case of health and long-term care workers and home in the case of long-term care residents — to making anyone over a certain age eligible creates hurdles for states trying to pivot quickly, Tolbert said.

“There aren’t structures in place necessarily to find those people,” she said.

Systems starting to contact patients

States are now starting to build those structures, Tolbert said.

Separate from the 65+ vaccine lottery run by the state, some Minnesota health care providers that are finishing up vaccinating their 1A health care workers both in their own health systems and in others are starting to call in older Minnesotans to be vaccinated with any doses available. Because vaccine supply is still extremely limited, MDH and providers are urging Minnesotans not to call their providers and instead wait to be contacted.

“We’ve used the terms ‘don’t call us, we’ll call you,’” said Karna Fronden, public relations manager for CentraCare in Central Minnesota. With limited supply, “We know it’s super frustrating [but] we are as excited to get out the vaccine to people as they are to get it.”

CentraCare is contacting patients age 65 and older when a vaccine is available based on age but also location.

“We’re a large health system, so there might be doses in a community hospital in Long Prairie, and they’re able to reach out to that area,” Fronden said.

Both HealthPartners and Allina Health are contacting a randomly selected subset of patients who are age 75 and older to make appointments for vaccinations when doses are available.

“Vaccinating our most vulnerable patients supplements the state’s recent decision to expand eligibility to older Minnesotans. If greater than 70 percent of patients aged 65 and older received both doses of one of the COVID-19 vaccines, we anticipate more than a 90 percent reduction in hospitalizations and deaths from COVID-19,” HealthPartners spokesperson David Martinson said in an email Friday. Health Partners quickly filled the appointments it had available and wasn’t, as of Friday, scheduling more.

Allina is selecting patients to contact on a randomized basis based on the pool of people aged 75 and older who have visited one of their clinics within the last five years.

“Because we are receiving limited amounts of vaccine and demand is far greater than supply, we cannot invite everyone in that age category at once. We are using a computer program to assign random numbers to patients in that group that determines the order in which we are reaching out to schedule vaccines,” Allina said in a statement to MinnPost.

Not all systems are contacting patients yet. Fairview is working through vaccinations for front-line health care workers, not including people who can do their jobs from home.

“Once supplies increase, we hope to begin giving vaccines to more people, including adults age 65 and older and those at higher risk for severe complications from COVID-19,” spokesperson Jill Fischer said in an email.

Some vaccinations have also been made available to marginalized populations through community clinics.

While vaccination efforts through these clinics, the state’s lottery system and health care providers have expanded eligibility to some older Minnesotans as limited supply allows, all the details of how and when the state plans to vaccinate older Minnesotans still aren’t clear.

Minnesota had planned to announce subpriority groups for 1B — which based on federal guidelines would include those 75 and older and essential workers — the week of Jan. 18, but the federal expansion of eligibility to those 65 and older on Jan. 12 postponed that announcement.

At a press conference Friday, Health Commissioner Jan Malcolm said the state is weighing when to announce future priorities: On one hand, it might make sense to announce the groups next in line before getting more information from the federal government, but it’s also possible there’s new guidance on prioritization or news about vaccine supply that could affect it.

“That’s a conversation we’re still having,” she said.