Changes to Public Charge as of April 2021

United States Citizenship and Immigration Services issued this interagency letter, asking other federal agencies to help spread the word that the Trump public charge regulations are no longer in effect. The letter provides information about the longstanding 1999 public charge guidance that has been reinstated, including public benefits not considered in a public charge inadmissibility determination: Medicaid (except for Medicaid for long-term institutionalization), public housing, or SNAP benefits.

It also notes that medical treatment or preventive services for COVID-19, including vaccinations, will not be considered for public charge purposes. The letter encourages immigrants to access benefits, saying that “It is critical that immigrants and their families, many of whom are essential workers, are able to access necessary government services for which they may be eligible to keep their families safe and healthy.”

Don’t Forget Your Second Dose

Getting vaccinated protects yourself and those around you from COVID-19. It is important people who receive a two-dose vaccine (Pfizer-BioNTech or Moderna) complete the series as close to the recommended time interval as possible.

  • If you received the Pfizer vaccine, you should get your second shot three weeks (or 21 days) after your first.
  • If you received the Moderna vaccine, you should get your second shot four weeks (or 28 days) after your first.

Across Washington, as of April 25 about 13% of people who received one dose of a two dose vaccine were overdue for their second dose by more than one week. We want this number to be as close to zero as possible to ensure the vaccine is fully effective and best protects people and communities.

Recently the Centers for Disease Control and Prevention (CDC) released data regarding overdue second doses. According to the CDC, nationwide 8% of people were overdue for their second dose. These national numbers are different from the state numbers due to the way the data were analyzed. DOH only considers people overdue if they miss the window and have only received one dose of a two-dose vaccine; whereas the CDC counted people who had completed the series.

Washington state resumes use of Johnson & Johnson vaccine

The Washington State Department of Health (DOH) will immediately resume use of the Johnson & Johnson (J&J) vaccine across the state. This decision is based on recommendations from the U.S. Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the Western States Scientific Safety Review Workgroup, as well as careful consideration and close review by DOH.

The 11-day pause was taken as a precaution after six cases of a rare but severe type of blood clot were reported following administration of the J&J vaccine. In these cases, a blood clot in the brain formed, which is called thrombosis. This is coupled with low blood platelets, known as thrombocytopenia. When those both occur after a vaccine, it is referred to as thrombosis with thrombocytopenia syndrome (TTS).

On Friday, the CDC said a total of 15 cases of TTS have been reported, which includes the original six cases. All the cases occurred in women between the ages of 18 and 59, occurring six to 15 days after vaccination. DOH is not aware of any cases in Washington. The warning signs of TTS include severe headache, abdominal pain, leg pain, and/or shortness of breath. People experiencing TTS symptoms following vaccination should contact their healthcare provider or seek medical attention immediately. At this time, available data suggest the chance of TTS is very low – with only 15 cases identified out of about 8 million vaccines administered nationwide – and the vaccine’s known and potential benefits outweigh its known and potential risks.

The Advisory Committee on Immunization Practices (ACIP) voted Friday to reaffirm its recommendation of the J&J vaccine for those 18 and older. ACIP recommended the FDA include a warning statement, and for J&J to provide an information sheet at vaccination that informs people about the increased risk of TTS. Members of the Western States Scientific Safety Review Workgroup agreed information needed to be created and shared as soon as possible. DOH quickly acted on the changes, sharing our J&J webpage with providers and creating materials providers can share with those receiving the J&J vaccine. People concerned about the increased risk may instead choose Pfizer-BioNTech or Moderna.

“Above all else, safety is our top priority. The pause was proof the surveillance systems in place to monitor the safety of COVID-19 vaccines are working,” said Secretary of Health Umair A. Shah, MD, MPH. “These findings once again show we have three vaccines available that are effective and safe.”

Providers with J&J on hand can once again begin scheduling appointments and administering the vaccine. During the pause, about 170,000 doses of J&J were being held by providers across the state. Our three-week forecast from the federal government shows Washington will begin receiving more J&J the week of May 2 when 4,300 doses are expected to arrive.

The CDC’s announcement can be found here.

COVID-19 Homebound Vaccination Services

Homebound? Not able to leave home to get the Covid-19 Vaccine? Know someone like this?

If you are unable to leave home to get the Covid-19 vaccine, homebound vaccination services are available. If you know of someone or you need homebound vaccination services due to a medical or behavioral health condition or have a physical or intellectual disability preventing you from getting vaccinated in the community, or require special needs accessible transportation, homebound vaccination services may be right for you.

The Washington State Department of Health and many local health jurisdictions already have mobile vaccine teams out in the field providing homebound vaccination services to those otherwise unable to get it. These teams are working together to help connect residents across the state to available supports.

If you need homebound vaccination services or know of someone else who needs this service, there are several options to get help:

If you have questions about this service, please email:

No Health Insurance and in Need of COVID Services?

NO HEALTH INSURANCE? NEED COVID-19 SERVICES? Free COVID-19 testing, treatment and vaccines. Who can get services? Anyone without health insurance, no matter their immigration status. A Social Security Number and/or government ID may be requested, but is NOT required.What is free? Testing for COVID-19 Treatment of COVID-1 Vaccines for COVID-1   9  9How is it free? A federal Uninsured Program pays for COVID-19 services provided to anyone without health insurance.

Who can get services?
Anyone without health insurance, no matter their immigration status. A Social Security Number and/or government ID may be requested, but is NOT required.

What is free?
Testing for COVID-19
Treatment of COVID-19
Vaccines for COVID-19

How is it free?
A federal Uninsured Program pays for COVID-19 services provided to anyone without health insurance.

Learn more here.

Eligibility expands to everyone 16 and older in Washington state

“Starting April 16th, everyone 16 and older who wants a COVID-19 vaccine can receive one in Washington. The eligibility expansion marks the four-month anniversary of vaccine rollout in our state. Since mid-December, nearly 4.3 million doses of COVID-19 vaccine have been administered across the state. More than 2.67 million people have received at least one dose and more than 23% of Washingtonians are fully vaccinated. Opening eligibility to everyone 16 and older will further protect our communities and help us get closer to crossing the finish line of this global pandemic.

The Washington State Department of Health’s (DOH) Vaccine Locator tool is a great resource to help you find a vaccine appointment in your area. Since launching the improved website, more than 1.6 million people have visited Vaccine Locator with 300,000 new users within the last week. More than 70% of people visiting the site click through to a provider’s scheduling website. We anticipate these numbers will spike today and we are prepared for increased traffic. If you need help making an appointment, please call the COVID-19 hotline at 1-800-525-0127, then press #. Language assistance is available.

Currently Pfizer-BioNTech is the only COVID-19 vaccine authorized for people 16 years of age and older. Moderna is authorized for people 18 and older. Those age 16 and 17 may need consent from a parent or guardian to get the vaccine, unless they are legally emancipated. To help simplify registration, we have added vaccine type to Vaccine Locator and are in the process of retrieving information from providers to show on the website and app. If the vaccine type is listed as “vaccine type unknown,” people may need to contact the provider. We know this information is important and we hope to include it throughout Vaccine Locator as soon as possible.

Currently about 6.1 million people in Washington are eligible for the COVID-19 vaccine. While we are pleased many people are eager to be vaccinated, we continue to ask for the public’s patience. If you struggle to find an appointment near you today, do not get discouraged. As we work to get our communities vaccinated, please remember to wear a face covering, get tested if you feel sick, practice physical distancing, and properly wash your hands. It is going to take time to vaccinate millions of people in Washington. The good news is, we are well on our way.”

Addressing concerns about the COVID-19 vaccine

Addressing concerns about the COVID-19 vaccine

Deciding whether to get the COVID-19 vaccine is not always a straightforward matter. Individuals who have complex health care needs, or those who live with people who have complex health care needs, may have questions about getting the COVID-19 vaccine. Here are some things to consider and discuss with your doctor.


The CDC recommends that individuals who have an allergy or past negative reaction to any vaccine ingredient, however minor, against getting the COVID vaccine.  Patients who are allergic to an ingredient are at risk of anaphylaxis, which could be life-threatening.  Unlike many vaccines, none of the current COVID vaccines contain eggs.  The ingredients of approved vaccines are as follows:

Pfizer-BioNTech: mRNA, lipids ((4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate), 2 [(polyethylene glycol)-2000]-N,N-ditetradecylacetamide, 1,2-Distearoyl-sn-glycero-3- phosphocholine, and cholesterol), potassium chloride, monobasic potassium phosphate, sodium chloride, dibasic sodium phosphate dihydrate and sucrose.

Moderna: mRNA, lipids (SM-102, polyethylene glycol [PEG] 2000 dimyristoyl glycerol [DMG], cholesterol, and 1,2-distearoyl-sn-glycero-3-phosphocholine [DSPC]), tromethamine, tromethamine hydrochloride, acetic acid, sodium acetate and sucrose.

Janssen/Johnson & Johnson: recombinant, replication-incompetent adenovirus type 26 expressing the SARS-CoV-2 spike protein, citric acid monohydrate, trisodium citrate dihydrate, ethanol, 2-hydroxypropyl-β-cyclodextrin (HBCD), polysorbate-80, sodium chloride.

Weakened Immune Systems

People who have weakened immune systems are likely to be more susceptible to COVID-19 and at greater risk for having severe cases of COVID-19. Individuals with weakened immune systems are eligible for the COVID-19 vaccine, but there is limited information on its efficacy and safety on the immuno-compromised. Consultation with a physician is recommended before taking the COVID vaccine.

Autoimmune Disorders

People with an autoimmune disorder are eligible for the COVID vaccine. However, there is little data on the health risks of any COVID vaccine on individuals with autoimmune disorders.  Several medications used to treat autoimmune disorders have been known to have mild to severe interactions with the mRNA vaccines, so consult a physician before getting the vaccine. A list of the medications that are known to have interactions with the COVID vaccine are listed below.

Interactions with Medications and other Vaccines

Several medications have been known to have negative interactions with the COVID-19 mRNA (Moderna and Pfizer) vaccines.  They are Efalizumab (commercially known as Raptiva,) Fingolimod (commercially known as Gilenya,) Siponimod (commercially known as Mayzent,) and Satralizumab (commercially known as Enspryng.) These medications are used for autoimmune disorders, multiple sclerosis, and neuromyelitis optica spectrum disorder.  Interactions with Janseen/Johnson & Johnson are not yet known.  It is likely that other medications, including steroids and anti-inflammatories, may lessen the effectiveness of the COVID vaccine.

The Hepatitis B Vaccine (commercially known as Fendrix) is known to have interactions with the mRNA vaccines.  It is not recommended to take any other vaccines, such as a flu shot, withing two weeks of the COVID vaccines.  The three available COVID vaccines are not interchangeable and should not be mixed.

Side Effects

For individuals not allergic to any of the ingredients of the vaccine they were administered, serious side effects were rare.  For the Pfizer, Moderna, and Johnson & Johnson vaccines, the most common side-effects were pain at the injections site, headaches, and fatigue.  For two-dose vaccinations, these side effects were more acute after the second dose.

There is a risk of a rare, but potentially serious side effect in the Johnson & Johnson vaccine, which causes a blood clot in the brain, called thrombosis.  The CDC has reported that all 15 cases (of the over 8 million doses given) occurred in women between the ages of 18 and 59, occurring six to fifteen days after vaccination.

Age and Weight Complications

Recommendations for the COVID vaccine are done by age, not weight. The Jensen/Johnson & Johnson vaccine and Moderna vaccine are available to individuals 18 and older, while the Pfizer vaccine is available to individuals 16 and older.  Trials on younger people are underway for both the Pfizer and Moderna. These initial trials are testing children as young as five-years-old, with the intent of eventually making a vaccine suitable for infants as young as six-months-old. These vaccinations use decreased doses of the available vaccine, and there is hope that school age children will be able to get the vaccination by the start of the next school year.

The Pfizer vaccine has been studied for its relationship to BMI (body mass index) and effectiveness. There did not appear to be any notable difference between individuals who are underweight, overweight, or who had normal BMI in the vaccines’ efficacy. Concerns have been raised about the effectiveness of the COVID vaccine in morbidly obese individuals, but no firm data has been found.

Questions to Ask Your Doctor

When consulting a physician about the COVID vaccine, ask specific questions and give details on your concerns.  Here are some questions you might ask:

  • I am concerned about possible interactions with other medications – is it possible to get the opinion of an allergist-immunologist for my particular situation?
  • I am not allergic to any of the ingredients of the vaccine, but I am still worked about anaphylaxis. Will I be able to be monitored right after receiving the vaccine to ensure my safety?
  • My immune system is compromised, is there a way to determine whether or not it would be safe for me to get the vaccine?
  • My schedule is hectic, so what happens if I cannot get my second dose at the recommended time?
  • Is there anything I can do or medication I can take that will lessen the side effects from the shots?
  • How long after my last dose of the vaccine will it take for me to be immune to COVID?

Download the pdf form here: Concerns about the COVID Vaccine

Statement on Pausing J & J Vaccine

The Washington State Department of Health will pause the use of the Johnson & Johnson (J & J) vaccine statewide starting immediately, following the guidance of the FDA/CDC. Use of that vaccine will be put on hold until we receive further recommendations from our federal partners about how best to move forward. Safety is the highest priority when it comes to all COVID-19 vaccines.

This action is being taken out of an abundance of caution based on the appearance of a rare but serious side effect including serious brain blood clots (CVST) combined with low platelet counts in six patients, all women under 50. The CDC’s Advisory Committee on Immunization Practices (ACIP) will review these cases in the days ahead and will recommend guidance going forward. 

About 149,000 doses of J & J vaccine have been administered in Washington so far, out of more than four million doses total. At this time, we have no knowledge of the six patients who experienced these blood clots being Washington residents.

For those who got the vaccine more than a month ago, the risk of this complication is very low at this time. People who have received the J & J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider. It also demonstrates how well the robust vaccine safety monitoring systems work, since this potential safety concern was identified quickly and vaccines were paused to allow for further investigation.

No definitive cause has been identified yet, but the FDA said today that a probable cause is a rare immune response generated by an individual after receiving the vaccine.

DOH will continue to monitor the situation related to J & J vaccine and update on its use as the pause is reviewed and once it is lifted.

Roadmap to Recovery Announcement

Statement from Umair A. Shah, MD, MPH, Secretary of Health:

“When we see increased rates of cases and hospitalizations, we need to act fast and do the right thing county-by-county to prevent more serious consequences from COVID-19 in our state. That is why the tough decisions are being made and some counties are being moved back to Phase 2.

There is still time to turn the tide and slow the spread of COVID-19 before it turns into a fourth wave. We need to take these preventative measures over the next few months at least to get numbers going in the right direction again.

We are still in a hopeful time. We’ve made a lot of progress in the last year and we continue to rise to the challenges as a state – not just with life-saving solutions, but with a sense of community and teamwork that has made Washington’s response the best in the country.

We need to focus on lowering disease transmission for the next several months, even though we have increased immunity across the state due to vaccination efforts.

Vaccine is a crucial tool, but it isn’t the only tool, and we don’t have enough yet to rely on it to shore up the virus and keep the majority of us safe from the spread of disease. We’ve administered more than four million vaccines to people in Washington so far, and more than 20% of our state population is fully vaccinated. We’ll keep up this important work of getting people vaccinated, with the goal of reaching a more robust level of community immunity.”

COVID-19 Vaccine Distribution for Teens

Vaccinating 16 and 17-year-olds

We know parents are eager to find COVID-19 vaccination appointments for their teens. Currently Pfizer-BioNTech is the only COVID-19 vaccine authorized for people 16 years of age and older. Moderna and Johnson & Johnson are authorized for people 18 and older. We are working to add vaccine type to our Vaccine Locator webpage and mobile app to help simplify the process. In the meantime, we encourage providers to clearly identify the type of vaccine they are offering for available appointments. If the vaccine type is not listed, people may need to contact the provider.

Starting April 15 everyone ages 16 and older will be eligible for the COVID-19 vaccine. Those age 16 or 17 may need consent from a parent or guardian to get the vaccine, unless they are legally emancipated.

Vaccine trials for adolescents

Friday Johnson & Johnson announced it’s expanding its vaccine trial to include adolescents 12 to 17 years of age. The vaccine will initially be tested in a small number of teens age 16 to 17. Following review of initial data, the study will expand to a larger group of younger adolescents. The news comes on the heels of a recent study released by Pfizer that shows the Pfizer vaccine is safe and 100% effective for adolescents age 12 to 15.

Moderna is also studying the safety and effectiveness of its vaccine on children. The company is currently conducting two clinical trials, including one for adolescents age 12 to 17. The second trial is for children age 6 months to 11 years old.