Initially, the state of Rhode Island told child care providers and early-childhood educators like Mary Varr that they would be eligible for the Covid vaccine alongside all other educators in the state. It made sense to Varr that they would come after health care workers and those working and living in long-term care facilities but ahead of the general population.

But then in late January the state announced that eligibility would instead be based entirely on age. Although the state estimates that 58 percent of K-12 teachers will be eligible ahead of the general population based on age, Varr figures that under this scenario, most of her staff won’t be able to get the vaccine until June. “Which is ridiculous,” said Varr, who is executive director of the Woonsocket Headstart and Child Development Association.

“It’s very frustrating,” she said. “We have been working since the beginning of the pandemic.” In her state, child care centers were allowed to reopen after the initial lockdown in June. Her center reopened as soon as it could, even when there were scant guidelines about how to do so safely. It has been operating as continuously as possible ever since.

“It just doesn’t make sense,” she said. She pointed out that there are more people inside her classrooms than the state currently recommends people interact with outside of their own households. Her employees “are in the trenches every single day,” she said. “It just continues to show the inequity of how people look on early childhood.”

“It’s a slap in the face,” she added. “That we’re not considered professionals, we’re not considered important, [that we’re] second-class citizens.”

The good news that effective vaccines against Covid-19 were developed so rapidly has now given way to a complicated debate over how to prioritize the limited and precious early doses. While many child care providers and early childhood educators have been open and serving children through most of the pandemic, many of them are finding that they won’t be eligible to receive the vaccine for months. Some states have even put public school teachers ahead of them in line, even though both jobs require caring for children and are crucial to the functioning of the larger economy.

The Centers for Disease Control recommended that child care providers be included in phase 1b along with elementary and high school teachers. But that was advisory, and it’s up to each state to make final decisions. Their decisions have varied greatly. According to an analysis by Child Care Aware of America, while 40 states have included child care providers in the same eligibility tier as K-12 educators, four of them—Oklahoma, Ohio, Utah, and Wyoming—and Washington, D.C., put K-12 teachers ahead of those teaching and caring for children at younger ages. Like Rhode Island, Vermont originally said that child care providers and teachers would be prioritized at the same time and then changed gears to set eligibility based on age, according to Mario Cardona, chief of policy and practice at Child Care Aware. Four states—Florida, Indiana, Texas, and West Virginia—haven’t made it clear when child care providers will be eligible.

There are many reasons that child care and early childhood educators argue they should be vaccinated ahead of the general population, however.

“Child care has been essential since before the pandemic,” Cardona said. “Providers around the country are losing money and putting their health and their families’ health at risk…to keep their programs running.” K-12 educators are often getting prioritized in the hope that widespread educator vaccination can help to safely reopen schools. But “it isn’t a situation where these child care providers need a vaccine in order to open. They are open,” Cardona noted.

It’s not just that child care providers and early-childhood educators have to go to work in person. They’re in high-risk settings. Children under the age of 2 don’t wear masks, and even older ones struggle to keep them on. Children with disabilities can’t wear them at all, and those who are struggling to learn language need to see their teachers’ lips. Caring for and teaching children so young requires a lot of contact: changing diapers, helping them eat, assisting in the bathroom. And children can’t necessarily wear masks when they nap.

Then there’s the financial component. Child care providers operate with little to no financial cushion during normal times. The pandemic has meant lower enrollment as costs for cleaning, smaller class sizes, and other safety measures dramatically increased. All of that has been exacerbated by constant closures when a child or their family is exposed or gets sick. Each time there’s a shutdown, the providers may lose subsidies from their state and revenue from parents. Even just one teacher out quarantining for 10–14 days is a hardship, particularly with so few people willing to work in person as a substitute.

“We’ve had to close classrooms multiple times over the last four months because of a parent of a child testing positive or a child testing positive or a teacher testing positive,” Varr said. Seventy-seven staff members have been out for Covid testing or quarantining over the last three months, she said. She’s never had to present her board with a budget deficit before; this year, she told them she’s $60,000 in the red. “I really don’t think that you can stabilize child care without [it] being included in the vaccine rollout sooner,” she said.

As of July, one in five centers nationwide were closed, and double that number were certain they’d have to close without financial help. As more providers succumb to the financial reality and shut down, parents’ options dry up. That will make any eventual vaccine-fueled economic recovery sputter.

Cardona was quick to say that his organization is not criticizing any of the states’ eligibility decisions, noting that they’re made by lawmakers and officials on the ground. But others have no hesitation criticizing them.

In Kentucky, K-12 educators were prioritized in the current phase along with first responders and those age 70 or older, even though many schools still aren’t offering in-person education. Child care providers were initially pushed into the next phase, which also includes anyone age 60 or older, all essential workers, and those at highest risk of complications. Bradley Stevenson, executive director of the Child Care Council of Kentucky, Inc., isn’t arguing that teachers shouldn’t get the vaccine or should be forced to reopen. “We have not been advocating here to be ahead of K-12, we’ve been advocating to be in line with K-12,” he said. “We feel these child care staff are educators too, and they should be prioritized with K-12 educators.” Stevenson’s organization has been vocal: The Kids Matter Coalition sent a letter to Governor Andy Beshear on December 17 asking that child care providers be prioritized alongside other educators and also circulated a petition that has been signed by over 1,000 people. The United Way of Kentucky also sent the governor a letter in January.

On February 15 they got their wish: Beshear announced that childcare providers are now eligible to get the vaccine. 

Things are even messier in Oklahoma, where the state has instituted universal preschool for 4-year-olds. Those educators, along with those who teach older children, are included in phase 2. All other child care providers and educators are in phase 3, just ahead of the final phase that will open it to all state residents.

Child care providers in Oklahoma get public subsidies only for children who actually attend, so if children are out sick or classrooms have to be shut down to quarantine that funding stops, even though costs like rent and salaries don’t. “It’s been very, very hard,” said Paula Koos, executive director of the Oklahoma Child Care Resource & Referral Association. “Their income is up and down, up and down, up and down.” Even providers who have been in the business a long time and know how to budget well “are ready to pull their hair out,” she said.

The explanation as to why child care providers are being put in lower tiers of the rollout has been varied. Kentucky Governor Andy Beshear had pointed to limited supply. In D.C., LaQuandra S. Nesbitt, the director of the city’s department of health, explained in a letter to child care advocates that it had chosen “to vaccinate a large percentage of our in-person public school workforce,” which would allow it “to expand the critical societal function of in-person school.” She added, “If we were to open to the entire tier, the demand for vaccine in the community sites would be extremely high, and we would not have the ability to make a meaningful impact on any one particular group of workers.” But, argued Ruqiyyah Anbar-Shaheen, director of early childhood policy and programs at DC Action, “There’s already something critical to societal functioning that’s open”—namely, child care—“and it’s not safe.”

The inability to get vaccinated is not just about providers’ financials. It’s also about equity. Child care providers and early childhood educators are disproportionately women of color. They also tend to lack health insurance, making the need to get vaccinated even more urgent. “This is their health insurance policy,” Stevenson said.

These issues are even starker for those who provide care directly in people’s homes, who are also disproportionately women of color. A 2013 analysis found that just 12 percent of domestic workers like nannies have employer-provided health insurance.

But it’s even harder for them to figure out if they’re eligible for the vaccine, let alone push to be prioritized. Arizona hasn’t defined child care providers, for example, but in Maricopa County, only those that care for five or more children qualify. In New York, the state has made licensed child care providers eligible but not clarified whether that includes nannies. “They just didn’t make clear exactly what that meant,” said Trudy Rebert, federal policy counsel at the National Domestic Workers Alliance, and also failed to outline who exactly will be included in the next phase after that.

There’s no good reason to exclude domestic workers just because they don’t work in day care centers, though. “They’ve been on the front lines of the pandemic,” Rebert said. They “are caring for our children, caring for our parents, and they’re doing work that really enables others to go to work, and they should be prioritized.”

Alicia Cleveland had worked as a nanny in Georgia for seven years until the pandemic hit, but now she’s been out of work for almost a year. She stepped away to protect the health of her three children: One has chronic asthma; another has a heart murmur; and the third has had respiratory issues. But going without employment for so long “has been a major setback,” she said.

Domestic workers like Cleveland haven’t been explicitly prioritized in Georgia yet, even though other essential workers who “ensur[e] continuity of functions critical to public health, safety, economic and national security” are. Cleveland doesn’t think that’s fair. “We make all other work possible,” she said. “Whether you’re doing it in a private setting or in a school, in a small center, in a lager center, in a church daycare, you’re caring for kids. If you’re caring for people period you should be able to be vaccinated.”

And she personally won’t be able to seek nannying work again until she’s vaccinated. If she could get the vaccine, she said, “The world would be able to open up a little bit more.”

The disparity between child care providers and teachers in particular has spurred some people to action. At first, Jessica Robins was optimistic that she and her staff at the early childhood program at the Mandel JCC of Cleveland, Ohio, would be prioritized for the vaccine, because that’s what the CDC recommended. But although the state announced that K-12 employees that want to or are already educating in person are eligible in phase 1B, there is still no word as to when the state will make early-childhood educators like her and her staff eligible. “It was surprising and it was disappointing,” Robins said. She estimates that only about a third of her staff will be eligible earlier based on age.

But rather than just complain, she decided to take action, so she and other providers in the area launched a petition on Change.org that’s been signed by more than 23,000 people and, she says, spread awareness of the fact that child care providers have been excluded.

She runs both a day care program for younger children, a preschool program for older ones, and she had to make huge changes to safely reopen in July. She cut part-time enrollment and flexible hours, allowing only children who came for the full day during a set number of hours. Class sizes shrank from 16 to 10 for preschoolers and from 10 to seven for younger kids; she went from eight classes to seven. She no longer has outside teachers come in for special classes like yoga or music. But even all of those steps won’t protect everyone’s health the way a vaccine could, she noted.

Now she’s looking ahead to the coming school year and trying to set her budget. “You have to know what you are planning, what are the class sizes, what are the hours, are their specials,” she said. Much of that is contingent on whether her staff can get inoculated in time.

Child care workers have succeeded in making changes in some places. In Washington, D.C., they were originally included in the same phase as K-12 educators, but when it came time to actually roll the plan out, they were excluded, with no indication as to when they would be able to get it. K-12 teachers became eligible January 25. “Folks were really confused, because child care had already been in person since the beginning of the pandemic,” Anbar-Shaheen said, noting that schools have been virtual up until the last few weeks. Providers “felt like an afterthought,” she said. There was a feeling that “we don’t feel valued, we feel like we’re not important to our government.”

But they didn’t stay quiet. They put together a petition similar to Robins’s and put out calls on social media. Others contacted City Council members directly, many of whom sent letters to Mayor Muriel Bowser asking her to prioritize child care providers. Even K-12 teachers spoke out alongside them, arguing both groups should be eligible at the same time.

The pressure paid off. On January 29, Bowser announced that they could get the vaccine beginning February 1. Now the challenge is ensuring vaccine access to a population that doesn’t always speak English as a first language, that may not have the technology to sign up for an appointment, and that can’t spend time during the workday to keep refreshing a website to find one. It will be hard for them to leave work during the day to get the shot with a staffing shortage making it difficult to find someone to sub in while they’re gone.

Still, eligibility is a crucial first step. Robins would settle just for some more information. “You look for that light at the end of the tunnel,” she said. Even if child care workers aren’t included in phase 1B, the current stage, she’d still like to just know when they will be. “At least we would have something to look forward to or something to plan around.”

Editor’s Note: This article was updated to reflect developments in Kentucky.