New Jersey is allowing 2 million smokers across the state to get in line for the COVID-19 vaccine as part of a significant expansion of the state’s immunization program that aims to inoculate 70% of the population by June.

Those 65 years or older and people between the ages of 16-64 who have underlying medical conditions like cancer, diabetes, or obesity are also eligible to receive the shot, Governor Phil Murphy announced earlier this week.

But the move to include smokers has raised eyebrows as groups of essential workers such as teachers and transit workers remain ineligible.

“I get it, I understand the optics here, and attacking folks who took up the habit of smoking and who are now addicted may be politically expedient,” Murphy said during a press briefing in Trenton on Friday, citing the need to save as many lives as possible. “But at this time, we are stuck in a position where we have to prioritize limited, federally-distributed doses based on medical fact and not on political want.”

Stephanie Silvera, an epidemiologist at Montclair State University, said smoking lowers the amount of oxygen that can come into a person's lungs, putting them more at risk of hospitalization or dying from the coronavirus. The addictive habit was one of the first risk factors for severe COVID-19 identified by public health researchers in China after the pandemic flourished in early 2020.

“If we want to reduce the number of people hospitalized because that's better for the community good because that's better for health outcomes, then including smokers in that category actually makes a lot of sense,” Silvera said. In her expert opinion, smokers should not be stigmatized; they encompass all ages and professions, including teachers. She added that rates of smoking are higher among men, low-income, and uninsured people—all groups who experience the worst health outcomes with COVID-19.

“Taking a moral stance on who deserves to be vaccinated, based on what decision we make in our lives, if we start to use that as a metric for who deserves to be vaccinated, we start going down a very dangerous road,” she said.

Yet, some officials are balking at prioritizing smokers, given the state’s limited vaccine supply. New Jersey has administered more than 310,000 doses, according to its dashboard. That’s a little less than half the supply the state has received, according to the CDC. Before the state opened the doors to the older and more medically vulnerable populations on Thursday, health care workers, police and firefighters, and those housing at long-term care facilities and prisons were eligible for the shot. It’s still unclear if vaping qualifies as smoking under the new expansion.

“Other states, like New York, have prioritized educators, and since the administration often follows lockstep with them, why aren’t we doing that here?” Assemblywoman Serena DiMaso, a Republican representing Monmouth, said in a statement.

For now, New Jersey health officials aren’t requiring proof of medical documentation for the list of eligible health conditions and relying on an honor system across more than 160 vaccination sites. All sites require an appointment.

But with more than 4 million eligible people and New Jersey only receiving about 100,000 Pfizer and Moderna doses a week, the biggest issue remains a lack of supply. Many sites ran out of appointments hours after Murphy widened the pool of those eligible for the shot.

“The reality is that the system is not even in a place where it can be gamed at this point,” said Shawna Hudson, a professor of family medicine and community health at Robert Wood Johnson Medical School.

Anyone who lives, works, or studies in New Jersey can get a vaccine when deemed eligible and can register on the state website here.