I’ve been hearing a lot from people concerned about the vaccine rollout.
The big picture is that we don’t have enough vaccine and the rollout has been messy. If we had enough vaccine to use all the distribution channels available to us, things would be going quite well.
Knowing the expected scarcity of the vaccine, Massachusetts planners worked last year to design a very targeted rollout, thoughtfully prioritizing groups based on tradeoffs among three main factors: risk of infection, likelihood of being critically ill if infected, and “essential” role in the economy.
The prioritization, while principled, was based on judgment calls — necessarily imperfect and subject to question. I’ve heard from many with significant risk factors or playing important roles who are still ineligible for vaccine. Now that the 65+ category is open, the most common and compelling appeal is from teachers – if teachers were vaccinated, it would be safer to open schools.
As thoughtful as the state was about its priorities, it did not give anywhere near enough thought to how the vaccines would be delivered to people. The first phase was straightforward. Health care workers are at high risk, health care workers are essential, they belong in the top group. Give vaccines to hospitals and they will vaccinate their staff.
But as the state opened vaccination more widely to older people generally, the path forward became much less obvious. There were least five major possible approaches: Pharmacies, public health departments, hospitals, doctors’ offices, new mass sites like Fenway Park. The state initially spread vaccine across the first four of these approaches.
Most importantly, the hospital systems stepped up to serve their patients and they were awarded roughly half of the first million doses to arrive in the state. Hospitals know how to run vaccination clinics and the larger health care systems have good patient databases and contact lists so that they can invite their patients in priority order. That seemed to be working well.
But it wasn’t working fast enough to put Massachusetts high in the statistical comparisons across states. Many analysts produced rankings of the states according to what percentage of vaccines delivered to them by the federal government they had administered.
The national average was 54% in late January and it has already risen to 76%. All the states are looking better and better on this metric as the process continues, because supply chain efficiency factors are mathematically exaggerated during the startup weeks.
But it is inescapable that Massachusetts was low in the rankings. Those low rankings resonated with our anxiety about getting access to the vaccine and offended our sense that Massachusetts should be better than other states.
Hearing the public concern about the rate of vaccination, the Governor changed direction and decided to set up mass vaccination clinics and direct vaccine supply to those clinics. That decision has accomplished its goal: Vaccines are getting out faster. Massachusetts has now risen from 38th to 17th among states and with 83% administered is well above the national average (as of February 20).
On the other hand, that decision has had some major downsides. First, it exposed the lack of planning for delivery of vaccines. If the state was going to directly run the vaccination process, it should have invested in an excellent and robust online scheduling system starting 9 months ago. The online scheduling system has been terribly frustrating for people.
Second, the mass vaccination sites cannot compete with hospitals and local public health clinics for convenience, familiarity, and trust. This is especially an issue for many of those most in need of vaccines – the elderly and those with other “comorbidities” that make them more vulnerable.
Third, hospitals and local health departments who have made investments in setting up vaccination clinics now have idle resources. While second dose commitments will be honored, those resources may remain largely idle until the state’s weekly shipments from the federal government increase dramatically. The state does contemplate a continuing role for local health departments in vaccinating those unable to leave their home.
Closely related to the decision to focus on mass vaccination sites has been a decision to rapidly broaden eligibility. More people eligible means more people trying to get through the scheduling system. That means more scheduling frustrations, but it also means rapid uptake of available appointments.
I don’t predict the state will change direction again until vaccine supplies increase. While I initially encouraged people to work with their health care systems, I now advise people to try to work with www.mass.gov/covid-19-vaccine or call 211. Each week, as supplies come in, more appointments will become available at the site.