The state has now opened a number of large vaccination sites and is prioritizing them in its allocation of supply. These sites may be the quickest route to vaccination for many people. Health care systems and other outlets like public health departments are receiving less supply, are not scheduling as many new appointments, and in at least a few instances, have been unable to honor scheduled appointments.
Additionally, the state’s vaccine information and scheduling system is improving. Now, for many of the sites, the state’s new portal, vaxfinder.mass.gov, offers current appointment availability before you provide personal information, so you can zero in on where you want to go and then sign up.
If you are already eligible, try the portal and see if you can schedule an appointment at one of the available mass vaccination sites. If you can find someone to help you get there, they can get vaccinated too.
Previously, my advice was to wait to hear from your health care system. The administration has changed its strategy. For better or for worse, the availability of interstate comparisons of the percent of vaccines delivered that have been administered has created a singular focus on this number. While the hospital systems were doing a good job getting vaccinations done, the big sites have even better numbers.
The emphasis on mass vaccination sites will likely improve the total vaccine throughput but it will result in a less equitable distribution. The hospitals were channeling available vaccine supplies to their highest risk patients and their highest risk communities. In the new system, some at lower risk will receive vaccine before others at higher risk.
While the administration initially hewed closely to the careful prioritization recommended by its eligibility task force, the administration is now shifting towards the choice that other states have made — to trade off some equity and rationality for overall rate improvement. The shifting priorities are disrupting expectations and, at least temporarily, stranding investments made in vaccine delivery capacity.
Expect continued changes.
The big variable is vaccine supply from the manufacturers and the federal government. If vaccine supply goes up, all of the inequities will even out. If there are supply interruptions, the inequities will be felt more acutely. One thing is clear: The state’s systems collectively now have capacity to administer more vaccine than they are receiving. We are ready to handle more vaccine if the federal government supplies it.
The legislature has created a new joint standing committee on Covid-19 Emergency Response and Recovery. We will be doing our best to shine a light on the decisions that the administration is making in this rapidly changing situation.
Background on administration/distribution as a performance metric
A state’s ratio of doses administered to doses delivered by the federal government is certainly a relevant metric. No one wants to see vaccines sitting in freezers unused. However, it is was understandable that initially many hospital systems felt that the conservative and responsible approach was to reserve the necessary second doses for their patients. This meant that many hospitals were holding vaccines in their freezers for the three or four weeks between first and second dose. This depressed the ratio of doses used to doses delivered. There were additional factors at play. Especially in the nursing home environment which was a top priority for vaccination, some employees were declining vaccination. Also, reporting of vaccines administered naturally lags reporting of vaccines delivered.
When I last wrote about this issue on January 26, the national ratio of doses delivered to doses administered was 53% and the ratio in Massachusetts was 51%. Given that the program had been running for only a few weeks and some second doses were being held back, these numbers were not surprising. Roughly speaking, they were what one would expect — at that point, second dose administration was just beginning so the number of doses held back should roughly equal the number of doses given, which would yield a 50% ratio. Some facilities and some states did not hold doses back and had higher ratios and some facilities and states undoubtedly had real delays, but it evened out to roughly 50%.
Even in the absence of any policy changes or actual efficiency improvements one would expect those ratios to go up. As deliveries continue at roughly the same rate, once second doses begin to be delivered (as they had as of my last writing on January 26), the total amount of second-dose hold-backs should remain roughly constant. Other supply chain effects and statistical delays are also likely to remain constant. These are all factors that affect the numerator of the administration/delivery ratio. However, the denominator, doses delivered, will continue to rise. So all states should see the ratio improve. As of February 12 at 6AM, the national percent delivered had risen from 53% to 70% and Massachusetts had risen from 51% to 64%.
While the numbers look better and that should help assuage fears that vast amount of vaccine are being wasted, I don’t feel the numbers say something good about Massachusetts, especially as compared to other states. The numbers had to get better just based on the mathematics of how they work and Massachusetts appears to be further off the national average.
Anecdotal evidence suggests that the early approach in Massachusetts was to give available supplies to any credible and qualified administrator of vaccines. Fortunately, Massachusetts does have well run major health care systems who stepped to the plate to deliver to their eligible patients. According to a message to legislators sent from Secretary Sudders on February 12
Since vaccines arrived in Massachusetts, hospitals and health systems have received and administered the vast majority of the vaccine available; as of February 11th, hospitals reported administering 460,000 doses, about 48% of the total supply to date and have been allocated and shipped 550,000 doses. This week, hospitals once again will be among the largest recipients of vaccine.
That would indicate that within the health care systems, the administration/delivery ratio is up to 84%. A couple of weeks ago, in response to lower administration/delivery ratios, the secretary had told the hospitals not to hold back second doses and it appears that their practices did change. In her recent communication, she says:
We . . . expect hospitals and health systems to administer doses within 10 days upon receipt and at an 85% administration rate.
Although hospitals are roughly meeting the 85% expectation, the state’s new mass delivery sites are achieving an even higher ratio, anecdotally near 100%. Apparently, driven by a focus on that metric, the state is channeling available vaccine supplies to those sites and additionally to pharmacy chains, effectively starving the now well-running hospital delivery systems so that they cannot schedule new appointments.