Vaccine Update

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.

Published by Will Brownsberger

Will Brownsberger is State Senator from the Second Suffolk and Middlesex District.

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59 Comments

    1. First and furmost Hospital Adm should not be involved its the doctors who should of been advising the administrations simply because it’s the doctors who knows deals with the patients and knows their diagnosis that’s the reason for primary care doctors, Next should of been infectious disease someone that has that issue should not come after nobody should be Top priority I under stand elderly but life long disease should be on that list weak immunue 1system for both catagories elderly and folks with chronic illness

  1. The basic inequities of our healthcare, like all the inequities of our society, are illuminated by the pandemic and measured by the numbers we collect to grasp the size and scope of COVID19.

  2. Thank you for the update. I know there will be bumps and glitches, but thank God things are FINALLY moving in the right direction!

    1. Lol. Uber drivers and strangers advertising on Facebook in their ‘20s are getting vaccinated and there are now TWICE as many people in line ahead of the next groups and that a “the right direction?”

      1. Wait — you’re complaining that 75+ are being vaccinated before you? Just because they have someone with them? You should be ashamed, IMHO.

  3. I received my first vaccination (Moderna) at Arlington High School on February 10th. They told me I would be getting my 2nd shot in about 2 to 3 weeks at the same place. I went with my wife but they didn’t offer her a vaccination.

  4. Thank you for the update.
    The faster more people
    Get vaccinated the sooner this nightmare can end…

  5. I am frustrated and angry at the new “bring an old person to the vaccine site” to get the numbers up! If the administration made it easier to register for the shots, they’d have their numbers in a hurry for people who really need the vaccine.

    1. This is the issue!!! There are plenty of 65/55 and folks with health issues who would sign up instead of giving to others who are bringing 75 year olds. Those doses should go to the priority not those who happen to be there. They would be there ready to get those ‘extra’ doses. This make no sense to me.

  6. Beyond vaccine administration issues, I hope the legislature’s new Covid-19 Emergency Response and Recovery Committee will get behind efforts to extend the Covid-19 emergency election procedures, like universal voting by mail, beyond their current sunset date of March 31. We’re not likely to be “out of the woods” by then, so voters and election workers in town elections after March 31 deserve to have these protections available. Town of Belmont votes April 6, Arlington April 10. At least three bills have been filed to accomplish this: SD156, SD189, HD240.

  7. Will, Thank you for a well-balanced information. It is disappointing that vaccine adminbistration appears to bypass doctor-patient relationships, built on trust – and the extensive infrastructure of the vaccine delivery by doctors’ offices. The article pointed out the well run vaccination process established by the Massachusetts hospitals already. I hope that at some point soon, when the supply limitations will be eased, the doctors and their offices, including Massachusetts hospitals and health centers, will be empowered to leverage the trust and the current infrastructure for expedited vaccinations. We are in the race against time. The longer it will take for us to reach herd immunity, the more likely we will see viral mutations that may render the current vaccines less effective. The role of the service organizations (e.g., community centers, religious and other non-profits) that built trust and communication outreach with the communities they serve cannot be underestimated in educating, encouraging and organizing mass vaccinations.

  8. I received my first vaccination of Moderna at Framingham on February 6th. As a Watertown resident I was told, after being given the inoculation, that Framingham would not give second shots to non-Framingham residents. I’ve spoken to my State Representative, Steven Owens about this. He assures me there will be a timely vaccination for me. However I feel uncertain and annoyed. There were a large number of non-Framingham residents receiving their vaccinations at the same time as I. It seems to me the State should give each of us assurance of a date. I wrote to Marylou Sudders and haven’t heard back.

    1. Right….and my husband signed up for Framingham and then got canceled because he was not a Framingham resident. This whole system is one big fiasco.
      They should have allowed husbands/wives under 75 to get vaccinated at the same time. But that would have required some common sense.

  9. Thanks for the additional clarity. Absent that clarity – the focus driven by the one metric, the decision made no sense. May still not be a great decision but at least mw know why it was made. Why isn’t that clarity provided at the outset?

  10. Thanks for the update. It seems that I keep getting pushed back to be eligible for the vaccine. I can understand that if a caregiver of a person 75 + takes daily care and takes that person to get their shoot, should be allowed to get the vaccine also. But that pushes someone like me further back I’m the eligibility line. I am 70 years old with 4 health issues that make me more likely to get the virus.
    If they continue to allow other group get in line ahead of me then if will be the end of March before I can get the vaccine.

  11. Why are they not giving supplies to physicians? It would be much easier for people to go to their own doctor than some mass site, especially if one has no car and no one who can drive them.

    1. It mostly has to be through bigger practices, at least. They need refrigeration capacity and they also need to be able to commit to deliver a lot of doses fast. The Pfizer vaccine comes in boxes of 1000 and the Moderna in boxes of 100.

  12. (from the boxed section) “Anecdotal evidence suggests that the early approach in Massachusetts was to give available supplies to any credible and qualified administrator of vaccines.” And to at least one administrator with debatable qualifications; https://www.bostonglobe.com/2021/02/12/metro/lawmakers-urge-gov-baker-abandon-plan-let-companions-elderly-get-vaccine/ reports two legislators’ assertion that Curative (operating in Springfield and Danvers) “is only about a year old with no long-term track record operating logistically complex vaccination programs.” Sounds like our own version of the recent Philadelphia story.
    The bigger story is Baker’s utter failure to start planning for vaccine administration soon enough; not a good showing for somebody described as a great manager. Somehow West Virginia could coordinate a large number of independent pharmacies administering vaccines, but Baker couldn’t.
    But thanks for the details. ISTM that cutting supplies to hospitals below what those hospitals can administer is a loss for equity without winning elsewhere; the state should be pushing harder to make more-accessible sites more successful.

    1. This entire story as about profits at the price of death. The over reliance on large private chains over smaller companies and public health organizations is literally killing people as the West Virginia example proves.

  13. Thanks for your clear explanation. However, I received my first dose
    administered by a hospital at a related site. It was very well organized
    and went extremely smoothly from showing us where to part in the
    garage through the check in and vaccine injection and appointment for
    the second shot. In contrast, a friend attended a state sponsored site,
    endured a mob of people not distancing and a long wait to be injected.
    So how is it fair to cut off supplies to hospitals?

  14. When could I get my COVID-19 Shot I work at Star Market and I am essential work and I hope to hear from you soon I thank you very much for your help

  15. Thank you for the update! The Baker administration has utterly failed. In terms of equity – they had over a month and failed at getting the most vulnerable people vaccinated. While the rest of us have been waiting, vaccine sits in the freezer! I think the best plan is to open it up to people who are ready NOW to get a vaccine. So I support the mass vaccination sites. Equity doesn’t matter if vaccine sits in the freezer due to utter mismanagement. I could have done better myself!

  16. Thank you for the clear information.
    It’s a good thing that we are prioritizing getting vaccines out, even though there are downsides. Those who would benefit most from an equity-based prioritization only benefit if they actually get those vaccines.
    Massachusetts is a state that normally excels. We shouldn’t be satisfied with anything less than near top performance in handling this pandemic. Average vaccine distribution shouldn’t be good enough.

  17. Why is there the entire list of world time zones to get alerts on the MA website? And countries? The website link you provided is ridiculous. Waste of time.

  18. Will, your summary seems accurate. I’m signed up for my first shot this coming week. Yesterday, my provider told me:
    “For patients who have NOT yet scheduled vaccination appointments with Beth Israel Lahey Health: Unfortunately, we are not able to schedule any new first-dose COVID-19 vaccination appointments for patients at this time, regardless of a patient’s eligibility under the state’s vaccine plan. In the event that this situation changes and we receive additional vaccine shipments in the weeks to come, we will reach out to you.”
    But this new policy of giving shots to companions is surely not helping institutions or pharmacies. It seems almost irresponsible for the state to open it up like that, given the current shortages.

  19. Will, thank you for this update. Massachusetts, unlike some other states, isn’t giving any special priority to K-12 educators, which concerns me. As a Belmont School Committee member, that’s something I’d like to see changed. Thanks for your efforts.

    1. Aren’t teachers already prioritized by being included in the 3rd group of Phase 2 along with other essential workers?

  20. I already know of a Belmont resident who got a first shot but was told that she couldn’t get a second at that site since they are not getting vaccine. That’s not right.

  21. Thank you for the informative message
    I agree that it is important to prioritize the most at-risk communities. I do however would like to know why we are still only vaccinating people over 75 when so many states, including New Hampshire, New York, and Pennsylvania, are vaccinating everyone over 65. (I and my wife are in our early 70s.) Can you explain this? Thanks.

  22. My husband and I got shots at Watertown St. CVS. We have an appt for our 2nd shot on 3-12-21. The private sector works efficiently. If you have Medicare and secondary insurance its easy to register and get the vaccine.

  23. I’m concerned we are not being presented with safety data on these vaccines. I see several countries that have banned some of these vaccines recently (India, Australia, South Africa). Other countries have put out specific warnings to certain at risk populations. We need transparency on this vaccine, particularly since it has been put on a rushed schedule. We cannot allow people to shut down legitimate questions with the “Trust the Science” mantra. For those who want a some great unbiased and uncensored facts…see link to the Chilren’s Heath Defense.
    https://childrenshealthdefense.org/protecting-our-future/covid-vaccine-safety-concerns/

  24. Thanks for your attention to this in a trying time. Hospital sites are most suitable for frail elderly living independently. I hope the supply will increase so these people can be served.

  25. I was surprised and disappointed that the state stopped giving COVID vaccines to MassGeneral Brigham and BethIsrael/Lahey, while they gave more to mass vax sites and retailers. These major hospitals and their clinics are better equipped to handle the frail elderly and disabled, and respond to the rare bad reactions to the vaccine. Also, MassGeneralBrigham participated in the clinical trials of the vaccines, and Beth Israel scientists developed the J & J vaccine which is awaiting FDA approval for emergency use.

    I’m very concerned that MassGeneral Brigham won’t have my second Pfizer vaccine which is scheduled. Also, giving vaccinations to any willing “caregiver” has attracted many lower-risk people who aren’t actually caregivers to accompany a person 75+ to get their shot.

  26. As a health care provider, it’s unconscionable to me that the state is going to stop providing hospitals with vaccines! The physicians, nurses and PAs are the providers who take care of our sickest and most vulnerable people and ensure equitable distribution to underserved populations, and now can no longer ensure vaccines for their patients. Shame on us!

  27. Hi Will,

    Any word on essential (non-healthcare) workers and vaccines? My understanding was as someone who works in a restaurant I would have access in Phase 2 but the site linked here to sign up for vaccination seems to indicate otherwise? I definitely those on the frontlines of grocery stores and in other big box jobs making minimum wage certainly should be a priority group if not restaurant workers too. Wondering if this was a change in the state’s strategy as mentioned above. Thanks!

    1. Essential workers will be up in the next group. We just got the 65+ opened, so that will last a few weeks at least before they go to the next. I especially want to see the teachers move though because of how that relates to the school opening.

  28. Inconvenient truth: if your constituents 65 and older had moved next door to Vermont over Christmas, they would already have be vaccinated. See “Grading Mass on COVID-19 Vaccination” by Globe editorial board Feb 13 that refers to my Mass Vaccination Report Card published by Globe several days earlier that show Baker government now earning Fs and Ds on key performance indicators. Graham Allison, Belmont resident for past 5 decades.

  29. I noticed the day after our meeting there was a notice in the paper that a hot line had been set up. Way to go! And a few days later I got the first of several invitations to set up an appointment to be vaccinated with the 75+ group. I took the first invitation and got my shot a week later in Needham. Very well organized. I wish everybody had such a good, easy experience.

  30. My wife and I were vaccinated by the Belmont Health Department last week. No lines; very efficient; kudos to them. Very different from the hours spent on the state website and hospital websites. Send more vaccine to local health departments.

  31. Deciding to stop distributing the vaccine to hospitals is the most ridiculous idea to ever come out of Baker’s office. Those of us who are disabled in any way (by age or physical disability) are being pushed aside: how can we go to big test sites to get immunized? Our doctors should be able to assist us, and yet… and yet, here we are. I’m furious over this – I’m 67 (almost 68) with four serious health conditions – I figure that if I get my vaccine by the time I turn 69, I’ll be lucky.

    I put the blame with all of this on Baker’s shoulders – I don’t blame him for the supplies, but I DO blame him for this sad distribution.

  32. hello
    we can’t fine any places in the Allston/Brighton to get the vaccine shot for my mother who is 91 and me who is only 62

  33. The DOC is almost done vaccinating those who opted to get the shots. I’m hoping all of the shots they were allotted but did not use (due to the painfully low rate of opting in) are able to be used elsewhere — Will, do you know if there’s a system in place for this?

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