Gov. Baker's botched vaccine rollout (and what we're doing to fix it)

SATURDAY, FEBRUARY 6, 2020

This week marked the one-year anniversary of the first confirmed case of COVID-19 in the Commonwealth of Massachusetts. There have now been some 513,526 confirmed infections and 14,921 lives lost to this terrible disease here in our state, according to the latest reports.

As I first noted back in the fall, if Massachusetts was its own country, we would have the worst per capita COVID death rate in the world — and unfortunately, that fact remains true as of this writing (with 212 deaths per 100,000 residents, according to recent figures tabulated by Johns Hopkins University). To put these numbers in context, the overall death rate in the United States is about 135 per 100,000.

By all accounts, Black, Indigenous, and People of Color (BIPOC), immigrants, and the working class have all been disproportionately impacted by COVID-19. These facts are my starting point as I continue to focus on advocating for an equitable response to the pandemic in Massachusetts.

Cases are falling, but Gov. Baker is expanding the reopening too soon

Fortunately, case rates and hospitalizations are now dropping after a second big surge following Thanksgiving and the December holidays.

But even as the development of safe and effective vaccines finally offers hope, highly-contagious variants of the virus are now emerging, with experts warning these variants could "escape" the powers of the vaccine, potentially leading to another surge. According to the L.A. Times, "Researchers once believed it would take several more months, or even years, for the virus to develop resistance to vaccines. They said the speedy evolution is largely a result of the virus’ unchecked spread."

Despite the precarious nature of these trends, Governor Baker announced this week that he will be expanding the reopening by allowing restaurants, close-contact personal services, movie theaters, casinos, office spaces, places of worship, retailers, driving and flight schools, libraries, arcades, fitness centers, and museums to go from 25% capacity to 40% capacity starting on Monday, Feb. 8.

The Governor appears to be under pressure from business leaders who want to allow greater economic activity in advance of Valentine's Day. For his part, Somerville Mayor Joe Curtatone thinks this is the wrong move; he says Baker's decision goes against the advice of experts, and I tend to agree.

I understand many are facing real economic pressures right now, but my preferred approach would be to raise taxes on wealthy individuals and on large corporations, and to use the additional revenue to directly support vulnerable residents and small businesses while we focus on ending the pandemic more quickly.

Governor Baker's Botched Vaccine Rollout

Now, the race to vaccinate the public is on. We need to achieve herd immunity before the virus mutates its way around the vaccine. Unfortunately, the vaccine rollout in our state is off to a poor start.

According to figures posted Thursday evening by the New York Times, Massachusetts has so far only been able to administer about 53% of the vaccines that we have received from the federal government. This places us 48th in the nation in terms of overall vaccine distribution. Only the states of Alabama and Mississippi have been less efficient than us. By this morning, the numbers have improved ever so slightly, with 55% of our doses used, moving us up one spot to 47th in the nation.

Back on January 13, I went on NBC10 Boston and started sounding the alarm about this situation. "The biggest concern I have is that a very significant chunk of our vaccines have yet to be delivered, even though they're on hand" is what I said on the evening news at the time. 

Over the past several weeks, I've been focused primarily on trying to understand what is going wrong with the vaccine rollout, and I've been working to push the Baker Administration for improvements. I've participated in several meetings with Health and Human Services Secretary Mary Lou Sudders and had numerous conversations with her staff at the state's COVID-19 Command Center. I've also been in regular contact with Somerville Mayor Joe Curtatone, Cambridge City Manager Louie DePasquale, and House Speaker Ron Mariano and his staff, and I've joined with legislative colleagues and municipal officials in advocating to the Baker Administration for a long list of improvements. 

In the text that follows, I will share some of what I've learned, along with the things we've been advocating for and some of the progress we've made. Truly, it feels like nothing is more important right now than getting this right, and clearly, a lot more needs to be done. I think about our seniors and our most vulnerable residents, especially those who are under-resourced and those who may not have someone to help them navigate what has been a far-too-confusing process — and it's just not fair or acceptable.

If you have any questions or concerns about the vaccine rollout, or if you need help scheduling an appointment — please do not hesitate to reach out via phone or email, as my staff and I stand ready to assist you as best we can — reply to this email or visit www.Connolly.house for our contact information.

Phase 1 Vaccinations — What the state got right, what the federal government got wrong, and how the Baker Administration could have better managed the situation

First and foremost, it must be said that supplies of the vaccine have been quite limited. There are almost 7 million people living in Massachusetts, with roughly 5 million people who will be eligible for vaccination (studies are still underway to determine the value of the COVID vaccine in children).

Based on the vaccine options currently approved (Pfizer and Moderna), each of these 5 million residents will need two shots. The pending Johnson and Johnson vaccine only requires one shot — and unlike the others it doesn't need to be kept super cold — so this offers additional hope for the vaccination program.

The state has been receiving about 100,000 doses of vaccine per week from the federal government, and so far, the feds have not provided much advance notice about upcoming shipments and quantities. We are hopeful that as the Biden Administration settles into office, this will all improve.

Given these circumstances, Massachusetts has adopted a phased approach, with goals of preserving the capacity of the healthcare system, preventing loss of life, and promoting equity.

Each state has been charged with establishing its own prioritization — and I will give some credit to the Baker Administration for their Phase 1 priorities. The state prioritized healthcare workers who deal directly with COVID, along with people who are most at risk in their living and work environments: Hospital workers, home-based healthcare workers, personal care assistants, longterm care and assisted living workers, folks who work with people with developmental disabilities, folks who work with the homeless population, and first responders.

From there, Phase 1 went on to include residents of nursing homes, skilled nursing facilities, and assisted living facilities, people with developmental disabilities who live in congregate settings, and people who are incarcerated or who are experiencing homelessness.

The prioritization of people who are incarcerated was a remarkably equitable decision and one that I've applauded — although the flip side is the Baker Administration is now ignoring measures we in the legislature passed to help promote decarceration in response to COVID-19.

Trouble with CVS and Walgreens

In order to supply vaccine to the congregate care settings such as nursing homes, the federal government created a program with CVS and Walgreens and delivered vaccine to those corporate giants based on an assumption that our congregate care facilities were 100% occupied and that 100% of the staff at these facilities would accept the vaccine. However, both of these assumptions were wrong. Our congregate care facilities are about 77% occupied, and unfortunately, only about 55% of the staff at these facilities have accepted the vaccine so far. For too many weeks, the Baker Administration didn't appear to do anything about this — now, in response to mounting criticism, the Administration has moved to reallocate unused vaccines, and yesterday, they announced plans for an intensive outreach effort with trusted messengers in hopes of improving acceptance of the vaccine among staff at these facilities. Notably, West Virginia, the one state that opted-out of the CVS/Walgreens partnership, has been leading the nation in terms of efficiency of vaccine distribution.

Challenges with the hospitals

Likewise, hospitals have also struggled to make use of all the vaccine they were given. At first, it was supposed to be deployed only to their COVID-facing workers. Soon, it became clear the hospitals had a lot of excess vaccine on hand, so the Baker Administration allowed them to give the vaccine to their non-COVID-facing workforce (including individuals who are working from home). While I understand this was better than allowing the vaccine to go to waste, it nevertheless speaks to the mismanagement that we've seen so far.

We have a lot of vaccine sitting in freezers, we have some vaccine that is going to waste, and we have some less-vulnerable folks getting the vaccine early because the system hasn't been set up in an equitable and efficient fashion. As a global leader in health care, innovation, and technology, Massachusetts must do better.

Phase 2, Step 1 — Our seniors deserved a much smoother rollout; the clunky scheduling website, the lack of a multilingual call center, the failure to coordinate more proactively with Local Boards of Health and Public Health Departments, and a variety of communications oversights are all symptomatic of a colossal failure of leadership and management by Governor Baker. 

Phase 2 began on Monday with residents aged 75 and up. Next, it will proceed to residents aged 65 and up and people with 2 or more comorbidities, followed by early education and K-12 workers, transit, utility, food and agriculture, sanitation, public works, and public health workers, and, after that, individuals with one comorbidity. Phase 3 will begin in future months by offering vaccines to everyone else in the general population.

There's a lot more detail about Phase 2 here on my State House blog, and I am actively involved in responding to concerns with the current prioritization, with a particular focus on equity and teachers/frontline workers. I'm also very concerned that people with asthma, people with disabilities, and people who are in an immunocompromised state from HIV have not been included in the official list of health conditions that qualify for Phase 2.

On Wednesday of last week, the state launched www.mass.gov/covidvaccine as an online scheduling tool intended to facilitate Phase 2 vaccinations. It became immediately clear this website was a confusing mess. One would have assumed the website would allow the user to enter their information and find options for available appointments. But that's not how it works. As it stands, the website is a clunky aggregator of several other websites and systems. It's left up to the user to parse through lists of other vaccine sites. Then, the user has to go visit those other websites, then enter all of their information into those other websites (including, in many cases, creating new accounts at corporate chains such as Walgreens) — and then, at the end of all that, the user will often find there are no appointments available and have to start the process all over again.

Hearing from constituents who struggled with this process, and hearing stories of seniors staying up all night or waking up at 4 am and spending many hours fighting with this terrible website only to not find an appointment — it was and is truly outrageous and even heartbreaking when one considers how much this vaccine means to our seniors, our most vulnerable residents, and their families.

Moreover, my colleagues and I immediately noted everything else that was completely overlooked with the rollout of this website: it was presumed our seniors all have high-speed internet access, the main website and many of the offshoot websites were largely based in English with few if any options for other languages, and all of this required folks to have lots of free time, a great deal of patience, and some technical skills. 

For his part, when asked about the website during a press conference last week, Governor Baker practically sneered in response: "How much more streamlined would you like it to be?"

It turns out, everyone wants it to be a lot more streamlined! And, in a demonstration of just how inadequate the Governor's rollout was — yesterday, a healthcare tech worker and mother of two who has been on maternity leave launched her own website that does something the state's website doesn't do — it actually lets users know where and when appointments are available on one convenient page.

See: https://www.macovidvaccines.com/

Right now, Rep. Livingstone and I are drafting a letter to the Governor asking him to support the efforts of this programmer and to incorporate this essential functionality into the state's official website.

The vaccine rollout is a victim of multiple fractured systems, one of the problems with our healthcare system in general

Overall, the Baker Administration has done a poor job helping residents navigate multiple fractured systems — hospitals, pharmacies, mass vaccination sites (such as Gillette Stadium and Fenway Park, et al.), community health centers, and locally run vaccination operations create a web of complexity that our most vulnerable residents are struggling with.

Pharmacies themselves have been running dual operations — supplying vaccine to congregate care settings, and also setting up vaccine distribution in their stores. Likewise, hospitals have been splitting their efforts between vaccination of their staffs and providing vaccine to affiliated doctors to offer to certain patients. I've heard anecdotal reports that well-connected, mostly white folks have been able to take advantage of some of these less formal distribution channels. And yet, some doctors don't have access to the vaccine for their patients, depending on their affiliation. For example, many local seniors are served by Atrius Health. My colleagues and I have been pressing the state to make the vaccine available to doctors in that system, but so far, we're hearing that hasn't happened. Meanwhile, patients of doctors in other systems are randomly getting calls asking if they would like to make an appointment for the vaccine. Following our advocacy earlier this week, Secretary Sudders met with the Massachusetts Medical Society to discuss a "depot model" for primary care practices. For my part, I have been advocating to the Baker Administration to ensure each vaccine distribution channel is operating in an equitable fashion.

To underscore the nature of these fractured systems, it's worth noting that in a meeting with Secretary Sudders this week, legislators were told that the there's been a very wide range of efficiencies among these systems. CVS and Walgreens have so far administered about 37% of the vaccines the federal government sent them for Massachusetts. On the other hand, the mass vaccination sites, run by CIC Health based in Cambridge, have managed to administer about 93% of the vaccine they have received. Hospitals are somewhere in the middle, at approximately 65% according to our latest reports. Fortunately, a change was recently made to stop making extra "deposits" with the corporate pharmacy chains, and the Baker Administration is now putting everyone on notice that if they don't administer available supply within ten days, they will be shut off and the distribution with be adjusted to favor more efficient channels.

Delivering vaccine to our large, low-income senior/disabled public housing buildings has been a top priority of mine

Since last week, my top priority has been advocating to the Baker Administration to work more closely with our local public health departments to provide on-site vaccinations at our large, senior and disabled public housing buildings.

When Phase 2 started, it became clear the Baker Administration wasn't doing enough to partner with our local boards of health and housing authorities. I'm very pleased to report we were able to advocate for distribution at places like Miller's River in East Cambridge and Manning Apartments in Central Square this week. Yesterday I heard from constituents at Miller's River who were able to get their shots right inside their building.

These on-side vaccinations ought to be part of our effort to ensure equity. Many elderly public housing tenants typically do not own their own automobiles, and unlike seniors who live in their own homes, these residents tend to face the added COVID exposure of shared/common spaces such as hallways, vestibules, and elevators in their large buildings. Everyone understands the current vaccine supply is limited, but that being the case, there is no excuse for the confusing mess many of our seniors have been made to endure in recent weeks. For some folks, a visit to Fenway Park sounds good. For others, getting the vaccine where they are at is far more preferable. It is the job of government to ensure equity and basic convenience in the administration of this life-saving vaccine.

Phase 2 continued — The road ahead, what we can look forward to, and what needs to continue to improve

  • We still have a long way to go to get through Phase 1 and the first part of Phase 2. People recently vaccinated will also need to get their second doses. The Governor says people will book their second dose during the 15 observation period following their first dose — but so far some say this isn't how all of the sites are being operated. Phase 2, Step 1 includes about 450,000 seniors aged 75 and up — but remember the state is only receiving about 100,000 vaccines per week at this point.
  • We need to do a lot more to address the racial vaccination gap. The Boston Globe's Abdallah Fayyad reports: "It’s not hard to look at the racial disparities in vaccinations and see the latest manifestation of the nation’s past sins...But the racial gap in vaccinations was not inevitable, and numbers should be seen for what they are: a scandalous failure on the part of governors who failed to adequately plan to go after the coronavirus in the hardest-hit areas...Unfortunately, Governor Charlie Baker of Massachusetts is one of those governors."
    • "Frankly, the state has botched the vaccination rollout," said Iván Espinoza-Madrigal, executive director of Lawyers for Civil Rights, an antidiscrimination advocacy group in Boston. "The program is almost an afterthought when it comes to people of color and immigrants."
    • "In Massachusetts, Black people, who make up 9 percent of the population and 14 percent of health care workers, account for only 3 percent of people who are fully vaccinated. Latinos account for less than 4 percent, despite constituting 12 percent of the state population and 10 percent of health care workers."
    • To help address this ongoing outrage, I have been calling on the Governor to launch an inclusive public information campaign (that's finally happening, see below), I have been advocating for the state to work more closely with local officials in communities most impacted (more vaccination sites are now coming to communities most impacted, see below), and I am co-sponsoring specific legislation designed to address concerns of racial equity (see below).
  • Though the Baker Administration hasn't posted any official targets, by all accounts we need to get to one million vaccinations per month by the spring. That will require greater production and distribution from the federal government and tremendous improvement with the administration of the vaccine in our state.
  • The state is continuing to scale up vaccination infrastructure; there are currently 125 vaccination sites up and running, and the Administration expects to have at least 165 sites up and running by the middle of the month. This week, over 120,000 new appointments were made available, including 55,000 new appointments at the mass vaccination sites. 8 new Walgreens locations opened this week, including in some of the most impacted communities like Chelsea, Everett, Roxbury, Mattapan, Dorchester, and Revere.
  • Next week, an additional 30 pharmacy sites will add about 21,000 appointments, and there are plans for a CVS site here in Cambridge as well as in other communities that have been disproportionately impacted by COVID-19.
  • For the past two weeks, we have been calling for a vaccine scheduling hotline. The Baker Administration finally rolled that out yesterday. Residents aged 75 and up may now dial 2-1-1 for multilingual live phone support. Over 500 staffers are working the phones weekdays during normal business hours. This should have been part of the Phase 2 rollout last week. When we reach the next step in Phase 2 (residents aged 65 and up), the hotline will be available to those residents as well. I'm also co-sponsoring legislation to make this hotline available 24/7 (see below).
  • Another item that we’ve been strongly advocating for is now getting underway as well — this weekend the state is launching an inclusive public awareness campaign focused on explaining why the vaccine is important and the steps taken to ensure it’s safe and effective. In particular, the campaign aims to connect with communities of color and address skepticism and hesitancy (which is legitimately based on the history and reality of medical racism and systemic racism) by leveraging trusted voices from our medical community and from local communities. See: https://www.mass.gov/info-details/trust-the-facts-get-the-vax-campaign-materials to learn more.
  • In yesterday's Boston Globe, public health experts issued a scathing indictment of Gov. Baker's leadership on the vaccine effort, calling it "abysmal and embarrassing." They offer a number of good suggestions for improvements to the program, and they also say that Baker's unbelievable statement on Thursday that Massachusetts is receiving too many vaccine doses to accommodate before their expiration date is "wrong and dangerous."

Latest Legislative Efforts

Recently, I've co-sponsored several bills that aim to address the vaccine situation, including:

  • SD.300, An Act streamlining COVID-19 vaccination sign-up in Massachusetts. This bill directs the Department of Public Health to immediately establish an accessible, one-stop online sign-up for COVID-19 vaccinations for both desktop computer and mobile registration. It also requires a phone hotline immediately be established in multiple languages, to be staffed 24/7, and directs the Department of Public Health to notify residents of these streamlined options for vaccination sign up using a text-based notification system such as "AlertsMA."
  • SD.699 / HD.1283, An Act effectuating equity in COVID-19 vaccination. This is emergency legislation designed to generate racial, economic, and regional equity through widespread access to vaccination in every corner of the Commonwealth. The bill represents a collaboration among legislators and infectious disease and public health experts. It requires the Baker Administration to further expand access to vaccination and testing in communities disproportionately affected by COVID-19 through: 1) Appointing a Director of COVID-19 Vaccination Equity and Outreach to address disparities in COVID-19 vaccination rates; 2) Partnering with trusted community-based organizations and locally-based health care providers to conduct direct outreach and education campaigns to promote vaccine acceptance in the Commonwealth’s hardest-hit communities, including through phone calls, text messages, and door to door campaigns; 3) Creating a mobile vaccination delivery program for door-to-door and open administration in communities with the highest rates of COVID-19 test positivity; 4)Improving partnership with local public health departments and locally-based healthcare providers for administration of COVID-19 vaccines; 5) Mandating that all administration sites schedule required second-dose appointments at the time of initial vaccine administration; 6) Appointing an expert on vaccine disinformation to the Vaccine Advisory Group; 7) Improving data publication, transparency and oversight by requiring publication of weekly updates on the number of unused vaccine doses in the Commonwealth; COVID-19 vaccination data by key socioeconomic and demographic factors; and monthly reports to state legislators on relevant state and federal funding and expenditures related to COVID-19 vaccination; and 8) Expanding "Stop The Spread" testing sites to all gateway cities.
  • SD.709, An Act relative to COVID-19 vaccination preregistration. This instructs the Department of Public Health to establish a preregistration system wherein residents may sign up in advance for the vaccine and provide any information helpful in determining vaccination eligibility — including but not limited to age, job description and whether or not there have health conditions that make them more susceptible to the impacts of the virus. Residents who choose to preregister would then be able to receive an alert when they are eligible, rather than having to constantly keep tabs on when they may be called forward for their turn.

In addition, Speaker Mariano and Senate President Spilka have responded to our concerns by creating a new committee with COVID-19 oversight capacity.

Speaker Mariano also issued a strongly worded statement to make it clear to the Governor that the legislature will assert its authority to demand improvements. This is particularly notable since former Speaker DeLeo tended to avoid criticism of the Governor. On the same day that the Speaker issued his statement, the Governor totally changed his tune and said he would work hard to fix things.

Cambridge and Somerville Resources

If you've made it this far into my blog post, then you're probably as interested and concerned about the vaccine situation as I am. There's a lot more I could write about all of this. I will continue to keep folks updated, and again, if you have any questions or concerns, please reach out and I'll do my best to help.

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