Lawmakers press Baker on scrapping local vaccination playbook
Governor says COVID required a more custom-made response
FOR 20 YEARS, Massachusetts public health officials prepared for an emergency scenario that would require local boards of health to set up vaccination clinics across the state. But when COVID-19 hit the state and a vaccination network needed to be set up, the Baker administration threw out the playbook, improvised, and went in a different direction.
Lawmakers, prompted in part by a panel of local health officials, pressed the Baker administration on Tuesday about why it scrapped plans that the state spent millions of dollars developing. Gov. Charlie Baker said the unique nature of COVID-19 dictated the change and his health and human services secretary, Marylou Sudders, said the decision was made in part because local boards of health did not step up in large enough numbers when vaccinations first began.
Rep. Bill Driscoll, a Milton Democrat who co-chairs the Legislature’s Joint Committee on COVID-19 and Emergency Preparedness and Management, said while there may not have been a playbook for dealing with the COVID pandemic, there was a playbook for dispensing lifesaving medications in a time of national crisis – one that had been developed and tested and improved for years. “The moment has arrived, yet…aspects of those playbooks and plans stayed on the shelves,” Driscoll said.
The extreme frustration of local officials and lawmakers was palpable at an oversight hearing held Tuesday by the committee, which is led by Driscoll and Sen. Jo Comerford, a Northampton Democrat. For two hours, a panel of public health officials detailed the ability their communities had to set up local vaccination sites – and their frustration with the state’s decision to turn instead to other distributions networks, including privately run mass vaccination sites. Lawmakers then spent an hour grilling Baker, who defended the administration’s approach as the most efficient way to deliver vaccines.
Baker said the plans were never designed for the current scenario of a limited vaccine supply with tight restrictions on how it is stored and used, and Massachusetts is following the same playbook as every other state in relying on a mix of mass vaccination sites, hospitals, community health centers, local boards of health, and pharmacies.
“I appreciate that some point to plans developed in a pre-COVID world and ask why we chose not to follow them,” Baker said. “The fact is that COVID – and the vaccines developed to prevent it – present very unique challenges that forced us to make adjustments.”
Baker said the extremely limited supply of vaccine, the need for ultracold storage, the preparation process, the potential for spoilage, and the two-dose regimen “were all on-the-ground realities that required a different playbook than the one that was developed to battle an outbreak using a traditional, understood, and widely available antibiotic.”
Yet local officials say they were prepared.
Thomas Carbone, Andover’s director of public health, said Andover identified vaccination sites, practiced a drive-through model, and trained local emergency medical technicians to work as vaccinators.
In Barnstable County, which has a regional vaccination site, Sean O’Brien, regional emergency planning committee coordinator, said local vaccination sites were used during the 2010 H1N1 pandemic. Barnstable County purchased an ultracold freezer to handle vaccine storage. “Unfortunately, during the COVID response, the state opted to ignore these plans, which proved to be very frustrating,” O’Brien said.
The health officials say residents lose out when a community like Andover does not receive vaccines. “Local health firmly believes our oldest residents are best served by being vaccinated in their communities by people who are known to them in easily accessible locations,” Carbone said. “Many people told me they will not be getting a vaccine because they cannot or will not make the trip to the large capacity sites, and this is a missed opportunity for vaccination.”
First, public health officials were told they would not be involved with vaccinations until the general population was eligible. Then they were asked with little notice to vaccinate first responders and continue to vaccinate certain priority groups. “The inconsistent and ever-changing messages from the command center about available vaccine and public health departments created unnecessary confusion and fear and increased vaccine hesitancy,” Sibor said.
Sibor said rather than use plans that were developed and tested, “the administration instead spent hundreds of millions more taxpayer dollars to hire consultants and private organizations to run clinics while ignoring the plans and clinics available from local public health departments.”
Sibor said she has asked state officials what the plan is for local boards of health when more vaccine is available and has been told nothing will change.
Sibor said local health workers know what their communities need and have partnerships with organizations that can reach hard-to reach populations. O’Brien added that in some cases, as with undocumented immigrants, community organizations are more trusted than government.
Sen. Cindy Friedman, an Arlington Democrat who is the committee’s vice chair, called the testimony at the virtual hearing “damning.” She added: “I wish at this moment we were in person, and the governor was sitting with us so he could hear this in person.”
Friedman later suggested that Baker’s concern about logistics was overblown. “Nobody asked them if they could do it. We just seem to have thrown the playbook out and decided on something completely different,” Friedman told the governor.
Sen. Julian Cyr, a Truro Democrat, accused Baker of “reinventing the wheel” and struggling to reach vulnerable populations by focusing on mass vaccination sites instead of local sites.
Baker responded that he had to pivot as the facts on the ground changed, whether due to the nature of the vaccines or guidelines by the federal government. “We ended up moving to a mixed model because it gave us the best opportunity in this race against time to get to the most people as quickly as possible,” Baker said. “Where so many of the things you thought will be true don’t turn out to be true, especially with respect to supply and the product itself, we made a decision to create a program consistent with what the feds are recommending.” Baker said Massachusetts’ strong metrics regarding how much of its population has been vaccinated show the mix has been successful.
Baker administration officials have asked local boards of health to dispense vaccines to hard-to-reach populations like homebound seniors, and 160 municipalities are doing so. The state has encouraged the development of regional collaboratives coordinated with local boards of health, of which there are now 13 with four more in the works.
According to state statistics, 11 percent of doses have been administered by local boards of health and municipal collaboratives, compared to 15 percent at mass vaccination sites, 33 percent via hospitals, 21 percent via pharmacies, and 6 percent through community health centers. There are 200 public vaccination sites in Massachusetts.
Baker said the local emergency management plans were designed for cases when medicines are abundant. No northeast state has used its plan to distribute COVID vaccines, and federal guidelines recommend using a mix of different sites. He said mass vaccination sites distribute vaccines quickly and efficiently, in a situation that requires a lot more shots and a lot more complexity than the H1N1 pandemic.
“Under both the Trump and Biden administrations, the federal government has distributed vaccines through the same channels we are using: mass vaccination sites, pharmacies, and community health centers,” Baker said.Sudders, the secretary of health and human services, said every city and town has its own board of health, with uneven resources and staff. A majority of local boards, she said in prepared testimony, do not have the capacity to run a vaccination clinic given all the requirements. She also said many boards did not step up when the vaccination rollout began. She said only 119 local boards of health responded when the vaccination of first responders started. When the state moved on to people 75 and above, she said less than 100 responded.
Carbone said local officials agree there should be an array of options for getting people vaccinated. But he would have opened sites in the opposite order from the Baker administration. “If I had to do it over again, I hope we would have started small with the amount of vaccine we were getting locally, and as we were expanding vaccine availability to a large population that we’d move toward large vaccine sites,” Carbone said.