‘Time is of the essence here’: High-risk groups await state vaccine plan

Massachusetts could see two vaccines arrive by mid- to late December

By Robert Weisman and Deanna Pan Globe Staff,Updated December 1, 2020, 2:19 p.m.

With the first COVID-19 vaccines on track to arrive in Massachusetts in less than two weeks, the groups most vulnerable to the deadly virus — from front-line health workers to residents of hard-hit communities — are awaiting the state’s plan for allocating the initial doses in what’s shaping up as the largest vaccination program in history.

Members of a state vaccine advisory group say they now expect Massachusetts could receive enough two-shot allotments to inoculate 300,000 residents in the first phase, considerably more than they’d anticipated two weeks ago. As drug makers Pfizer and Moderna press forward with their bids for federal emergency use authorization, they think both vaccines could be available in the state by mid- to late December, and distributed over the course of several months.

“Current projections are something on the order of 300,000 [allotments] in the first month or so, and it will take a couple months or so to deliver all of those doses,” said Dr. Robert Finberg, a professor at the University of Massachusetts Medical School in Worcester and a member of the advisory group.

At a press briefing Tuesday, Governor Charlie Baker reiterated that “high-risk individuals,” due to their work, age, or physical condition, will be first in line for the state’s vaccine supply.

“That’s probably gonna be where most of the activity is in December, January, February, and March,” he said.

Assuming all goes according to plan, “Joe Q or Jane Q Citizen” likely will have access to the vaccine by spring, Baker said.

The distribution plan, which eventually could involve the vast majority of the nearly 7 million state residents, came into sharper focus after a meeting Tuesday of a Centers for Disease Control and Prevention panel that’s preparing a national vaccine distribution framework. That was to be followed by a Tuesday evening meeting of Baker’s vaccine advisory group, which will recommend who in the state will get the vaccines first. The governor’s plan is expected to follow that recommendation.

States have until Friday to submit their final vaccine distribution plans to the federal government.

“We are getting close” in establishing a priority list, said Dr. Asif Merchant, a geriatrician at Newton-Wellesley Hospital who represents the Massachusetts Medical Society on the state’s vaccine advisory group. “Time is of the essence here.”

The CDC’s vaccination priorities won’t be binding on Massachusetts or other states. But most are expected to broadly follow its recommendations and those of the National Academies of Sciences, Engineering, and Medicine. While they differ in some areas, both phasing plans list “COVID-facing” direct care health employees as a top priority, including those working in hospitals, adult congregate settings, community health centers, and private homes.

High-risk sites, such as long-term-care facilities, which have accounted for nearly two-thirds of virus deaths in Massachusetts, are jostling to be at the front of the pack. “There is a moral imperative to make sure our staff and residents are at the top of the list,” said Tara Gregorio, president of the Massachusetts Senior Care Association.

Direct care health employees would be followed, in later phases, by other health workers and critical employees such as teachers and child care, transport, and food supply workers; adults with two or more chronic medical conditions such as cancer or emphysema; people over 65; and, younger adults and children between 8 and 12 years old.

Younger children won’t be vaccinated initially because they weren’t part of the first large-scale vaccine clinical trials. Whether residents of long-term care facilities, who also weren’t included in initial clinical trials, will be vaccinated in the first phase in Massachusetts isn’t yet clear.

“Those people were not enrolled in these vaccine trials so there’s questions about whether they should be the first group,” Finberg said. “You could argue that they might not respond as well . . . or that they might have more side effects. But we don’t know that.”

The CDC panel, known as the Advisory Committee on Immunization Practices, voted 13 to 1 Tuesday on an interim recommendation to include residents of long-term care facilities, in addition to health care personnel, in the initial phase of distribution. Some panel members, however, expressed reservations about the lack of patient safety data on long-term care residents and safety surveillance at these facilities.

While the precise “phasing” has yet to be determined, “we’re going to work hard to stay in sync with the CDC,” said state Senator Cindy Friedman of Arlington, a member of the state advisory group.

Federal and state officials are working on two separate supply chains for the first batch of the vaccines. The state Department of Public Health is expected to allocate shipments to hospital systems, which will determine where and how to administer their doses. And nursing homes, rest homes, and assisted-living facilities are enrolling in a pharmacy partnership program whereby pharmacies such as CVS and Walgreens will deliver allotments and administer shots.


Other vaccine access points are expected to include community health centers and, eventually, retail pharmacy outlets. The vaccine will be given free of charge to recipients in Massachusetts, advisory group members said.

In a statement Tuesday, the DPH said it’s working with the vaccine advisory group in “developing plans for the equitable and speedy distribution of the COVID-19 vaccine to Massachusetts communities” based on CDC guidance.

The state advisory group has been meeting about twice a week for the past three weeks to address distribution priorities, and members describe their sessions as highly collaborative. Among the debates are how to balance the needs of cities and towns disproportionately hurt during the pandemic with the need to protect the broader health care infrastructure given limited initial allotments.

But in their discussions, “health care workers are always at the top of the list,” said Dr. Marc Lipsitch, an advisory group member and professor of epidemiology at the Harvard T.H. Chan School of Public Health in Boston. “It’s a judgment that first we need to protect the capacity of the health care system.”

At the same time, “equitable distribution” has been at the heart of their discussions, said Michael Curry, an advisory group member who is president of the Massachusetts League of Community Health Centers. Curry’s organization represents 52 community health centers across the state, which treat more than 1 million patients, including many who are people of color or immigrants.

“It’s critical that we’re integrated into the process of getting the vaccine out,” Curry said. “We know the communities most impacted [by COVID-19] are the communities we serve. And we have a dilemma. Many of these communities don’t trust the vaccine.”

While antivaccination sentiment is a challenge nationally, hesitancy may be most acute among communities of color, especially Black Americans who recall a history of health care abuse and discrimination, and may not trust government health authorities, Curry said.

To combat that sentiment, Curry’s community health centers league has scheduled a Dec. 16 virtual town hall for staffers to encourage vaccinations and try to reassure skeptical community members of the vaccines’ safety and effectiveness.

Other groups are also lobbying actively for their members in anticipation of the vaccines. “We support prioritization of health care workers, not only those who work in health care facilities but also those who work with a vulnerable population at home,” said Marlishia Aho, communications director for Service Employees Local 1199, which represents more than 70,000 nurses and nursing aides.

Finberg said the first phase of the state’s distribution plan could begin as early as the end of next week. An expert advisory committee convened by the Food and Drug Administration will meet next Tuesday through Thursday to evaluate Pfizer’s emergency use application to the FDA.

If the FDA grants authorization, the Advisory Committee on Immunization Practices will meet again to determine who should be vaccinated first. Once the CDC recommendations are approved, “the vaccine should go out hopefully in the next day,” Finberg said.

A similar process will follow soon after for the Moderna vaccine.