I want to thank the Chairs of the new Joint Committee on Covid-19 and Emergency Preparedness and Management for quickly organizing this important oversight hearing on Governor Baker’s roll out and management of the life-saving Covid-19 vaccinations. Every attempt to sign up by an eligible resident that is delayed quite honestly just buys the virus more time to spread, leading to further sickness and loss of life–it is really that simple. I am struck by comments I heard this week in a NPR story from Major General James Hoyer, who is leading West Virginia’s Joint Interagency Task Force for COVID-19 Vaccines. He talked about the call system, designed by a Massachusetts company that allows people to call and talk to a real person to book an appointment. “The last time I looked, it was 6 minutes,” Hoyer says disapprovingly, of the hotline’s average wait time. “What that tells us is we probably need more people manning the hotline.” He believes that the wait time should be reduced to two minutes.
Leadership is understanding that even when, or especially when, there are limitations on supply, we must reduce and eliminate all other obstacles. Every step of this vaccination process has led to obstacles and an increase in frustration and anxiety for those who are eligible.
Equity was not intentionally built into this delivery system. The system has primarily operated on a FIRST COME FIRST SERVE basis, being available primarily to those who are also able to navigate the confusing system, operate a computer, take significant time out of their day to schedule and attend an appointment, and find transportation to and from the vaccination sites, along with a dose of luck.
Governor Baker continues to talk about supply as the largest obstacle–this is simply not true. Supply does not speak to a system design that seems more inspired by the Game of Thrones or Survivor. The tools offered by the state have proven to be unreliable. When the vaccine-booking website was rolled out, it quickly crashed. People have reported being hung up on, repeatedly, while trying to reach the 2-1-1 service. I was contacted by someone who wasted 90 minutes in a virtual waiting room, and still was not able to schedule an appointment. These tools are not in the Governor’s own words just“lumpy bumpy”; they have led to private citizens developing an online mutual aid society approach of building independent websites that automatically report vaccine appointment openings on Twitter, or through texting friends. These problems should not be dismissed as growing pains. This is not a system that is working. This is not a system that’s foundation integrated equitable access from the first attempt to schedule an appointment to the vaccine in the arm.
Principles and practices of public health are always rooted in equity. It’s not just the number of shots in the arms; it’s about relying on local communities, hospitals, and community leaders who can reduce and remove barriers to access. Mr. Rogers reminds children in moments of crisis to look to the helpers…. THESE ARE THE HELPERS who have been excluded, ignored, and certainly not consistently engaged or collaborated with–and WE KNOW they haven’t because this would be a very different experience for everyone otherwise.
We are the epicenter of health care, good public health practices, and have a long history of training and doing drills to meet this moment. Yet, here we are…
The criticism is not about a lack of understanding, supply limitations, or an absence of appreciation for those 300,000 individuals who have been able to jump through hoops to get vaccinated. We don’t get a pass on ensuring that access to a life-saving vaccination has worked well or adequately for some people.
In Massachusetts, White residents are 13x more likely than Black residents and 16x more likely than Hispanic and Latinx residents to have received one dose of the vaccine. We know that the populations that have been impacted with the loss of life and severe illness is higher among communities of color, immigrants, and people living in poverty working in low-wage jobs. However, the roll out of the vaccination distribution plan was not centered on the same populations who have been struggling to stay alive, bury their loved ones, and pay their bills.
Moving forward, it will be important to know that Governor Baker is truly learning from his mistakes, specifically the lack of intentional inclusion, planning, collaboration. Especially since it was announced Thursday, February 25, 2021, that Governor Baker is expanding the number of places where people can now gather–the urgency in equity is a life or death matter. The Governor is pushing to get more kids back to school, which I agree is paramount. I worry about the timing of the rollback, which is in direct conflict with the recommendations of the CDC, while the administration is trying to bring more kids and teachers back to school. Risk mitigation requires that we continue to limit indoor gatherings rather than encouraging them. We need to be sure the focus is not on just the number of vaccines in the arms. Instead, we should be intentionally targeting those who cannot navigate the current system and are essentially waiting for supply to no longer be the issue.
Research shows that vaccination uptake is high when vaccines are made easily available. Public health research also confirms that hesitancy to any health care access is rooted in trust and faith that the needs are not afterthoughts, and it’s clear many of the needs are afterthoughts.
But every day is a new day and a new opportunity to do it differently and better. I know we have a wealth of experts in our state and local government, healthcare industry, community-based partners, and non-profits who are waiting to be heard with time tested solutions that meet people where they can be reached.
I want to especially thank Secretary Sudders for the impressive work to reach almost 80% vaccination rates for nursing home staff, who are predominantly women and immigrants. This is an example of intentional planning and collaboration with nursing homes, workers, unions, and public health leaders who put the time and effort in. I do hope to hear from the Governor and find out the plan to replicate this result in the Department of Corrections (DOC). We know shaming and punitive actions do not inspire better public health outcomes. I will be curious to learn what the DOC has done, and is doing, to meet the success of our nursing home health care workers.
There is no question, we can and must do better as we move forward on the vaccination roll out. Our lives are dependent on it.