Digging into why the Baker administration opted not to embrace years of local disaster planning when the COVID-19 pandemic hit, one member of a Massachusetts legislative panel probing the vaccine rollout, Sen. Julian Cyr, said what he heard Tuesday from the administration and local health officials sounded like "a tale of two public healths."
Local and regional health officials described dedicated efforts in the wake of the Sept. 11, 2001, terrorist attacks to prepare emergency responses and contingency plans for a range of disasters, including a pandemic, and expressed frustration that Gov. Charlie Baker's team shelved that work to instead elevate private-sector vaccination sites during the coronavirus pandemic.
By sidelining the experts closest to the ground, the Baker administration created confusion and placed obstacles in front of residents who need a more proactive support system to get the life-saving immunization, the local health officials argued during a Joint Committee on COVID-19 and Emergency Preparedness and Management hearing.
Baker and his team countered that the COVID-19 crisis, which has upended public life for more than a year, created unique challenges that could not have been addressed without a pivot, including the cold storage challenges of the early vaccines.
"We have a long way to go and a ton of work to do, and I wouldn't begin to say for a minute that we don't, but I do believe given all the issues associated with supply, the nature of the rollout, how fast it had to happen and how people have to manage the process itself, we made the right decision," the governor said, making his second appearance before the committee where he defended what he described as a nation-leading vaccination effort using a strategy backed up by federal guidance.
Local and Regional Public Health Officials
There is some precedent to relying on local experts in a health crisis, as the first panel of municipal health officials told the committee Tuesday: In 2009 and 2010, vaccination and emergency response plans prepared by local agencies played an important role in the state's response to the H1N1 outbreak.
Some communities expected that they would again step into a similar role. Barnstable County, which is now part of a regional vaccine consortium, purchased an ultra-cold freezer to prepare for administering COVID-19 vaccines, according to Sean O'Brien, director of the county's Department of Health and the Environment. Thomas Carbone, Andover's director of public health, said his team practiced a drive-through vaccination model and scouted dozens of locations for clinics.
They were not asked to do so, however, creating frustration among many who felt their preparation and expertise had been sidelined. Nine out of 16 public health emergency preparedness coalitions voted not to concur with the Baker administration's operating plan, Carbone said, intending to send a message.
"We've spent 20 years managing this, putting these plans together, being ready for it, and the state has decided to go a different route," Carbone said. "There's really some frustration among the members as to why we're going to continue doing what we're doing if that's not the plan anymore."
Challenges with the COVID-19 vaccine, such as specific transportation requirements or the need for ultra-cold storage, are "nothing that can't be overcome" by local departments, Carbone said.
Dawn Carmen Sibor, executive director of the Massachusetts Health Officers Association, told the panel that local leaders received "inconsistent and ever-changing messaging" from the Baker administration about their roles despite producing "scalable" and "solid" disaster plans.
Sibor noted that the administration's vaccine rollout has relied on several private organizations to help run sites such as CIC Health and Curative.
"The administration instead has spent hundreds of millions more taxpayer dollars to hire consultants and private organizations to run its clinics while ignoring the plans and capabilities available from local health," Sibor said.
On March 1, the Baker administration shifted its distribution plans by halting shipments of first doses to municipalities for clinics serving only that city or town's residents, except for 20 of the hardest-hit localities. At the time, officials said the goal was to increase capacity at mass vaccination sites, pharmacies and regional collaboratives, which could administer more doses per day.
Some are still involved in regional collaboratives, such as one running in Barnstable County, but Sibor said she does not expect local health offices to be recalled into the vaccine administration fold once larger shipments start arriving.
Sibor said she has been asking the Department of Public Health for about a month and that they are likely "tired of hearing my question."
"The answer I've gotten is that basically nothing is going to change, that it appears that mass vax sites are not at capacity right now and they will be at capacity with adding the general public," Sibor said. "At this point, nothing is going to change from plans that are happening now."
Local health officials raised several other noteworthy points during their testimony:
- "Feeding Frenzy": The pace at which the Baker administration pushed forward through eligibility steps created "a really difficult situation" in Barnstable County, according to O'Brien. Cape leaders were still trying to get first responders vaccinated, O'Brien said, when Baker opened up vaccine access to adults 75 and older — a population with a significant presence on the Cape — and made it more difficult to finish already-eligible groups. "It put everybody into the same feeding frenzy," O'Brien said. "It was almost like the Daytona 500 of people trying to get appointments down here."
- Achieving Equity: O'Brien and other panelists tied the administration's focus on higher-volume sites and the appointment-booking system directly to equity concerns that have been a central focus of the vaccine rollout. Although Baker said later that the state has booked more than 50,000 appointments through its 2-1-1 call center, that phone line did not launch until more than a week after adults 75 and older gained eligibility, leaving many of them with no option other than to fight for slots online. In O'Brien's view, that placed further disadvantaged those who lacked reliable internet access. "Putting everything into this mass vaccination clinic and this software created such a problem where if you had a fast computer or you were a tech-savvy person, you got an appointment," O'Brien said. "If we had it go out to the local levels — and as I've mentioned, local health departments know their populations — they could've gone out to that vulnerable crowd a little quicker."
The Baker Administration
The governor used his hour with the committee Tuesday to specifically defend his administration's use of mass vaccination sites and its decision to not use local emergency response plans.
On the issue of dose distribution, Baker pointed out that hospitals have administered more vaccine doses than any other practice type. As of the administration's latest weekly vaccine report, hospitals had administered about 34% of the total, CVS and Walgreens had administered 22%, mass vaccination sites had delivered 15%, regional collaboratives or local health departments had delivered 11% of the total, and community health centers had administered 6% of the doses.
"We believe the facts on the ground, given the nature of the product that was being distributed, the speed with which we had to move, and, frankly, the guidance we were getting from federal authorities at the CDC and the White House and from many of my colleagues in other states, was that the program that we established — which was based on hospitals, pharmacies, community health centers, mass vax sites and regional collaboratives — was the right way to go," Baker said.
The governor added, "And I have to say that as unhappy as some people may be with that decision, we are outperforming every other state in the country across most of the CDC's key performance measures and I think that's an important fact with respect to whether or not the choices we made were effective or not."
In addition to following the guidance he was getting from the federal government, Baker said his administration opted not to embrace local emergency plans prepared before the pandemic because of the "unique challenges" COVID-19 presented.
"I appreciate that some point to plans developed in a pre-COVID world and ask why we chose not to follow them. The fact is that COVID — and the vaccines developed so far to prevent it — present unique challenges that forced us to make adjustments," Baker said in his opening remarks. "The extremely limited supply, the need for cold and ultracold storage, the prep process, the potential for spoilage and the two-dose regimen were all on-the-ground realities that required a different playbook than the one we developed and is different from the one we would have used to battle an outbreak using a traditional, understood, and widely available antibiotic."
Baker's hour with the oversight committee touched upon a number of COVID-19 and vaccine-related topics:
- Friction Between Baker and Friedman: The governor said he wanted to talk Tuesday about how vaccine doses are distributed across the state "as we learned through media reports that the committee wants to discuss the value of mass vaccination sites." That comment and Baker's opening statement did not sit well with Sen. Cindy Friedman, who became upset with the governor and insisted that the committee did not leak anything to the media and had communicated clearly with the governor's office. "We have been your partners since March. We have done everything we can to be supportive to help you all to be good stewards of this whole pandemic," she said. "And I just feel like we've gotten to this point or in this vaccine where we have tried very hard — very hard — to continue that collaboration and what we're getting from you is, 'You're all wrong, we're doing great. Please, we don't want to hear it anymore.' And I find that really hard to take. I just feel like there isn't any give-and-take here." Earlier in the hearing, Friedman responded to the panel of local experts frustrated about the administration's approach by saying, "The word that comes to mind when I hear your testimony is 'damning.'"
- J&J Distribution: Spurred by a question from Auburn Rep. Paul Frost, a fellow Republican, Baker on Tuesday refuted some of the implications of a Politico report this week that suggested the next wave of single-shot Johnson & Johnson vaccines won't be shipped to states until the middle or end of April. The governor said White House officials told him that states will get 2 million J&J doses next week and the federal pharmacy program will get 1.5 million doses, less than the 6 million doses once expected, but not nothing. "I think the great challenge we all face on this, and this is just one more example of it is the bumpiness associated with supply projections generally. The good news is the answer wasn't, 'No, there's not any,' which is what that story in Politico implied, but it's certainly not what we were originally expecting," he said.
- 14 Million Doses by April: To demonstrate the importance of having plans that can change based on the facts on the ground, Baker shared an anecdote about the supply of vaccine doses the state once had been told to expect. "As recently as December, we were being told that it was possible that we would have as many as 14 million doses by April," he said. "I mean, we're gonna have three [million]. And when you get into that kind of a conversation where so many of the things that you thought were going to be true don't turn out to be true, especially with respect to the supply and the product itself, we made decisions to try to create a program that was A) consistent with what the feds were recommending, both the Biden and Trump administration."
- Senate Report: Throughout Tuesday's hearing, Baker kept referring to what he said was a report from a Senate vaccine working group that recommended an approach to vaccination similar to the one he took. He held it up to the camera at one point and told lawmakers they were looking at "the Senate proposal which I've written over all over for the better part of the past few months," and he said the document "is a nice piece of work." The only problem was that none of the senators participating in Tuesday's hearing knew what Baker was talking about. "Governor, can I just ask: this Senate report you're referencing, I'm not familiar with that report. I'm texting with my colleagues, Cindy Friedman isn't familiar with the report, Jo Comerford isn't familiar with this report. Can you tell us what this report is because I just want to make sure we know what we're talking about here," Sen. Julian Cyr said. Baker said he thought the report was done by a committee chaired by Sen. Barry Finegold. Sen. Jo Comerford, the Senate chair of the oversight committee, later clarified that the report Baker was referencing was not a formal Senate document. Baker's office said after the hearing that Finegold's office had sent Baker the report and other materials in October, and Finegold told the News Service the report was the product of a collaboration and conversations between himself, MassBIO and officials at the Department of Public Health. The documents reference meetings with members of the administration, including Health and Human Services Secretary Marylou Sudders. "This was sort of a collaboration between myself, MassBIO and some people at DPH. It was sort of a private-public sector type thing and the goal was to make some recommendations to the Command Center and hopefully see them adopted," Finegold told the News Service.
Executive Office of Technology Services and Security
The state's chief information officer expects the new COVID-19 vaccine pre-registration system to stand up to the potential for added traffic when the pool of eligible residents expands next month.
Technology Services and Security Secretary Curt Wood told lawmakers Tuesday that his team "immediately jumped in" to work with vendors PrepMod, Color and Curative after the state's vaccine-booking website failed on Feb. 18 in the face of enormous demand as about a million residents became newly eligible for appointments.
Since the crash that prompted outrage and intensified scrutiny of the options to book vaccine appointments, the Baker administration launched a new pre-registration system for securing slots at mass vaccination sites. Wood said the state selected Google after conversations with Microsoft and the Burlington-based Everbridge, and almost 1.2 million people have so far pre-registered "without incident."
"We certainly believe the pre-registration system is ready to go," Wood said. "There will be no issues when we add eligibility, when the folks on April 5 and April 19, we don't anticipate any problem."
Wood had more to say about the vaccine website and other state pages:
- Chatbot Plans: The secretary said the state plans to add a COVID-19 chatbot to the state's website in the next few days as another way to help residents access information.
- Possible Pre-registration Expansion: Responding to a question from Rep. Mindy Domb, Wood said talks were underway about potentially expanding pre-registration so that it would be available for other sites in addition to mass vaccination locations. He said he doesn't think pharmacies and hospital networks would be part of such an extension, but officials "are having some discussions about regional collaboratives and other opportunities." "From a technology perspective, we're ready to support whatever our administration would like us to do in this area," he said. The administration previously said it hoped to add sites to the pre-registration site in April.
- Load Testing: Sen. Eric Lesser asked Wood if he did a load test of the vaccine-scheduler before the Feb. 18 eligibility expansion, or if he was aware of such testing being done to gauge the tool's ability to stand up to significant volume. "I did not personally load test. I believe there was testing done with the vendors. I believe there was no reason to believe that they would fail. It's evident from what happened that they did," Wood replied. He said new technology, procured from the Cambridge company Akamai, was immediately put in place to "do a better job of content delivery" to prevent a future crash.
Matt Murphy of State House News Service contributed reporting.
