With a potential COVID-19 vaccine suddenly closer on the horizon, planning is intensifying over which Massachusetts residents will be first in line to receive the shots and how to persuade communities that are deeply mistrustful of vaccines and the health care system to step forward.
The two missions intersect in countless nursing homes, hospitals, and neighborhoods, as many residents who may be prioritized for getting one of the limited number of vaccines are wary of the system delivering it. Nursing home workers in Massachusetts, for instance, face a higher risk of infection. They also tend to be disproportionately Black and Latinx, communities in which trust has frayed.
From Boston to Springfield, advocates and health organizations are launching listening sessions. Some are surveying their communities to identify trusted local leaders who can help communicate reliable information about coronavirus and counter rumors and fears. But they face a daunting prospect as many communities that have shouldered a disproportionate share of coronavirus illness and deaths also harbor deep-rooted suspicions stemming from years of discriminatory treatment by physicians and researchers.
In Boston, the Roxbury Presbyterian Church is hosting none other than the nation’s top infectious disease expert, Dr. Anthony Fauci, in a Zoom event later this month about grappling with “health, equity, access, and trust” during the pandemic.
“I was a little surprised that so many people in my community don’t trust this vaccine," said Rev. Liz Walker, church pastor and a member of Governor Charlie Baker’s COVID-19 Vaccine Advisory Group. “I am talking to parishioners to try and get people the real information and then they can make wise choices."
The drug maker giant Pfizer raised optimism last week when it announced preliminary trial results indicating its vaccine may be 90 percent effective against COVID-19. If it gets federal approval, the company said, it intends to distribute enough doses to immunize 15 million to 20 million people by the end of December.
In its latest vaccine distribution plan, the Baker administration expects to receive between 20,000 and 60,000 doses in the first batch. The state intends to prioritize workers who have “direct or indirect” exposure to COVID-19 patients or infectious materials in hospitals, nursing homes, and other health care settings. Next in line would be essential workers and people with underlying medical conditions at risk for severe COVID-19 illness, including those over 65.
The state’s blueprint doesn’t indicate priority vaccination for such hard-hit communities of color as Lawrence and Chelsea but pledges that the planning will be completed with a “social equity lens” to ensure those who are prioritized reflect the most vulnerable.
To get an idea of just how many health care workers are thought likely to be vulnerable because of exposure to COVID-19 on the job, consider Baystate Health in Springfield, the largest health care system in Western Massachusetts, with over 12,000 employees. Dr. Mark Keroack, Baystate’s president, estimates half of those workers are at risk.
“We have looked at direct care givers, people who lay hands on patients — the doctors and nurses,” Keroack said. “But it also involves people bringing in the food trays and cleaning the rooms. People who transport patients would be in that group as well.”
In early October, the Baker administration assembled the 17-member vaccine advisory group, composed of public health and medical experts, community leaders, and elected officials for guidance on communication, distribution, and equity issues. The administration acknowledged, in its recent vaccine report to federal regulators, the uphill climb it anticipates in persuading some immigrant, Black, and Latinx communities the vaccines will be safe.
Walker said she joined the group because, as a person of color, she feels a responsibility to learn as much she can about the vaccines and share it with her community.
“We can’t just say ‘I won’t do it’ without at least knowing what the real information is," she said. "We are living in a time with so many rumors and outright lies, and I am going to try my hardest to get at the facts and my way to do that is to be at the table.”
Kate Reilly, a spokeswoman for the state’s COVID-19 Command Center, declined to say whether the Baker administration will mandate that residents get a vaccine, as it did with flu shots this season for workers in nursing homes, assisted living centers, rest homes, and dialysis centers, where vaccination rates are historically low. The mandate seeks to head off a devastating “twindemic” of flu and COVID-19.
Dr. Asif Merchant, medical director at four nursing homes in the Metro West area and chief of geriatric medicine at Newton-Wellesley Hospital, said the flu shot mandate has significantly boosted vaccination rates. But it’s an open question whether that will translate to more buy-in for COVID-19 vaccines.
“I see a mix of staff members who want the [COVID-19] vaccine as soon as possible and some who say ‘what if it’s not safe and it could be dangerous,’" said Merchant, also a member of the governor’s advisory group.
Merchant said many nursing home workers have been devastated by the magnitude of death and disease they’ve witnessed in the pandemic and that may help sway acceptance of a vaccine.
“We need to amplify that to say this is for the greater good," he said. “But there will need to be a lot of education.”
A higher hurdle will likely be among the state’s homeless, who would not be prioritized in the first batch of vaccines under the state’s plan, although elderly homeless people who are at risk for severe complications from COVID-19 could be considered in the second phase. During the first peak of the pandemic, a third of homeless people in Boston were found to be infected.
Last flu season, about 3,500 homeless Boston residents, roughly half the city’s estimated homeless population, agreed to get the flu shot, said Dr. Denise De Las Nueces, medical director of Boston’s Health Care for the Homeless Program.
Gaining acceptance for the COVID-19 vaccine, she said, will be “unchartered territory.”
To better address gaping inequities surrounding the virus, the Baker administration recently launched a 62-question survey and asked community groups statewide to share it with residents. The survey inquires about race, ethnicity, education, income, and gender identity and asks where respondents seek “the most reliable and up-to-date” information about COVID-19 and whether they believe their community is receiving adequate support to prevent infections and bolster those who have lost work during the pandemic.
The state’s vaccine distribution plan indicates the Baker administration will rely on the dozens of community health centers across Massachusetts to help bridge the gap in trust with many neighborhoods.
Michael Curry, the incoming chief executive of the Massachusetts League of Community Health Centers, said YMCAs, churches, and local groups within its "community health ecosystem'' are banding together to hold listening and learning sessions about the vaccine.
Recognizing that each community is different and that doubts borne of discrimination run deep, they are asking at each stop whom residents trust as authority figures.
“Is it your bishop? Your minister? Your local Dr. Anthony Fauci? Curry said. “A lot of children educate parents in first-generation immigrant families. We should be educating those children on the vaccines.”
Dr. Dean Xerras, medical director of Massachusetts General Hospital’s Chelsea Healthcare Center, sees a ray of hope. Convincing residents, many of whom are immigrants uncomfortable with the health care system, to get flu shots each year is a struggle. But this year, he is seeing something different.
“I have had people say, ‘This is probably the only year I am going to get a flu shot,’” Xerras said. “I think people were so devastated by coronavirus, at least families I have talked to, that patients who have not gotten flu shots in the past are willing to get a coronavirus vaccine.”