After nine exhausting months at the front of the state’s battle against COVID-19, Massachusetts hospitals in coming days will take on a new and momentous challenge: rolling out the first doses of vaccines to health care workers, even as they contend with an increasing number of patients stricken by the illness.
Health care employees at high risk of contracting COVID-19 on the job will begin getting vaccines as soon as next week, according to a phased-in rollout plan detailed by Governor Charlie Baker Wednesday. As hospitals figure out which employees should get vaccinated first, they’ll face questions of logistics and fairness. No matter what they decide, there likely will not be enough of the vaccines to go around initially.
“No one can be completely prepared,” said Dr. Saul Weingart, chief medical officer at Tufts Medical Center, because there hasn’t been a global pandemic of this scope in a century. Weingart said he is drawing on knowledge gained from previous health crises, including the emergence of HIV/AIDS and the vaccination campaign amid the 2009 H1N1 pandemic. But those experiences, he said, don’t provide a working model for COVID-19.
State officials said they expect to receive an initial shipment of 60,000 doses of vaccine from the drug maker Pfizer on Dec. 15. Those supplies will go immediately to the state’s hospitals, starting with 21 that can properly store the vaccines. Tufts, like several other major medical centers in Massachusetts, said it could begin vaccinating workers as soon as the next day, Dec. 16.
By the end of the month, the state expects to have received a combined 300,000 doses from Pfizer and Cambridge-based Moderna, Baker said. Both vaccines require two shots administered several weeks apart. The governor said the initial order would all be used as first doses.
More than half of those doses — 164,000 — will go to clinical and nonclinical health workers who are involved in COVID-19 care.
The vaccines will allow hospitals to begin the process of protecting workers who have been on the front lines at a time when more beds are filling with COVID-19 patients.
Though hospitals are still waiting for precise details from the state about how many doses they will get, and when, they believe they’ll be able to quickly vaccinate the highest-risk employees.
“We have great confidence in our [protective equipment], in our care systems, in our plans, and compared to what we’ve been through, the next eight weeks or so really is very small in comparison,” said Dr. Paul D. Biddinger, medical director for emergency preparedness for the Mass General Brigham hospital system.
Biddinger, who is chairman of the advisory group convened by Baker to plan for the vaccine, said Mass General Brigham ― the state’s largest health care system ― is making plans to begin vaccinating about 20,000 employees in its first phase starting within a day of receiving doses.
The system hopes to next begin vaccinating nearly 30,000 additional people who are in clinically based roles but aren’t directly involved in COVID-19 treatment.
UMass Memorial Medical Center said it expects to provide doses to 500 people per day, and to have gotten both doses to its highest risk employees by early February. At Boston Medical Center, officials are preparing to give workers initial shots next week, and could administer between 2,500 and 5,000 by the end of the year.
At Tufts, Weingart said he believes about 2,500 staff members are eligible for the first wave of shots, which will take about two weeks to administer.
But even though health care workers who are at risk of exposure to COVID-19 are in the first group to get the vaccine in Massachusetts, it will fall to the hospital to determine which workers receive it first — and which will have to wait until more doses are available.
“If we have more people who want to be vaccinated than we have vaccine, how do you make people comfortable, knowing that we’ll get to them, and we’ll get to them soon?” Weingart said. “We understand their desire and want to address it, but at the same time, want to distribute it in an equitable way.”
Weingart said that even among employees who routinely interact with patients, some are at higher risk of contracting the virus than others. They include those who work in departments such as emergency rooms and care for high numbers of patients, those involved in procedures such as intubations, and those who have prolonged contact with patients and other staff members.
That population includes doctors, nurses, other medical staff, and workers who provide support services, such as custodial workers.
Tufts also wants to take into consideration employees who have medical conditions that may make them more susceptible to the virus.
And because the vaccine can produce side effects such as body aches, fever, and mild nausea that could cause some people to miss work, he said, the hospital may not want to vaccinate all members of a single unit at once.
In clinical trials for the Pfizer and the Moderna vaccines, however, most symptoms last only one or two days.
David Twitchell, chief pharmacy officer for Boston Medical Center, said that aside from concerns about supply and staffing, vaccination requires space that might otherwise be needed to treat patients.
“This high-priority group is all being vaccinated within weeks,” he said. “It is operationally how it would have to work anyway, so we’re trying not too much to emphasize who is going number 1 vs. number 2,000.”
Because the first vaccines would come with a special emergency use authorization from the US Food and Drug Administration, hospitals can’t make vaccination mandatory, but they will seek to inform employees about the rationale for accepting the shots.
Tim Foley, executive vice president of 1199SEIU, a union representing 70,000 front-line health care workers in Massachusetts, said in a statement that education will be a crucial part of the process.
“All workers should be given focused and culturally competent education/training on the available vaccines, and afforded a full and fair opportunity to make an informed decision about the vaccine,” Foley said. “All education must include a strong health equity component and racial justice lens, which addresses both related historical racial inequities and the known culturally-related gaps in the level of trust that people of color have in the COVID-19 vaccine.”
Dr. Yonatan Grad, an associate professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, said “vaccinating health care workers emphasizes the importance of supporting the health care infrastructure.”
”Sharing images of doctors, nurses, and other health care workers rolling up their sleeves . . . can also be a strong message to the community about the critical need to get vaccinated and inspire confidence in doing so,” he added.