Local health directors say lax communication and a chronic disconnect with the state’s pandemic response unit fueled a chaotic run-up to this week’s vaccinations of first responders in Massachusetts.
A months-long, behind-the-scenes struggle between local public health leaders, who are operating many of the vaccination sites, and the state’s COVID command center has come to a head in recent weeks, according to six local health directors and the director of a state coalition of public health groups.
After an eleventh-hour request from the state for help in vaccinating first responders, many local departments scrambled to secure medicine that would counter potential allergic reactions and to find adequate protective gear and staff to administer the shots. Others crammed to learn a new software system that uploads vaccination information to a state database.
“The rollout from the governor’s office and the command center has been very poor,” said Dr. Swannie Jett, Brookline’s director of health and human services. “It’s very last minute.”
The state is leaning on local health departments to help administer vaccines widely in their communities. All sides agree that an unprecedented, fast-moving, and massive vaccine rollout is not easy. But local health leaders say they’re increasingly concerned, and because of poor communication from the state, unable to answer a flood of vaccine questions from anxious residents.
Massachusetts remained behind all other New England states in per-capita vaccinations Wednesday, federal data show. Part of the problem, local health leaders say, may be tied to the state’s uniquely fractured public health system, which is largely administered at the local level, rather than a more cohesive regional or county approach.
The state’s COVID-19 Command Center said in a statement that it has kept local health leaders in the loop through webinars and conference calls up to four times a week, as well as daily e-mails.
“It has been, and continues to be, a priority of the Command Center to have an ongoing relationship with local health departments, especially as we continue to ramp up the Commonwealth’s COVID-19 vaccine distribution plan,” the center said.
The center, created by Governor Charlie Baker in March, includes representatives from key state agencies, including transportation, education, emergency management, and public safety. It’s designed to develop, coordinate, and monitor the state’s response to the pandemic, from quarantine policies to testing and vaccine capacity.
The state’s vast vaccine initiative has dozens of moving parts and features three main phases for administering the shots. It first administered vaccines in December to health care workers and is expected to stretch into the summer for the general public. Shots for police, fire, and other responders started this week.
The command center first asked local health departments in mid-December if they were interested in helping with first responder vaccinations, according to e-mails shared with the Globe. If so, local officials were told, they would need to have everything in place by Jan. 4.
The notice prompted local agencies to sprint to prepare for vaccine deployment, a weighty addition to their current pandemic initiatives, which include contact tracing as well as routine business inspections and other duties.
“We are happy to vaccinate our first responders who are on the streets everyday,” said Sharon Cameron, Peabody’s director of public health. “Many of us recognized vaccinations would be ultimately at our doorstep [later in the rollout], but it was more frustration that the last-minute [notice] caused us to scramble.”
Tensions about communication gaps during the pandemic have been brewing for months. A coalition of public health groups — representing more than a thousand nurses, health directors, inspectors, and local health boards — sent a letter on Dec. 1 urging the command center to include local health representatives in the state’s overall pandemic planning, including vaccinations.
“We are the experts on local public health and on our communities, and we are the boots on the ground who work each day to implement command center policies,” the letter said. “At the same time, we frequently learn of new orders, guidance, and rules at the same time they are announced to the public at large, and occasionally after they have gone into effect.”
The letter highlighted two instances in which a lack of communication led to widespread confusion in communities. In one instance, the center abruptly changed how it measured the number of COVID-19 infections, which determines color-coded risk levels in communities and affects business closures and more.
The change “directly contradicted” decisions about business closures and other guidance to residents many public health departments had issued earlier that same day, the letter said. “We were forced to reverse our own orders with little to no understanding of why and with scant rationale to provide to local businesses and residents.”
Shortly after, the command center relaxed quarantine rules, again with no notice to local health departments.
“Public health nurses were on the phone ordering residents into quarantine and explaining its terms at the very same moment the Governor was on television contradicting the information,” the letter noted.
The coalition said it has yet to receive a response from the state.
State lawmakers recently approved about $10 million more for local public health departments but nixed legislation that would have created a more regionalized public health structure as well as a uniform data collection and reporting system. The Coalition for Local Public Health, which includes local health departments, strongly advocated in favor of the proposal.
The pandemic made it “more brutally clear that we didn’t have the foundation we needed in local public health to meet this crisis as effectively as we could,” said Senator Jo Comerford, a Democrat who represents Franklin, Hampshire, and Worcester county communities and a cosponsor of the legislation.
“These folks are there on the front lines keeping us well,” she said. “But local public health is invisible, until it’s not.”
Claude Jacob, Cambridge’s chief public health officer, said the pandemic has presented a powerful opportunity for local and state health leaders to apply lessons learned about the need to improve communication and to adopt a more regional approach to help smooth out inequities in public health across communities.
”The fatigue, the wear and tear is palpable, which is why we want to make it easier on the ground,” Jacob said. “There can’t be this disconnect.”