State’s deliberate approach on vaccines frustrates some seniors

Senior residents at The Palace assisted-living facility in Coral Gables in Florida awaited inoculations with the Pfizer-BioNTech COVID-19 vaccine.Lynne Sladky/Associated Press

When Florida opened the floodgates to vaccinate anyone 65 and older against COVID-19, chaos and confusion followed.

In some parts of the Sunshine State, older Floridians camped out overnight to secure their spots in line. A few counties turned to EventBrite, an online ticketing platform better known for coordinating book readings and comedy shows, to schedule appointments. Slots were filled in minutes, leaving tens of thousands unsure when or where they’d receive the precious shot.

Massachusetts has tried to avoid the Florida-style free-for-all with a deliberate three-phased approach to vaccinating its population, but there is growing consternation that the Commonwealth is not moving quickly enough to inoculate older residents who remain especially vulnerable to the virus. The limited supply of doses and complex logistics have constrained officials’ ability to widen the pool of residents eligible for immunizations.

“We wanted to prioritize the sickest, the most vulnerable people, which are seniors. But we also were very cognizant about the supply and the logistics of it,” said Dr. Asif Merchant, a geriatrician at Newton-Wellesley Hospital and member of the committee advising Governor Charlie Baker on vaccine distribution. “It’s easy to say, ‘Let’s vaccinate everybody over 65,′ but when you put it out there, it creates a little bit of panic.”

Regardless, sometime in February, Massachusetts health officials will launch Phase Two, the most complex phase yet of their distribution plan. Eligibility will expand to every state resident age 75 or older, a cohort of some 450,000 people.

The first vaccinations were administered in mid-December, starting with front-line health care workers and residents and staff of long-term-care facilities. Eligibility here has since widened to include first responders and residents and staff of congregate care settings, such as prisons and homeless shelters. Phase One, which ends with home health workers and other health care providers who are not treating COVID-19 patients, is expected to overlap with the beginning of Phase Two.

According to the most recently available data, approximately 540,000 doses of COVID-19 vaccines have been shipped to providers in Massachusetts, and roughly 279,000 shots had been administered.

On Jan. 12, in an effort to accelerate the sluggish pace of inoculations around the country, the Trump administration called on states to immediately start vaccinating all Americans as young as 65. But in states that have already expanded eligibility to residents age 65 and older, or included older adults from the start, demand for the vaccines has far outpaced supply.

New York City, for example, which opened eligibility to seniors 65 and older Jan. 12, is on track to run out of doses by the end of the week, forcing some hospitals to cancel or suspend vaccination appointments. To keep up with surging demand, the governors of several states, including Michigan, Wisconsin, and Minnesota, have asked for permission from the federal government to buy COVID-19 vaccines directly from manufacturers, while Governor Andrew Cuomo of New York has appealed to the CEO of Pfizer to purchase more doses.

Adding to governors’ frustration was outgoing Health and Human Services Secretary Alex Azar’s pledge last week to release all of the vaccine doses held in reserve for second shots by the federal government. No such stockpile, however, existed.

“The bottom line is the reason [states are prioritizing groups for vaccinations] is because of limited supply — not because the state wants to have to say, ‘You go first. You go second,’” said Jen Kates, senior vice president and director of global health and HIV policy at the Kaiser Family Foundation, a nonprofit organization focused on national health. “I don’t think any state wants to be in that situation, but there’s not really an alternative now.”

Merchant said he understands the anxiety from seniors desperate for vaccinations. But, he said, supply of the vaccines is limited and the logistics of vaccinating larger pools of people become more difficult and complex, requiring access to cold storage, more vaccinators, and supplies to administer the shots. The group advising the Commonwealth on vaccine distribution is also trying to ensure there is equitable access to the doses, Merchant said.

“People of color have to have equal access, and when you get over 65, it’s mostly a white population that you’re serving,” he said. “And then you may miss out on other minorities who have chronic medical conditions.”

To inoculate more people faster, Massachusetts already has launched one mass vaccination site at Gillette Stadium and announced Tuesday that it will open another at Fenway Park on Feb. 1 for eligible residents in the Phase One priority groups. Officials also announced vaccines will be offered to eligible groups at one of at least 15 CVS and Walgreens locations, starting this week.

Dr. Daniel Teres, 80, a clinical instructor at Tufts University School of Medicine who lives part of the year in Florida, was vaccinated recently in West Palm Beach. Securing an appointment at his local health department was an exercise in patience.

“We had called about 100 times to the Department of Public Health in Palm Beach, and we finally got through,” Teres said. “A woman took our name, address, telephone, and said, ‘We will get back to you in a week.’ We didn’t believe her. So we called Okeechobee, Vero Beach and Fort Lauderdale.”

But the employee at the Department of Public Health did call back, and Teres and his wife were able to set up an appointment to get vaccinated a week later. Despite the hassle, Teres credited Florida Governor Ron DeSantis for “giving a sprinkling of vaccines” to pharmacies and public health departments so seniors have access to the shots.

“It’s a totally different approach,” he said, adding that it’s “a disgrace” that vaccines haven’t been offered yet to the elderly residents in Massachusetts.

Kates, of the Kaiser Family Foundation, said that in addition to large-scale vaccination sites, states should create an easy and centralized method for registering for vaccinations to aid in their rollout and minimize confusion. But according to the state-run website detailing the vaccination distribution timeline, the Massachusetts Department of Public Health “does not maintain a central sign-up or scheduling system for the vaccine.”

A spokesperson for the COVID-19 Command Center did not respond to questions Tuesday about plans for vaccinating Phase Two residents.

“Everybody is understandably feeling either confused or not thrilled that we’re in this situation and having to wait,” Kates said. “But I think it really is mainly a function of the limited supply.”

Asked at a press conference Jan. 13 about other states that have already begun vaccinating seniors, Baker defended his administration’s priorities.

“I really hope that early on we are able, with the vaccine that’s available, to hit the populations for whom life is most at risk and for whom the health care system relies on and depends on to provide care,” he said.

In some other states, Baker added, “people who are the same age as my kids have got vaccinated before people who are home health workers or health care workers or long-term-care workers or long-term-care residents . . . or people who have multiple co-morbidities and are over the age of 70. Honestly, I just don’t think that’s the way we should do this.”