Six weeks after the first COVID-19 vaccines were authorized for emergency use, Massachusetts — celebrated as a national health care leader — ranks in the bottom half of US states in getting injections into the arms of its residents.
Massachusetts trails every other New England state, as well as New York, in the number of vaccine doses administered per capita, according to federal figures. Less than 5.4 percent of Massachusetts residents had been inoculated as of Friday, compared to 8 percent of residents in Connecticut, over 10 percent in West Virginia, and 11 percent in Alaska.
A Globe review suggests that a combination of technical problems, unexpected rates of resistance by health workers to taking the vaccine, and policy choices — including a decision to start vaccinating nursing home workers and staff a week later than four other New England states — conspired to set Massachusetts back coming out of the gate.
And there are warning signs that the state could face more logistical obstacles as the vaccination campaign moves to much larger populations starting in February. Unlike some other states, Massachusetts has no central place where people can sign up for injections, confusing and frustrating a growing number of residents hoping to be immunized against the raging virus. By contrast, New Mexico launched a website in December that allows its residents to preregister for a vaccine and alerts them when an opening is available.
It’s clear that vaccinating 5.8 million adult residents in the midst of a crippling pandemic is one of the most challenging assignments that Massachusetts officials have ever faced. And the federal government has made the task harder with its lack of guidance and unpredictable allocations and shipments.
But every other state faces similar hurdles, and Massachusetts’ highly rated hospitals — accounting for two thirds of all doses thus far administered — have struggled to efficiently schedule shots and make sure no doses go unused. Only about 43 percent of doses shipped to Massachusetts have been administered, federal data show. Even at Mass General Brigham, the state’s largest hospital system, which has used 79 percent of its doses, nearly 13,500 doses were sitting on freezer shelves last week.
The slow start has alarmed many in the state who see immunization as key to ending the pandemic, fueling calls for the Baker administration to ramp up its vaccination program.
“If we don’t do something really quick, and fast, and soon, we will end up still having to provide doses at the end of this year,” warned Bill Walczak, a Boston community activist who founded the Codman Square Health Center and is a former president of Steward Carney Hospital in Dorchester.
State officials said their vaccine program is on track, noting that they set clear priorities for who goes first: front-line health workers who treat COVID-19 patients, and residents most vulnerable to coronavirus. In comparison, they said, other states have taken “a more open access approach,” that enables them to inject greater numbers but also leaves unvaccinated some who are at higher risk.
Governor Charlie Baker unveiled several steps last week to speed up injections, including plans to launch a second mass vaccination site at Fenway Park, slated to open Feb. 1, in addition to the one now operating at Gillette Stadium. The state also expanded its network of local injection sites to more than 150, and said CVS and Walgreens — pharmacies that run vaccine clinics at long-term care sites — eventually will stock vaccines at retail outlets for the general public.
“The Commonwealth will keep opening more sites in all regions of the state to make sure that everybody has access to a site that’s convenient to them,” Baker said Thursday.
His complex three-phase vaccination plan, developed with health leaders, does not lay out specific targets for the number of vaccine doses to be administered in January and coming months. State officials say that hinges on factors outside their control, such as federal orders for shipments, but the lack of specific goals makes measuring the program’s progress difficult.
Baker is hoping federal cooperation will improve under the new Biden administration. President Biden signed several executive actions Thursday to launch his COVID-19 strategy, promising “immediate steps” to partner with governors to streamline the vaccine rollout. Among other things, the Federal Emergency Management Agency will designate a point person to work with every state and will open up to 100 federally run mass vaccination sites.
But some logistics experts say Massachusetts officials need to change as well, by showing more willingness to set clear vaccination goals, being more flexible, embracing best practices from elsewhere, and acting with more urgency.
“You can be building the perfect system and prioritizing the high-risk people but not saying, ‘How can we move faster?’ ” said Retsef Levi, a professor at the Massachusetts Institute of Technology’s Sloan School of Management.
The rollout in Massachusetts fell behind from the start. Other states, including Vermont, New Hampshire, Maine, and Connecticut began vaccinating nursing home residents and staff a week before Massachusetts started on Dec. 28. Since then, both of the required rounds of doses have been given at nursing homes in other New England states. In Massachusetts, which has one of the nation’s highest virus death rates in long-term care, most nursing homes have just completed their first round.
Christine Finley, immunization program director at Vermont’s Department of Health, said states choosing to start Dec. 21, the earliest authorized date, had to commit to channeling a substantial share of their first vaccine allotment to long-term care sites. “Our state’s priority has been vaccinating people in long-term care and other at-risk older adults,” she said.
New Hampshire, similarly, raced to activate its nursing home vaccine program “as soon as it was ready to go,” said Jack Leon, spokesman for the state’s Department of Health and Human Services. “Because long-term care facilities in New Hampshire have been disproportionately impacted by the pandemic, making vaccines accessible to residents and staff as quickly as possible was our highest priority,” he said.
In Massachusetts, the first shipment of vaccines went to front-line health workers at hospitals who were grappling with a second surge of COVID-19 patients. Protecting hospital staff was the Baker administration’s top goal, just as it was during the first surge last spring, when hospitals got more tests and protective equipment despite hundreds of outbreaks — and thousands of deaths — in long-term care sites.
Further slowing vaccination efforts, staff at long-term care centers were sometimes hesitant to be vaccinated. Operators say between 40 and 70 percent of their staffers were injected in the first series of vaccination clinics, compared to 85 percent or more of residents. Resistance is highest among immigrants from Haiti, Russia, and other countries, including some young women rattled by unfounded Internet rumors that vaccines will make them infertile, administrators say.
“I’ve been in the buildings on weekends trying to get my staff to take the shots,” said Frank Romano, chief executive of Essex Group Management, which owns six nursing homes and two assisted-living residences in Massachusetts. “But they see all the misinformation on these crazy [Internet] sites.”
Vaccine hesitancy isn’t just a nursing home problem. Interviews with hospital leaders indicate a number of their workers are at least initially declining shots, prompting intensive, time-consuming education sessions aimed at overcoming hesitancy. Although no statewide data is available, Mass General Brigham estimates about 20 to 25 percent of its workers have so far declined.
“We would love for all to get it, but it’s not mandatory,” said Dr. Paul Biddinger,medical director for emergency preparedness at Mass General Brigham. “For those who are hesitant, we have a set of initiatives to address their hesitancy, to see if we can answer their questions.”
One sign that the Baker administration is trying to speed the process came in an e-mail to hospitals Wednesday immediately granting them permission to vaccinate all their workers, including those working remotely or in back offices. It also said hospitals could use existing vaccines on “selected high-risk patients.”
Across the country, states are encountering a slower-than-expected rollout in hospitals, said Claire Hannan, executive director of the Association of Immunization Managers, a national trade group that works on vaccination issues.
“We really thought the way to go was to distribute it in hospitals, because they can handle ultra-cold storage of vaccines,” Hannan said. “But we’re seeing it’s not getting into arms as fast as possible, and now states are adjusting with a move toward more large-scale vaccination sites.”
But, as Massachusetts moves toward large-scale public vaccinations, local officials face a pressing technical challenge of their own: updating the antiquated and often paper-based method that local health departments have long used for transmitting data for flu vaccinations and other critical health data to the state.
The Baker administration purchased a software system designed to modernize and streamline the process for hundreds of communities. Local health directors say they were repeatedly told it would be in place last fall so they could use it in their annual flu vaccination clinics as a dress rehearsal for upcoming COVID vaccinations.
“It was frustrating because we were told, ‘It is coming, it is coming,’ but it didn’t come,” said Ruth Mori, a nurse in Wayland’s health department and president of the Massachusetts Association of Public Health Nurses.
The software for local health departments was finally provided in early January, just days before they had to launch their vaccination clinics for first responders.
Mori and other health directors say the system, called PrepMod, has made a significant difference in speeding up the process of recording vaccinations and transmitting the data to the state. But local officials say they must still file paper reports to the state each time they move vaccines from one site to another.
The paperwork is time consuming, and it may also lead to delays in tracking the total number of vaccinations. In February, when the state plans to significantly expand who is eligible for a vaccine, experts agree that a finely tuned local vaccination network will be crucial.
Now, with little more than a week before Massachusetts residents 75 or older become eligible for the vaccine, the state has an even more basic gap: providing information to the tens of thousands of people now clamoring for news about when and where they will be vaccinated. So far, they’ve received little definitive information from the state. That has led to residents barraging their local health departments and doctors offices with calls, even though the departments and physicians say they, too, are in the dark about many details.
“Each call is a conversation because each person wants to go over their individual situation,” said Sigalle Reiss, president of the Massachusetts Health Officers Association and Norwood’s health director.
She said state health administrators have advised local health departments to direct residents to the state’s website, but that site doesn’t allow registration for a vaccine if a person is not yet eligible. It directs them to seek information from their doctors or local health departments.
“That’s not a great answer,” Reiss said.
Hannan, of the Association of Immunization Managers, said many states are struggling with a similar communications issue.
A number of states that are doing well have a preregistration system that matches supply with demand, she said. New Mexico, Oklahoma, and Indiana are among states that have some sort of central preregistration system and are in the top third nationally for administering more doses per population. New Mexico’s system, however, recently hit a snag when it reportedly allowed some residents to enroll before they were eligible.
For Bruce Hauben and Joyce Brinton, both 79, a retired couple living in Littleton and hoping for the vaccine in the coming weeks, a simple registration interface can’t come soon enough. Hauben said he recently asked his doctor, who had no information on when and where patients could get COVID-19 shots. He has also fiddled with the state’s website, which links to a raft of local sites with “a lot of shortcomings and things they should tell you that they don’t,” he said.
“It leaves us up in the air,” Hauben said. “We need a central website page that, regardless of where you live in the state, will let you make your timed reservation.”
Robert Weisman can be reached at email@example.com. Follow him on Twitter @GlobeRobW. Kay Lazar can be reached at firstname.lastname@example.org Follow her on Twitter @GlobeKayLazar.