Governor Charlie Baker outlined a plan on Monday to add more than 60 injection sites across the state, including three new mass vaccination locations, while moving residents age 65 and over forward in line for the next phase of COVID-19 shots.
The steps came as state officials acknowledged that while large clusters of Massachusetts residents who are not yet eligible are clamoring for vaccines, hundreds of thousands of doses are sitting on freezer shelves in hospitals and the warehouses of pharmacies serving senior care sites.
State officials disclosed Monday they have temporarily halted vaccine shipments earmarked for nursing homes and other long-term-care sites because so many are unused, and this week withheld allocations to hospitals for the same reason.
At the same time, a state public health official warned Massachusetts cities and towns that their vaccine shipments would be “capped going forward through February” because the US government is not making enough doses available.
The blizzard of activity — on a day when 45 more Massachusetts residents died from COVID-19, bringing the total death toll to 13,889 — suggested the Baker administration was struggling to match the anticipated vaccine supply with demand.
“We can only move as fast as the federal government shifts vaccines to the Commonwealth,” the governor said at a State House press briefing. “Our goal remains the same: to provide our health care system with the support that they need to protect our most vulnerable residents and to ensure an equitable distribution of the vaccine to all residents.”
Baker’s moves to expand capacity while simultaneously warning that vaccine doses could be cut underscored the complexity of managing a program to immunize more than 4 million adults in the state. The governor has faced growing complaints about the slow pace and rigid priorities of the Massachusetts vaccination program. He is also reacting to a federal recommendation, endorsed by the new Biden administration, to give higher priority to seniors, a population at higher risk of serious illness and death from COVID-19.
The logistics for a mass coronavirus vaccination effort are daunting, said Dr. Howard Koh, a former Massachusetts commissioner of public health and a former assistant secretary for health in the Obama administration.
“In usual times with flu vaccination, these challenges are invisible, but in the harsh light of a pandemic now we see how extraordinarily complicated it is to ensure a seamless vaccination system,” said Koh.
Facing uncertainty over the supply of vaccines for the next two months, Baker said state officials are “overbuilding” the infrastructure needed to deliver injections to people who will become eligible starting Feb. 1, including people 75 and older.
Massachusetts will have 103 sites open this week, state officials said, with a capacity to give 240,000 doses weekly. But officials expect to receive 173,175 doses in this week’s allotment from the feds. Both of the vaccines currently authorized for emergency use are based on two-dose regimens, requiring residents who are given their first shot to return for a second shot a few weeks later.
By mid-February, state officials said, the administration expects to have 165 injection sites across the state, with the capacity to administer 305,000 doses per week, though the vaccine supply is expected to be significantly fewer.
The new mass vaccination sites announced Monday will be at the Eastfield Mall in Springfield, opening Friday; the Double Tree Hilton Hotel in Danvers, opening Feb. 3; and, the Reggie Lewis Center in Boston, opening at an unspecified date in the first week of February. The state already is operating a mass vaccination site at Gillette Stadium in Foxborough and is preparing to open a second at Fenway Park next Monday. State officials plan to open at least two other mass vaccination sites in coming weeks.
They’ll also open scores of smaller locations, including some specifically for residents in those communities and 44 opening this week at pharmacy and retail locations such as Big Y, Wegmans, Price Chopper, Retail Business Services at Hannaford, Stop & Shop Pharmacies, and CVS Health. The sites are listed on a website, mass.gov/COVIDVaccineMap, with details at each location on when residents are eligible for injections and how they can book appointments.
As the state plans to transition to Phase Two of its vaccination plan next week, Baker said residents age 75 and over will be the top priority group, starting Feb. 1. But in a change from the state’s previous plan, residents 65 and over, along with those with two chronic health conditions, known as comorbidities, will be in the second priority group, eligible to get shots later in February. The start date will hinge on vaccine shipments and the demand for appointments.
After the seniors and those with multiple comorbidities, shots will be available to essential workers such as early education and K-12 teachers, transit, utility, and food and agriculture employees, and sanitation, public works, and public health workers, and residents with one chronic health condition.
COVID-19 vaccinations will be available to the general public in Phase Three, scheduled to start in April. In Phases Two and Three, state officials have committed to setting aside 20 percent of doses at mass vaccination and community sites for low-income neighborhoods and at-risk communities, such as Roxbury, Dorchester, Mattapan, Chelsea, and Revere, that have been disproportionately hit by COVID-19.
But as Massachusetts prepares to move to the second phase of its vaccine rollout, officials confirmed Monday that more than half of the doses already shipped for front-line health workers, congregate care residents and staff, and first responders haven’t yet been used. They said many in those groups, at hospitals, nursing homes, prisons, and other sites, thus far have refused shots.
As of Sunday, they said, 876,125 doses were shipped to hospitals and other providers in Massachusetts, along with the pharmacies that vaccinate at long-term-care facilities, but only 448,892 doses had been administered. An unknown portion of those doses are set to be injected during appointments in the coming week.
Marylou Sudders, the state’s secretary of health and human services, said officials are actively monitoring allocations and inventory at hospitals and long-term-care sites and redirecting vaccine shipments accordingly.
“Last week, we made it crystal clear that [hospitals] have 10 days from the receipt of the vaccine to administration,” Sudders told reporters Monday. “This week hospital systems did not receive additional vaccine inventory. They need to utilize what they have in hand. And if we must, we will redistribute these fragile vaccines to other providers.”
She also said state officials had halted shipments to senior care sites, through a federal pharmacy partnership program, until they use what they’ve already received. As of Jan. 19, they’d received 300,000 doses but only administered 80,000.
“These programs have been much slower to ramp than initially anticipated,” Sudders said.
Meanwhile, local health departments received a letter from the state Sunday saying their vaccine doses would be limited through February because the federal government isn’t making enough doses available. Many were capped at 100 doses per week, even if they administered far more.
The departments have been vaccinating first responders, such as police and firefighters, residents in congregate care settings, workers in private health practices, and others.
Sudders said that vaccine orders from providers across the state were far exceeding supply. That, combined with limited doses from the federal government, has prompted Massachusetts to scrutinize whether each site was using all of the doses supplied.
Claude Jacob, the Cambridge chief public health officer, said the cutbacks mean it may take longer to vaccinate people.
“Delays are not denials,” he said. “But we will have to message this differently [to the public] to better manage expectations.”
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. Travis Andersen can be reached at email@example.com. Follow him on Twitter @TAGlobe. Matt Stout can be reached at firstname.lastname@example.org. Follow him on Twitter @mattpstout.