Opening doors wider makes sense for speeding up COVID vaccinations, experts say

Arthur Alba received his vaccination shot from SPC Jose Estrada at East Boston Health Center's vaccination site on Thursday.Nancy Lane/Pool

The state’s move allowing younger people who accompany older residents to mass vaccination sites to also get shots drew mixed reactions from epidemiologists concerned with efficiency, equity, and protecting those at highest risk.

The plan could help speed up vaccinations, some said, a crucial goal in Massachusetts, where just under 11 percent of residents have received even their first vaccine dose. Experts also said the plan will help bolster protection of elders, the group most likely to die from COVID-19.

But the state’s vaccination plan — which has recently begun to move at a dramatically faster pace — is beset by problems beyond efficiency, many experts added. Opening the door to elder companions and no one else, they said, could leave some vulnerable groups behind, especially the state’s Black and Latino populations, who already face significant barriers to vaccine access despite being at elevated risk.

Opening the door for more people to be vaccinated is a good goal, epidemiologists agreed, but they said it still matters who is first in line.

“Even if this isn’t the best possible plan, the fact that we seem to be coming up with a plan for how to ensure that we don’t waste any of the vaccines and they get into people’s arms — this is a good step,” said Samuel Scarpino, a Northeastern University epidemiologist. “Doing something early is almost always better than waiting around until you have the best possible plan.”

The state has learned the hard way that delaying public health interventions can come at great cost, Scarpino said. Seventeen states, Washington, D.C., and several US territories are ahead of Massachusetts for the percentage of their populations to receive a first vaccine dose.

Scarpino said the plan to vaccinate elders’ companions could help protect elders themselves, as younger family members and caregivers are often their only source of potential exposure to COVID-19.

“But I would want to see an analysis from the state around how it is that this particular plan . . . is addressing equity,” he said. If data reveals that opening vaccination up to elder companions has left racial gaps in place or widened them, “at a minimum, [the state] needs another set of plans around vaccine distribution to decrease that inequity,” Scarpino said.

Vaccinating people ages 75 and older more quickly benefits everyone, not only their caretakers, said Dr. Sarah Fortune, a professor of immunology and infectious diseases at Harvard T.H. Chan School of Public Health.

“If you unpack this, it’s both rational and a step towards getting the population vaccinated,” she said.

Fortune and others said that protecting elders is an important goal on its own.

Since vaccination occurs in two doses, with each requiring two weeks to be effective, partially vaccinated elders could still contract COVID-19 if other members of their household are exposed. Offering the highest protection to vulnerable populations means extending that protection to the people they spend time with, Fortune said.

“I think it makes a huge amount of sense,” Fortune said. “They’re trying to protect households in which older people live.”

Opening the door to caregivers could be one way of boosting vaccine uptake and efficient distribution for elders, said Dr. Mary Bassett, director of the FXB Center for Health and Human Rights at Harvard University. But she said the policy’s effectiveness will depend on whether younger peoples’ willingness to take older relatives and neighbors to appointments is really the primary barrier elders are facing.

Limited appointments, unevenly distributed vaccination sites, the challenges of navigating all-digital scheduling platforms, and caregivers’ access to time off and transportation could also be at play, Bassett said, problems she said this policy does not address.

“I don’t think the notion of caretaker incentives should become a widespread idea of how to get vulnerable people vaccinated,” she said. “It should be having a vaccine that is accessible and having people convinced of its safety because they trust government.”

Vaccinating as many elders and their companions as possible is a distinct goal from reaching herd immunity, Bassett said. Just over 7 percent of Massachusetts’ population is 75 or older, while experts estimate that population-level protection will require at least 70 percent of people to be immune, either through prior infection or vaccination.

Several experts noted that people ages 75 and older are more likely to be white and higher-income that the state’s overall population, meaning tying younger people’s vaccine eligibility to that group is unlikely to correct inequities.

“Who can take time off to take their elderly neighbor to a vaccination? It’s not the essential worker, who probably doesn’t have much flexibility in their job. It’s the person working from home, who can afford to take a day off,” said Dr. Ashish Jha, dean of the Brown University School of Public Health.

But experts’ ultimate critique was not that the policy should be abandoned. Rather, they said, the state should consider ways of further widening access to vaccines, to include other vulnerable groups more quickly.

“Vaccinating all of the elders is not going to get us to herd immunity, even if [this policy] works,” Bassett said. “It begs the question, when are we going to start reducing transmission and making the vaccination available to essential workers?”

She added: “We have larger issues in our fragmented health center that are all coming to the fore. I just hope that some of these larger, systemic problems that have made the vaccine rollout slower than anybody wanted it to be also remain [in focus].”