Stung by criticism it was moving too slowly, the Baker administration has overhauled its approach to delivering COVID-19 vaccines in just three weeks, increasingly relying on a network of massive facilities equipped to give more shots quickly as it expands the pool of eligible residents.
The rise of mass vaccination sites such as Boston’s Fenway Park and Gillette Stadium in Foxborough has helped to rapidly boost the state’s standing in national vaccine distribution. Its ranking shot up to 17th in per capita doses administered, according to the latest federal data. As recently as Feb. 1, Massachusetts ranked 34th among states.
With growing capacity to give shots assembly-line style, emboldened state officials doubled the number of residents who qualify for a vaccine literally overnight last week, adding almost 1 million aged 65 to 74, living in low-income senior housing, or suffering from two or more medical conditions.
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“The big message we got from the public was, ‘Vaccinate. Vaccinate,’” explained Governor Charlie Baker at a State House briefing on Wednesday. “And there’s no question the fastest way to do this is with high-volume sites.”
But the dramatic crash of the state vaccination website the very next day — freezing out tens of thousands of people — underscored the potential hazards of the more aggressive strategy. Ramping up the program quickly caused not only technology nightmares, but also long lines at high volume sites in Danvers and Springfield. It’s also raised questions, not addressed by the state, about whether these so-called Mass Vax sites attract mostly wealthier white residents at the expense of the Baker administration’s stated goal to give people of color and other marginalized communities high priority.
Adding to the risk, state officials are raising public expectations by making many more people eligible while the vaccines remain in short supply. Last week, the federal government had promised a 28 percent increase in the state’s weekly allotment. But the first larger shipment was delayed by snowstorms, fueling worries about canceled appointments, before it ultimately arrived Friday.
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Baker has warned it may take more than a month to schedule all the residents who now qualify for the vaccine and want shots unless the supply grows considerably.
Public health advocates are concerned about another risk in the shift to mass vaccination sites: people who could be left out. As the state embraces large-scale operations, it has pared the number of doses sent to local doctors and health agencies funded and trained to give vaccines in their communities. Advocates fear homebound residents and other overlooked groups may not get their shots at all.
The focus for reaching such groups — a stated priority of the Baker administration — should be “putting things in places people can access, putting people in places they are familiar with and trust,” said Dr. Atyia Martin of the Black Boston COVID-19 Coalition.
Despite these concerns, the pivot to high-volume sites — still in its early stages — has helped propel improvements in the state’s vaccine performance by several measures.
For instance, the state is doing a vastly better job at using the vaccine doses once the federal government ships them. On Jan. 22, the state had used only 43 percent of the doses shipped, one of the lowest rates in the nation, according to the Centers for Disease Control and Prevention. That percentage topped 83 percent on Friday, the CDC data showed.
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In the same one-month period, vaccine doses injected per 100,000 residents more than tripled from 5.4 percent to 19 percent in Massachusetts. And, reflecting the stepped-up pace, the state now ranks 10th nationally in residents per capita who were given the first of the two-dose vaccine regimens required to gain full immunity.
That pace is expected to quicken in the coming days. New sites open Monday in the Natick Mall and Wednesday at a former Circuit City in Dartmouth, and operations will expand this week at the Reggie Lewis Center in Roxbury.
While hospitals and pharmacy companies still lead the pack in the cumulative number of shots given, the number administered at mass vaccination sites is growing faster — and has surged more than 13-fold since the end of January.
But the ramp-up has just begun. Vaccinators were scheduled to give about 3,900 shots daily at Gillette and 1,000 at Fenway last week. Each site hopes to be giving 5,000 a day by early spring as eligibility is opened, first to essential workers such as teachers and grocery clerks and then to the wider public.
A tipping point in the state’s effort to channel more people to mass vaccination sites may have come Feb. 11 when Baker unveiled a program that let younger people who accompany residents over 75 to those sites get shots themselves. The companion program was only approved for the larger sites, giving people a new incentive to go there.
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However, state officials say they’re still committed to an early goal: ensuring equitable access to the vaccine, especially in 20 communities with large Black and Latino populations that have been especially hit by the virus.
Although the state is halting vaccine shipments to most municipalities, it still plans to provide doses to high-risk communities including Boston, Worcester, Springfield, Brockton, Chelsea, and Lawrence. And it’s pledged to work with them on outreach to hesitant or hard-to-reach residents.
But critics worry the state’s new approach could still leave people behind, including those who live far from big sites. Secretary of State William Galvin, who proposed using local voting stations for injections, was one of the early voices favoring a decentralized approach.
And, many towns would prefer their health departments do the job.
“We can run clinics efficiently and safely, and in a community that our residents know and with people they trust,” Amesbury Mayor Kassandra Gove wrote in an angry letter to Baker and his administration on Thursday.
Massachusetts has had a much more complex vaccine schedule than many other states, something Baker described as a “very equitably framed process.” It started with a targeted approach at the outset of the vaccine effort in December, focusing especially on front-line health workers and long-term care residents before expanding to first responders and then residents over age 75.
But in the ensuing weeks, Baker was roundly criticized for overseeing a vaccine rollout that was both slow and complicated to navigate.
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Now, with more of the population eligible for vaccines, supply chain experts say it may be more important to accelerate the pace by delivering injections at greater scale.
A centralized approach, especially in densely populated areas, “makes good sense,” even if some residents can’t get shots right away, said John Carrier, a systems dynamics specialist at MIT’s Sloan School of Management. “To get to herd immunity, an unfair system that moves quicker may be more fair than a fair system that’s six months late.”
The logistics of administering the authorized vaccines from Pfizer-BioNTech and Moderna, which are packed together in bulk shipments and require cold storage, also work best on a large scale. So Baker, a data-driven former health insurance executive, has turned to outside efficiency experts.
Tim Rowe, the well-connected cofounder of CIC Health, which operates the high-profile Fenway and Gillette sites, previously built a global network of incubators for technology startups and, before the pandemic, organized about 2,000 business gatherings a year drawing 200,000 attendees from Cambridge to Philadelphia to Warsaw, Poland.
“We view ourselves as logisticians,” Rowe said in an interview. “For us, people and space and events and planning and scheduling, all of that, that’s what we do.”
To achieve maximum speed and productivity, CIC Health has organized efficient flow lanes in and out of the stadiums, installed banks of freezers with cold storage capabilities for vaccines, and set up rows of safely distanced injection stations, steps that are more difficult in smaller sites.
Perhaps most important, CIC Health is using all the vaccine it gets right away rather than holding some in reserve to give people their second doses a few weeks later. That’s a striking contrast with the hospitals and pharmacy companies that gave most of the shots in the early going while stockpiling hundreds of thousands of doses to guarantee each person could get a second shot.
The game plan at CIC Health clearly gets more shots into arms, but depends on a consistent supply from the federal government. Any disruption threatens to delay or defer entirely the second dose for those residents.
At the community level, the rapid change in the state’s vaccination approach is causing some whiplash. As state officials announced they were cutting off first doses to most small-scale community operations last Wednesday, they said they will continue to deploy vaccines to other locations beyond the mass vaccine sites.
State officials added that plans will evolve as the vaccine supply grows. The 20 vulnerable communities could eventually become the sites of “targeted” initiatives such as mobile and pop-up clinics, Kate Reilly, a spokeswoman for the state’s COVID Command Center, said Friday.
The Baker administration has also pointed to a growing network of retail and pharmacy locations where people can be vaccinated closer to home.
Additionally, the state has told municipalities they can still receive vaccine supplies if they band together to form their own high-capacity sites. These so-called “regional collaboratives” must be open to the entire state and capable of vaccinating high numbers of people each day.
Such operations are already running in several areas, including in the Berkshires, Plymouth County, and on Cape Cod.
But the collaborative model has so far not satisfied critics.
On Cape Cod, state Senator Julian Cyr would prefer the state operate a mass system on the peninsula. The main vaccination site currently run by Barnstable County needs more doses to immunize the Cape’s large older population, he said. Otherwise, too many are forced to travel far from home for appointments.
For now, he said, “We are operating under the assumption that we won’t get any meaningful support from the state for large-scale vaccination, so we’re going to do it ourselves.”
Community health centers, which serve primarily low-income people, immigrants, and people of color, are also running vaccination clinics, and officials there say they are still receiving adequate supplies.
But the frequent changes in distribution, often announced just before taking effect, reflect a frenzied and unclear vaccination process, said Carlene Pavlos, executive director of the Massachusetts Public Health Association and co-chair of the Vaccine Equity Now! coalition.
“The administration’s attempts to improve the vaccine rollout have been episodic and seemed rather like a fire drill,” she said. “A fire erupts, and the administration pours all of their efforts toward the particular fire, and meanwhile the smoldering embers in other parts of the vaccine response erupt.”
Robert Weisman can be reached at robert.weisman@globe.com.