The state’s vaccination rollout has improved, but the full picture is more complex

Yury/stock.adobe.com

Nearly a quarter of all Massachusetts residents have received at least one dose of the COVID-19 vaccine, an encouraging statistic that shows a marked improvement in the state’s vaccination effort compared to early January, when Massachusetts lagged in the middle of the pack nationwide on most measures of the rollout.

In the twelve weeks since vials of the vaccine first arrived in Massachusetts, the state has, by some metrics, improved its ability to distribute available vaccine supplies swiftly and efficiently. It now ranks 10th nationally (including the District of Columbia and Puerto Rico) in total doses administered per capita, and sixth in the percentage of supply used, a metric that demonstrates efficiency and minimal waste.

Those measures, however, fail to capture the broader picture of the state’s rollout. That includes the snafus that for weeks prevented all but the most tech-savvy and persistent of eligible residents from getting appointments, and the vast inequities in terms of who has gotten the vaccine, especially when it comes to communities of color across the state.

The Globe sifted through the latest data to find out how the state rollout has improved and what aspects still need work. Here’s what we found:

As of March 2, the Commonwealth ranked 10th among all states, as well as Washington, D.C. and Puerto Rico, in total doses administered per 100,000 residents, at 33,571, according to the Centers for Disease Control and Prevention. The state currently ranks second in New England behind Connecticut, which has 35,694 doses per 100,000. But Massachusetts is now number one among states with populations over 6 million. In the first week of January, Massachusetts had given just 2,197 doses per 100,000 people and ranked dead last in New England, a surprising showing for a state lauded as a health care nexus and the birthplace of the Moderna vaccine.

By this metric, the vaccination efforts in more rural, less populous states like South Dakota and West Virginia have ranked among the best in the nation since the vaccines first became available.

Massachusetts appears to be making the most out of its limited federal vaccine supply. With 83.09 percent of total doses used, the state ranks sixth in the nation behind New Mexico (87 percent), Wisconsin (85.14 percent), North Dakota (84.36 percent), Virginia (84.18 percent), and New Jersey (83.32 percent) in the percentage of available vaccines administered, according to the CDC. This suggests that vials are not sitting idle in freezers while residents scramble to snag appointments. By comparison, Georgia and Puerto Rico — which rank last by this metric — have administered just 63.3 percent and 49.04 percent of their total supply, respectively, leaving some 2.1 million doses unused at a crucial time in the vaccination timeline, according to the CDC.

This is another metric that has improved steadily in Massachusetts since the beginning of the rollout, not surprisingly since vaccinators were still finding their footing in December and January when the state was only using 24 percent to 68 percent of its supply. But as supply has risen, so has the state’s capacity to distribute the vaccine more efficiently. Inevitably, there will always be a cushion between the number of doses allocated and the number of doses administered.

Part of the reason Massachusetts has been able to use its supply more efficiently is due in part to the opening of mass vaccination sites at places like Gillette Stadium and Fenway Park. Such sites can accommodate hordes of eligible residents each day. In the span of seven days between March 2 to 9, mass vaccination sites administered over 13,000 vaccines a day on average. But critics say such sites can be difficult for many people to access, especially for groups who have been disproportionately affected by the pandemic.

“The question is: who is coming to those sites?” said Jen Kates, senior vice president at the Henry J. Kaiser Family Foundation, which has been closely monitoring vaccine distribution equity since the start of the nationwide rollout.

The state does not release data on the race or ZIP code of those who receive vaccinations at each vaccination site. But at the opening of the mass vaccination site at the Reggie Lewis Center in Roxbury, the early crowds were overwhelmingly white and from affluent enclaves in Boston and beyond. (Since late February, 50 percent of vaccination appointments at Reggie Lewis have been set aside for residents of color and members of vulnerable communities.) A February poll by the Kaiser Family Foundation found that only 31 percent of Black respondents nationwide were very likely to get vaccinated at “a large vaccination site run by the government.” Respondents from all racial and ethnic groups overwhelmingly said they preferred to get vaccinated at their doctor’s office, a local pharmacy, or a hospital.

For all the attention on mass vaccination sites, Massachusetts hospitals have led the vaccination rollout, responsible for doling out more doses than any practice type, according to state data. While hospitals got a leg up by receiving nearly all of the vaccine shipments in the first few weeks of the rollout, they have remained a powerhouse contributor ever since, with roughly 102,000 doses administered in the week of March 2 alone.

The state received intense backlash in mid-February when it decided to halt vaccine distribution to hospitals and funnel the available supply to mass vaccination sites and pharmacies. “Shifting shots to mass vax sites and away from hospital and clinical infrastructure increases racial disparities,” Attorney General Maura Healey said in a series of tweets on Feb. 12.

“Turning off the supply to our hospitals isn’t fair to the people disproportionately hurt by COVID, stuck at home, without computers or someone to navigate websites or a ride to Foxborough,” she continued, referring to the mass vaccination site at Gillette Stadium.

A week and a half later, Massachusetts officials reached an agreement with hospitals and health systems, again integrating them in the massive state effort. Public health experts advocate for a diversity of vaccination sites to reach all populations quickly and equitably.

Massachusetts is vaccinating more equitably in terms of race and ethnicity than most states across the country, data from the Kaiser Family Foundation shows. But such a distinction speaks more to the nationwide failure to inoculate communities of color than it does to the commonwealth’s effort. As Kates points out, no state, including Massachusetts, is doing “fabulously well” in terms of equitably distributing the vaccine.

Almost universally in the United States, Black and Latino residents have made up the greatest percentage of cases and deaths throughout the pandemic. Massachusetts lags in its efforts to vaccinate Black residents, who make up 7 percent of the population and 8 percent of total COVID cases, but have received just 6 percent of vaccinations. The situation is worse for Latino residents, who account for 12 percent of the population and a staggering 28 percent of total COVID cases, but have been administered just 5 percent of total vaccinations.

White residents in Massachusetts, meanwhile, comprise 70 percent of the total population but only 49 percent of total COVID cases. Meanwhile, they have received 82 percent of the available vaccine.

The state released new data Thursday on vaccination rates by ZIP code which reaffirmed this alarming gulf in vaccination rates among Latino residents. In Lawrence, for example, where 82 percent of the population is Latino, just 2 percent of Latino residents have received at least one dose of a vaccine, compared with 47 percent of white residents, who make up just 12 percent of the population. In Chelsea, where 68 percent of the population is Latino, just 7 percent of Latino residents have been vaccinated, compared with one-third of the city’s white residents.

More than half of all Black, Latino, and Native American workers nationwide hold essential and nonessential jobs that must be done on-site in close proximity with others, a greater share than white workers, according to a December study by the Urban Institute. Meanwhile, low-wage essential workers risk losing wages to attend vaccination appointments scheduled during the work week and may not have the resources to sign up online. On top of that, Latino residents are more likely to be uninsured, which may keep them from getting vaccinated, though the vaccine is free. Some families may also be fearful that getting the vaccine could have negative impacts on their immigration status, said Sam Artiga, director of the Racial Equity and Health Policy Program at the Kaiser Family Foundation.

The state data also shows a striking gender gap that reflects the priority groups targeted in the first months of the vaccine rollout. Women account for 51.5 percent of the total statewide population but have received 60 percent of the total doses administered.

A significant portion of the vaccination gap is likely because women make up 76 percent of all health care workers, according to the US Census. The group was given first priority when the nationwide rollout began in mid-December.

Women also generally live longer than men, and thus make up a larger part of the long-term care population, the other top-priority group. Of the 38,000 people in Massachusetts nursing homes, roughly 68 percent are women, according to the latest Medicare data. In Massachusetts, the coronavirus has taken a greater toll on women — who account for 52 percent of total deaths — in part because nursing home populations are particularly vulnerable to the virus. The grim trend is unique, however, as studies have repeatedly shown that men generally tend to get more seriously ill and die in greater numbers from COVID-19.

The gender gap will likely persist through March since educators ― the latest eligible group as of Thursday — are also overwhelmingly female. Government analysis of all Massachusetts public school educators in 2020 revealed that 80 percent identified as female.