Fragmented Massachusetts system makes for confusion and uncertainty and impedes access
If you’re a Massachusetts resident over 75 years old (or you’re planning to accompany a family member), you might try to sign up for a COVID-19 vaccine through the state’s website. There, you can search for vaccination sites near you or pan over a map where vaccination sites are marked with stars, colored yellow for sites open only to local residents, and green, red, or blue, for different types of statewide sites.
If you happen to be a Boston-area resident and zoom into your area, you might notice some cities and towns that don’t contain any sites. Somerville, Quincy, and Belmont, for instance, have no state or local vaccination sites listed on the map. The locations surrounding Quincy—a Braintree CVS, a Weymouth CVS, a Dorchester Walgreens, and the Mattapan Walgreens site on River Street—had no available appointments listed as of February 15. Sometime between noon on Feb. 10 and 4pm on Feb. 11, sites at pharmacies popped up in Cambridge and Watertown, and Family Practice Group PC made the map in Arlington, but before that, these municipalities were also among the empty patches.
As of February 15, none of these new locations had any open slots listed. However, this doesn’t mean there are no vaccines available in these areas. Municipalities can choose to run separate vaccine sign-ups and include them on the map, and some healthcare providers are vaccinating their patient populations. The state is just one player in Massachusetts’s vaccination system, and its website is a far cry from a complete catalogue of available appointments. The fragmented nature of this system leaves a lot of room for confusion and uncertainty, both for people trying to sign up for a vaccine and for administrators trying to plan.
Cities fend for their own
Watertown set up its own municipal clinic in large part because of how inaccessible the state mass vaccination sites are. Larry Ramdin, Watertown’s director of public health, said that it is “extremely challenging” for many of the currently eligible residents of his municipality “to access one of the mass vaccination sites, because of their age and frailty.”
Fenway Park, he says, is the closest one of these to Watertown. While the state website touts Fenway’s “ramps and walkways,” “wheelchairs available on-site,” “staff available to assist with mobility issues,” and “chairs throughout the queuing process to give guests a break,” Ramdin emphasized the difficulty of using this site for seniors. Depending on one’s mode of transit, obstacles may include the lack of nearby parking, a public transportation journey especially difficult for people who have stopped driving due to their age, and a walk to the site that is particularly challenging in snowy weather, Ramdin explained.
Watertown’s clinic is open once a week and staffed by members of the Metro East Medical Reserve Corps. “It was really a question of access for this most vulnerable of our populations right now,” Ramdin said, noting that many seniors said they appreciated “that they didn’t have much walking to do to get into the facility and got home in short order.”
Why is Watertown not listed on the state’s map? Ramdin explained that the city is doing its own outreach to its residents, and is not opening up a statewide clinic due to the low supply of vaccines. “We had a clinic yesterday, we had only 200 vaccines. I cannot vaccinate the entire state at the expense of my residents. Same thing next week: We have only been allotted 100,” Ramdin said on February 11.
While he understands the state’s vaccine supply is limited and expects to receive bigger shipments for Watertown once the shortage lets up, Ramdin expressed concern about the allocation priorities of the state, which seems to be putting pharmacies and mass vaccination sites before municipalities. Meanwhile, his city’s capacity to vaccinate remains underutilized: “Local health departments in the Commonwealth have the resources to administer these vaccines quickly,” he said. “We’ve been training, we’ve been preparing for this. Right now, I have—and it can be increased—the ability to administer 1000 vaccines a week. But I only have 100 doses to administer.”
Though its population is more than twice that of Watertown as of 2019, Somerville is also currently receiving 100 doses per week. Doug Kress, Somerville’s director of health and human services, echoed Ramdin in his response to the limited doses.
“We really want to make sure that our 100 are able to go into some arms of Somerville residents, because that’s who it’s really geared towards, especially with our 75-plus-year-olds.” Kress said that a challenge his department has been hearing of from other municipalities is that even if a site is listed on the state website as serving only local residents (like the ones marked with yellow stars), members of other communities can still take up appointments. That’s why, like Watertown’s, Somerville’s public health officials have decided to keep their weekly clinic off the state’s map.
As for accessibility, Kress says the city’s clinic has a parking lot right in front, and is providing vaccinations to those with limited mobility right in their cars. Somerville and Cambridge are also running services to transport seniors to this site, as well as to state sites. Kress said that as far as he is aware, these features are not available at the state sites. He described a contrasting process at the Foxborough mass vaccination site: according to a colleague of his, the process of getting from the car into the building when she took her mother to get vaccinated was “a nightmare.”
Healthcare providers go it alone
Kress said his city has been holding its clinics at Somerville Community School. According to Ramdin, Watertown held last week’s clinic in the Community Room of the Watertown Police Station, where it’s also happening this week, and the city is in the process of switching to another site for future clinics. Quincy is also using a nontraditional medical setting.
“We have a clinic at 180 Old Colony Ave.,” said Chris Walker, the Quincy mayor’s chief of staff. “It’s an office building owned by the city that will ultimately become a school building, but their construction has not been done yet. So we’re using it as a vaccine clinic.”
Meanwhile, healthcare providers with medical venues in the area are administering vaccines to their patient populations independently of the towns and cities in which they are located, and, like the municipal clinics, have stayed off the state’s map.
Cambridge Health Alliance (CHA)—a safety-net health system with 140,000 patients in Cambridge, Somerville, and Boston’s metro-north region, according to a fact sheet from Fiscal Year 2019—has used its pre-existing system to reach out to eligible patients, book their appointments, give the shots, and register the vaccinations.
“We’ve been focused on our highest risk patient population to make sure they have access to the vaccine,” wrote Brian Herrick, the chief information officer for CHA, in an email. “We are reaching out to them online and by phone. We just want to get the vaccine out there.”
Tufts Medical Center in Boston is operating similarly. Nick Duncan, the director of emergency preparedness at Tufts Medical Center, wrote in an email that “Tufts Medical Center is vaccinating our patients in the 75 and older category as outlined by [the Massachusetts Department of Health]. We are not vaccinating the general public, which is why we are not listed on the state vaccine site sign up.” The center is, however, collaborating with the city of Boston to vaccinate “first responders and other frontline groups in phase 1 and phase 2,” Duncan wrote.
A recent development has cemented the reduced role of established healthcare providers in Massachusetts’ vaccination system: the state has decreased allocations to them. Sprawling healthcare system Beth Israel Lahey Health, which provides services from primary to hospital care and includes Boston-area locations such as Mount Auburn Hospital in Cambridge, New England Baptist Hospital in Boston, and almost 100 primary care practices in Eastern Massachusetts, released a communication to its patients on February 12 saying that its locations will honor already scheduled vaccine appointments, but that it can schedule no new ones for first doses due to the state’s allocation priorities.
“Today, the state informed us that, due to supply constraints, it will be greatly reducing the supply of vaccines to hospitals and health systems for at least the next few weeks in order to consolidate vaccine doses for use at state-run vaccination clinics,” said the email.
This appears to be part of a statewide issue. Massachusetts state Sen. Eric Lesser’s district is in the Western part of the state, and he has actively pushed for reforms to the COVID-19 vaccination system, criticizing the state’s failure to partner with existing healthcare providers as resources in its mass vaccination program. “Why are we signing contracts with fly-by-night vendors from out of state when we have the most recognizable healthcare brands on Earth, based here?” he asked. (Ed. note: We put that question to the DPH and the COVID-19 Command Center, and are awaiting a response.)
With the state taking a major step away from integration of its vaccination system with those of healthcare providers, it’s no surprise that providers are reluctant or even unable to serve those eligible for vaccines beyond their preexisting patient populations.
Working together, or trying to
Meanwhile, some cities and healthcare providers have found ways to collaborate, with more in the works. However, lines of communication with the state are lacking.
Quincy has partnered with local provider Manet Community Health Center. Manet and the city are pooling their dose allocations to vaccinate both those who sign up through the city and Manet’s existing patient population.
“We did 600 last week, and that was a combination between first dose and second dose,” said Chris Walker on February 11, noting also that Quincy, like Watertown and Somerville, has the capacity to administer many more at the municipal level. “We could probably do between 1,500 to 2,000 a week [at the current venue.] We’re scouting additional locations around the city to handle a larger capacity when the time comes,” Walker said.
Arlington, Belmont, and Lexington have banded together, pooling their 100 doses each to deliver a total of 300 doses at one location open to residents of all three towns. “We’ve had a small clinic just in the mornings on Wednesdays at Arlington High School. And Arlington is a nice central location to Lexington and Belmont. So it’s easy for our residents to get to,” said Wesley Chin, the director of Belmont’s health department. He estimated the region is administering vaccines at about 30% capacity, as he said they could scale up the operation fairly easily to deliver 1000 vaccines per week.
Somerville is exploring the possibilities for similar collaborations. According to Doug Kress, “the state is also asking or suggesting that we do a more regional approach, so that multiple municipalities come together and do a larger site.” He said he is considering doing so, especially if that means each city would get more vaccines than it does alone, though he does not know the details of the allocations for municipalities participating in regional clinics. Somerville’s health and human services department is also considering collaborating with a local healthcare provider on vaccination, as Quincy is doing. “We have been working with CHA to see if we can identify a location to actually do that partnership,” Kress said.
However, municipalities are short on information about vaccines delivered by other municipalities and healthcare providers, as well as by the state. Chris Walker from Quincy said that some of the people who requested appointments and whom the city has been calling back have successfully signed up in other places, whether through private providers or the state’s resources. While he marks this development as a sign of progress, the lack of communication with the state is a running theme.
According to Kress, the state did not communicate with the municipal administrators organizing vaccine distribution in Somerville about the opening of a nearby state site at a Cambridge CVS. The same was true of Watertown’s CVS site: the state did not discuss the opening with Ramdin’s office.
But Kress and his colleagues, he says, did their own research despite a lack of input from the state, and knew about the new site. According to Kress, Somerville’s Council on Ageing has been able to help residents set up appointments at other locations besides the municipal clinic, but the CVS appointments have been hard to come by.
“We don’t know how that’s gonna work out,” he clarified of the new pharmacy sites. “That could have just been, you know, opening day blues… we have to see how they actually function.”
Kress also mentioned the need for more data in order to target outreach and plan ahead. Regarding how many people in the eligible demographic have been vaccinated, he said, “Part of the challenge is that we only know what we’ve been able to vaccinate here [through the city clinic]. There may be some people who have been vaccinated through their primary care providers, and we may not necessarily have that information. And I think the state is going to have to address some of those questions.”
All providers are required to register their vaccinations with the state, so Mass should have those records. Kress said on February 12 that Somerville’s health and human services department asked for this info from the state the previous week, and that he doesn’t know the request’s current status.
Ann Scales, the director of media relations at the Massachusetts Department of Health, wrote in an email that nobody from the department was available for an interview for this article, and forwarded DigBoston’s written request for comment on the fragmented nature of the vaccination system to the press people at the state’s COVID Command Center. They have not responded to that request for comment.