State and local officials continue discussion of vaccine challenges

The COVID-19 vaccine process again dominated the discussion among municipal CEOs and high-level state officials during today’s biweekly conference call convened by the MMA.

While the administration vows to continue its concerted efforts to improve its deficient web-based vaccine appointment-booking system, local officials have been expressing frustration that they have not been able to access vaccine doses in order to help their older residents.

Lt. Gov. Karyn Polito said state vaccination data are now showing dramatic improvement, and she explained the rationale behind the state strategy to focus on regional high-volume vaccine sites rather than a large number of broadly dispersed locations.

Once the state got through the first phase of its three-phase vaccine plan, which focused on smaller groups and specific job descriptions, she said, it needed to pivot quickly toward building capacity as larger groups of residents were becoming eligible. Following the ongoing vaccination of residents age 75 and older, the next group of eligible residents — individuals age 65 and older, individuals with two or more specified medical conditions, and residents and staff of low-income and affordable senior housing — numbers about 1 million, she said.

“That’s the overall strategy, is to be able to scale up to meet the massive demand, in terms of the population that we have in front of us … and to be able to scale up quickly” when the vaccine supply increases, potentially with the addition of a third vaccine from Johnson & Johnson.

“We have close to five million people in Massachusetts to vaccinate, that are eligible, over age 18,” she said. “We have such a constrained supply, and we have such a valuable, precious resource in a vaccine. We need to make sure that we do not have unused vaccines at the end of the day.

“This isn’t a perfect process,” she said. “This process evolves.”

Polito pointed out that 95% of Massachusetts residents live within a 45-minute drive of one of the high-volume, large venue Mass Vaccination sites — currently in Boston, Danvers, Dartmouth, Foxborough, Natick and Springfield — or within 30 minutes of 11 approved regional collaboratives or 105 CVS and Walgreens pharmacy locations. Additional clinics are operating in 20 “disproportionately impacted communities.”

If there’s an unmet need, she urged local leaders to pursue regional collaboratives, which can play an important role in closing geographic gaps in the system.

On Feb. 17, Health and Human Services Secretary Marylou Sudders notified local health departments and boards of health that, effective March 1, the state will no longer provide first-dose vaccines to individual municipal clinics, with the exception of the 20 disproportionately impacted communities and approved regional collaboratives.

The same letter outlined the state’s criteria for a regional collaboration vaccine site. It must:
• Serve an unmet need geographically, as identified by the Department of Public Health
• Have the capacity to vaccinate at least 750 individuals per day, five days per week
• Meet an administration rate threshold of 85% and report doses within 24 hours
• Be open to all Massachusetts residents
• Provide public links for vaccine appointments on Mass.gov/COVIDVaccine

During the conference call, Jana Ferguson, assistant commissioner at the DPH, said the clinics would need to have a fixed location and the DPH will also review staffing plans, traffic management plans, and the identified lead community. She said the COVID-19 Command Center is developing a map that will provide a clear indication of the geographic gaps in the system.

“There is a process,” Ferguson said. “We are looking primarily at geographic areas where there is not already ready access to another vaccination opportunity.”

She acknowledged that limited availability of vaccines may prevent some regional centers from hitting the 750-dose-per-day target, at least initially, and may cause DPH to put some proposals on a wait list. She cited successful regional programs currently operating in Berkshire and Barnstable counties.

Ferguson said the DPH was creating a Google form that municipalities may use to submit proposals, and she announced a new email address — municipal.vaccine@mass.gov — that municipal officials may use to submit information or questions related to plans for a regional vaccination clinic or for vaccinating those who are unable to leave their homes.

After having successfully run programs to vaccinate public safety personnel, however, many municipal leaders have pressed for a larger ongoing role in the vaccine program. In a Feb. 18 letter to the governor, the MMA requested that the administration “consider restoring a stronger vaccine distribution role for those local public health departments with the capacity and desire to serve.”

Specifically, the MMA asked that local health and fire departments be allowed to vaccinate teachers, public works employees and other essential municipal workers who become eligible shortly in Phase 2, and that local governments be considered to vaccinate other segments of the population as they become eligible.

Administration officials are saying the municipal role currently is to help ensure that “really vulnerable residents” get vaccinated, particularly homebound residents and those in low-income and affordable senior housing, who are now eligible, along with staff. Ferguson said she gave an update to local health departments and boards of health last Friday about this effort, with more information coming soon. She said municipalities may connect senior housing facilities with a “clinical partner,” such as a community health center, pharmacy or the local health department to develop a vaccine plan.

Ferguson said the DPH is “building a process” for ensuring vaccinations for the homebound, either by using a statewide vendor, creating a partnership between the vendor and the local health department or council on aging, or using municipal staff. She said guidance and a toolkit is expected to be released next week.

Polito reviewed the latest vaccination data. More than 1.4 million vaccine doses have been administered in Massachusetts thus far, a bit more than a million of which are first doses. Some 272,000 residents in the age 75 and older group have received vaccines, accounting for about half of that population. Of the doses released to Massachusetts by the federal government, 85.5% have been administered. She said Massachusetts is the per capita vaccine leader among the 24 states with populations of at least 5 million.

Last Friday, Massachusetts was notified that its weekly vaccine allotment is being bumped up from about 110,000 doses per week to 139,000.

Federal aid
Heath Fahle, special director for federal funds at the Executive Office for Administration and Finance, gave an update on a federal COVID relief package – the $1.9 trillion American Recovery Plan – working its way through Congress, which includes an estimated $2.3 billion for Massachusetts municipalities in addition to aid for the state.

“There is activity at the federal level that may flow through to municipalities in a way that has a pretty material impact on your planning and on your efforts to respond to the pandemic,” he said.

Fahle also reviewed several recent changes to the Federal Emergency Management Agency’s Public Assistance Program. An executive order signed by President Joe Biden on Feb. 2 increased the reimbursement rate for eligible pandemic response expenses from the traditional 75% to 100% and applied the new rate from the beginning of the disaster period, Jan. 20, 2020, through Sept. 30, 2021. The order also expanded the definition of eligible costs, in areas such as PPE, cleaning and sanitation, and school reopening costs. Fahle said he’s awaiting additional details and guidance from FEMA.

Fahle said the FEMA changes will prompt municipalities “to go back and look at costs they’ve incurred over the past year, because some of the things that you thought were ineligible before are likely to be eligible now. … I think it’s very likely that FEMA Public Assistance will play a much larger role in supporting COVID-related costs as we go forward.”

Fahle said the state has extended the reconciliation period for the Coronavirus Relief Fund Municipal Program through at least the end of the current fiscal year, June 30. His office issued updated guidance on Feb. 19.

• Audio of Feb. 23 call with administration (38M MP3)