FROM THE START, the Commonwealth’s vaccination efforts have suffered from a pervasive disconnect. No one thought to involve municipalities and local health boards in the planning process. Multilingual call lines and functional websites weren’t in place at the start of the process. Local agencies, advocates, and providers who best know the barriers to access were sidelined. It has taken weeks for the state to recognize communities hit hardest by COVID-19 need greater support in their vaccine efforts. Due to that, Massachusetts has been receiving failing grades for its vaccination program.
Normally for a major public outreach program like this, the state has a detailed plan and our job at the local level is to fill in the well-defined holes of what the states can’t cover. Unfortunately, in the case of coronavirus vaccinations, it’s been all holes.
In order to run a local vaccine clinic last week on 48 hours notice, our city had to train 22 phone operators for a multilingual local call line, our Council on Aging triaged hundreds of calls from seniors and reached out to community agencies to make sure we could help some of our most vulnerable residents, and we arranged rides to the vaccination site for those who needed them. It was a do-it-yourself effort that ended in plenty of tears of gratitude as well as some fun selfies with a life–size cutout of Dr. Anthony Fauci. We didn’t waste a single dose of vaccine. We’d gladly repeat the entire exercise — except the state now isn’t giving us any more vaccines.
Now our residents are being told to go to mass vaccination sites or to CVS vaccination locations in other cities. It’s a horrible model for older residents who need some assistance, for people who don’t have a car or paid time off, and for communities that don’t have state-designated sites. Massachusetts is creating a vaccine hierarchy.
It is the consequence of technocracy gone off the rails. Everyone in government prides ourselves in good management. It is an essential part of what we do. Yet you cannot manage services for a population with whom you’ve lost touch.
We’ve created lines for people who know how to get to the front of lines. Situating clinics at Fenway Park and Gillette Stadium may sound like a fantastic idea to those of us with financial wherewithal to attend pro sports games, but those sites are not in lower-income neighborhoods or places with which lower income residents are familiar. Even when the state put a clinic in Roxbury, few people of color lined up for the initial round of shots. Who did get there? A financial planner who had a younger employee navigate the web to get an appointment for him.
And that’s the problem in a nutshell. Our whole COVID experience has been a lesson in the disparities between those who have access to health care, who have eaten healthier food, who have breathed cleaner air, and those who have gone without. Every set of statistics and heat map will show you this disease has hit people of color harder and in higher percentages. They are getting serious and fatal cases of COVID-19 at much younger ages because a higher percentage of people in our minority communities are vulnerable to respiratory diseases. Yet we still had to spend weeks convincing the state to include asthma on the list of comorbidities for those eligible to get the vaccine earlier.
Even when our blind spots are made self-evident, we fail to adjust our mirrors. While vaccination spots for companion drivers were exploited by those with cars and means, we’re still waiting to get vaccines for onsite vaccinations at our low-income senior housing. We’re fighting to get vaccines distributed by trusted health care providers like hospitals, community health centers, and doctors’ offices so that people with vaccine hesitancy have greater faith in the process. When cities and towns begged for equity, a ham-handed designation of 20 priority areas left out equally vulnerable residents in neighboring communities pretty much because they have the wrong zip code.
What we’ve done in Massachusetts seems like it will work great if you live in a suburb and spend lots of time on your smart device and can free up time to drive your SUV over to a vaccine site. Yet millions of people in our Commonwealth aren’t living that life. We need to plug into their reality too.
I get that the hope is the Biden administration soon floods us with as many vaccines as we could possibly want, that we can employ a brute force solution to the problem. Yet those of us at the local level still don’t know what role we’ll need to play if and when that happens because the state hasn’t told us. We’re in the dark in the middle of the most important public health challenge of our lifetimes.
We also aren’t out of the woods when it comes to COVID. We’re just about to start vaccinating the Baby Boom generation. It’s going to be a huge glut of people and already on the first day of that effort the Commonwealth’s appointment website has crashed. It’s going to be the same chaos we’ve already experienced and the same people going first, just on a bigger scale. This will be occurring as more contagious variants of COVID become the dominant strains of the virus. That means the same demographics and communities that have suffered hardest will be in danger as they stand at the back of another line.
What we have is a tale of two Massachusettses. We keep making it harder on those who have gone without because we can’t conceive of a system that works for them. The technocracy keeps churning and the same people keep getting caught in the gears.
Joseph Curtatone is the mayor of Somerville.