The beginning of the end: who is first in line for the long awaited vaccine

Massachusetts residents began receiving the COVID-19 vaccine in modest numbers on Dec. 14, 2020. Photo by fernando zhiminaicela/Pixabay

By Claudia Chiappa
BU News Service

BOSTON – The nightmare which has held the world hostage for most of the year is approaching its end, or so it seems. After the Food and Drug Administration issued an emergency use authorization for the Pfizer COVID-19 vaccine on Dec. 10, distribution started across the country.

Massachusetts received its first shipments on Dec. 14 and groups prioritized in the state’s Phase 1 started receiving the first doses last week.

Gov. Charlie Baker announced that during the first phase, implemented from December to February, priority will be given to healthcare workers, residents and staff of long-term care facilities, first responders, including police, fire and emergency medical services and a recently added plan for homeless shelters and correctional facilities. 

“Clinical and nonclinical healthcare workers, doing direct care and COVID facing care, are at the highest risk for COVID-19 exposure due to what they do every day,” Baker said in a press conference prior to the FDA approval of the Pfizer vaccine. “Providing this group with the vaccine first will protect them from exposure and ensure that they can continue to provide healthcare to others safely.”

As of Dec. 19, more than 280,000 health care providers have been infected with COVID-19 nationwide, with 946 deaths according to the Centers for Disease Control and Prevention data tracker. Studies by the Kaiser Family Foundation show they work in high-risk settings and are exposed to the virus more than the general population. 

Katie Murphy, president of Massachusetts Nurses Association and an ICU nurse at Massachusetts General Brigham, said after witnessing the ravages of pandemic since March, “we wish everybody could receive the vaccine.”

“We’re glad healthcare workers are in Phase 1, as well as residents of long-term care facilities, but we wish that our most vulnerable population everywhere was receiving the vaccine too,” she said.

Similarly, another Kaiser Family Foundation study found that long-term care facility residents and staff accounted for 6% of cases and 40% of deaths in the U.S.

Tara Gregorio, president of the Massachusetts Senior Care Association, said the association is thankful that nursing home residents and staff are being prioritized by the state.

“Our nursing homes will be working with retail pharmacies CVS and Walgreens to implement three immunization clinics in order to ensure that every person gets the required two doses of the vaccine,” Gregorio wrote in an emailed statement. “It is expected that those three clinics will suffice to cover 100% of current staff and residents.”

Baker’s new plan also includes “congregate care settings” in the first phase, which extends to homeless shelters and correctional facilities – settings that were disproportionately hit by the virus and are often overlooked in the decision-making process. 

Findings by the Marshall Project and the Associated Press indicate that one in five prisoners in the U.S. had COVID-19, a rate four times higher than the general population. According to the Prison Policy Initiative, Massachusetts is now one of seven states to explicitly include prisons in its Phase 1. 

“In most prisons right now the virus is there, it is moving through the prison and it is infecting people,” said Wanda Bertram, communications strategist from the Prison Policy Initiative. So unless we get the vaccine to people who are most at risk of dying should they contract the virus, we are continuing to put people behind bars in grave danger.”

Homeless shelters are also high-risk settings: people’s proximity to one another combined with an inability to isolate accelerates spread. 

“It’s like throwing a matchstick onto dry wood,” said Dr. Courtney Pladsen, a spokesperson for the National Health Care for the Homeless Council. “People who are homeless are generally older, have many more chronic conditions, and because of the living conditions and living in shelters and congregate settings are at a much higher risk of being infected. And if they were to be infected, they are at much higher risk of having much more severe diseases.”

Vaccine distribution in prisons and congregate settings comes with a share of challenges. Residents in homeless shelters are often on the move and it might be hard for staffers to track them down when it’s time for the second dose of the vaccine. 

Another component is the storage of the vaccines, as correctional facilities and homeless shelters may not have deep freezers such as the one required to store the Pfizer vaccine. Because the Moderna vaccine does not require as extreme temperatures, it has potential to be a better choice for these environments, Pladsen said.

Baker said the vaccine will be provided free of charge to all individuals. In the Commonwealth, particular emphasis has been put on vaccine access to communities disproportionately affected by the pandemic.

“This is really an equity issue,” Pladsen said. “We know that people of color are disproportionately impacted by COVID-19, and people of color are also disproportionately experiencing homelessness and have higher incarceration rates. In order to have an equitable distribution of the vaccine, it’s important to give it to people who are disproportionately affected by the virus.”

Kelly Turley, associate director at the Massachusetts Coalition for the Homeless, said Massachusetts’ choice is to be praised, but efforts should not stop there. Access to testing and prolonged support for homeless populations are just as important as vaccine distribution.

“There are other steps that could be taken in conjunction to make sure that we are minimizing the number of people in these congregate settings,” Turley said. “It’s not just about housing justice. It’s about public health. It’s about equity.”

The arrival of the vaccines has raised other issues, however, especially the hesitation among part of the population to get the vaccine. According to a recent survey conducted by the Western New England University Polling Institute, one third of Massachusetts residents said they are unlikely to take the vaccine. 

The survey, conducted via telephone and online and involving 415 adults, found that 22% of those surveyed are very unlikely to take the vaccine and another 16% said they would be somewhat unlikely. The main reasons cited were a lack of trust in the approval process and “concerns about potential side effects.”

“I think that the primary driver of that is that the process was so truncated,” Murphy said. “We are so used to the FDA taking a really, really long time to run trials, look at the studies, look at the side effects, and this has just been such a telescoped process, people are a little bit concerned about that, that something is going to happen that we didn’t foresee.”

Murphy said she will not hesitate to take the vaccine once available, but she believes the choice should be left up to the individual.

“A lot of healthcare workers have real physical reasons why they cannot take a vaccine,” said Murphy. “We’ve been on the frontline since March, so we feel that we’re the right ones to make those decisions about our health.”

In prisons and homeless shelters, where mistrust and hesitancy towards the medical staff is high, transparency is needed to communicate with residents. Bertram fears that without a successful approach, many prisoners might choose to not receive the vaccine out of a lack of trust for prison’s medical units. 

“It’s also really important to recognize who is delivering that message, we want people to hear it from trustworthy sources,” Pladsen said. “We don’t want to diminish some of those fears and concerns.”

Turley said keeping the vaccine voluntary is important, but so is promoting voluntary participation encouraged by science.

“People experiencing homelessness have a lot of their daily life dictated,” Turley said. “So we don’t want to take away their autonomy.”

Baker confirmed that 300,000 doses of the vaccine are expected by the end of December. Additional shipments are expected to come in the first months of 2021.

But officials are warning the public not to let its guard down. 

“We all need to continue to wear face coverings, avoid groups, and work to stop the spread,” said Baker at Wednesday’s press conference.

The numbers back Baker’s warnings. Over the past week, there has been an average of 4,927 cases per day, a 27% increase from the average two weeks earlier as reported by the New York Times data tracker. Recent holiday travel and “mask fatigue” are thought to be partially responsible for this surge in cases.

“In spite of the vaccine being available, people need to still be so careful,” Murphy said, emphasizing the continued need for masks, small gatherings, hand sanitizing and maintaining a 6-foot distance from others.

“I know how tough that is,” she said. “But I think people need to really continue as if there is no vaccine.”

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