Municipalities key to turning vaccines into vaccinations

From the Beacon, March 2021

This month marks the one-year anniversary of COVID-19’s miserable rampage here in the United States. March also marks one year of extraordinary crisis leadership under the toughest of circumstances for our municipal and state leaders. You have been saving lives, standing up massive public health services, reworking municipal operations to deliver essential services, and calming your residents, whose daily lives have been disrupted.

Although news reports had identified a collection of cases in the Pacific Northwest, the virus’s first furious wave was in the northeast corridor, hitting New York, New Jersey, Connecticut and Massachusetts with the initial crisis-level spread of infection, illness and death. This was before scientists discovered that asymptomatic transmission was a central aspect of COVID-19’s exponential growth. While the pandemic eventually blanketed all 50 states, local and state leaders in this region have been running at full speed longer and faster than the rest of the nation.

Perhaps that is why we seem to have reached an inflection point in the battle to beat back the virus and restore normalcy to our lives and economy. The production of vaccines has raised expectations that we are entering the last mile of a long and arduous journey. Yet the demand for vaccines far exceeds the supply, creating huge challenges and deep frustrations in every corner, from every stakeholder. The last mile now seems a lot longer.

The federal government provided no planning or guidance to states or localities regarding how to best prioritize, organize and actualize the transformation of vaccines into vaccinations. States were left to do this on their own, and while Massachusetts is now a national leader in the percentage of individuals who have received their first dose, the process has been fraught with changing strategies, communication gaps, and shifting supply allocations to delivery channels. The role of municipalities, mass vaccine sites, regional clinics, health care institutions, community health centers, pharmacies and employers have seemed to be a moving target, which has forced planning and implementation into last-minute exercises. Talking with my colleagues across the country, I can report that this is the case in every state.

Though state and local leaders may not agree on every decision that has been made during the past year, we firmly believe that the level of mutual support and partnership between state and local government here in Massachusetts has been the national model in fighting the virus, and this strong working relationship provides a powerful platform for success moving forward.

While most communities had not established local vaccination clinics, nearly 100 cities and towns have devoted much time, energy and resources to setting up their own programs. These communities are understandably upset by the recent announcement that supply for new first doses is instead being prioritized for mass vaccination sites and approved regional clinics.

Local public health departments and local public health professionals have spent decades planning, training and preparing for emergency distribution of vaccines. This is a well-deserved point of pride for local public health professionals, and though no one ever wanted this pandemic to occur, its existence provided an opportunity for local public health departments to put this investment in planning and training to good use as part of the current vaccine distribution plan.

Part of the frustration that local officials have felt is that they have worked so hard to engage and ramp up over the past several months, with an expectation that their role would be central to the vaccine distribution process. Hindsight is always easier, but if the state’s decision to construct the vaccine delivery around mass sites for maximum efficiency had been announced in December, the frustration would have been replaced with conversation and planning around how municipalities could complement and fit within this system. The MMA is committed to working with state health officials to enhance communication so that communities can engage as full strategic partners.

Communities are already moving forward to vaccinate those who live in senior housing or are homebound, and will continue to work to connect residents with appointments at vaccination sites across the Commonwealth. As the vaccination campaign continues and the supply from the federal government increases, the MMA is asking that the administration restore a stronger vaccine distribution role for those local public health departments with the capacity and desire to serve.

First, we are asking that local health and fire departments be empowered to vaccinate teachers, public works employees and other essential workers in our communities once they become eligible to receive the vaccine. No city or town would contest that there exist certain economies of scale at mass vaccination sites that cities and towns cannot achieve. Local clinics can’t replicate the huge volume and productivity of the mass vaccination sites, particularly once Phase 3 is reached and millions more people join the line. However, allowing municipalities to receive doses through the conclusion of Phase 2 would allow local officials to reach targeted populations of vulnerable communities and essential personnel on the front lines of the pandemic, especially when these individuals are living or working in the community.

Second, as the supply of doses increases in the coming weeks and months, the MMA is urging that local governments be included in the plan to vaccinate other segments of the population as they become eligible. As the vaccination process continues, those who are vaccine-hesitant will grow as a percentage of the remaining eligible population. Local governments are best equipped to serve as connectors to residents who may be hesitant, unwilling or unable to travel to the mass vaccinations sites established by the state. Those will be the last steps of the last mile, and communities are best positioned to make that final push.

Cities and towns are essential partners with the state in this race toward achieving herd immunity, given their existing public health infrastructure and, perhaps even more importantly, their trusted relationships with residents. Local and state officials are all on the same team, fighting a common enemy. That’s how we can transform vaccine supplies into actual vaccinations in the fastest, most efficient way possible.