The vaccine rollout in the United States is progressing — albeit not as quickly as anyone would like. But there isn’t a single “vaccine rollout” — instead responsibility for distributing the vaccines has been delegated to states, and some states are getting shots into arms faster than others. Connecticut is one of those states.
Connecticut was one of the first states in the U.S. to get over 2% of the population vaccinated with the first dose of a Covid-19 vaccine. It’s also ranked #1 in vaccine distribution in nursing homes, according to local news outlets. As of Wednesday, the state has administered 93,056 doses, according to Bloomberg, which means it has used 62.1% of its shots so far — a notably high percentage compared to other states. New York is at 33.5% of shots used and Massachusetts is at 37.8%. Both are much larger states than Connecticut, but experts say the state has valuable lessons to share.
Connecticut Gov. Ned Lamont said in a press briefing on Monday that the state is on track to complete the first doses for all nursing home residents and staff who are willing to take the vaccine by the end of this week. Assisted-living facilities will begin to be vaccinated this week as well. Frontline hospital workers and those working in nursing homes are expected to receive both vaccine doses by the end of the month. The state is now meeting to discuss who will be next in line.
So what is Connecticut doing right?
The state brought in a veteran of the management consultancy McKinsey, Benjamin Bechtolsheim, to help implement its vaccination plan. Bechtolsheim is now the director of Covid-19 Vaccination Program at the Connecticut Department of Public Health and is tasked with working across state agencies and with health care providers and community organizations to ensure that everyone in the state will have access to a Covid-19 vaccine.
Perhaps one of the most important factors is that the state’s plan allows for some flexibility in who qualifies for a vaccine, prioritizing getting shots into arms over strictly following a preset roadmap for how vaccines will be distributed.
To prevent doses of the vaccine from going unused, which is happening in many states, Lamont said on Monday that Connecticut developed a “just-in-time inventory” system where unused doses of vaccine at a given location can be transferred to other facilities where there is demand at the end of the day. The Connecticut Department of Health has said to prevent vaccines from being wasted, vaccination providers should have a waitlist of people they can call in ASAP if they have leftover vaccine doses.
As the CT Examiner reports:
In a press conference on Monday, Gov. Ned Lamont spoke about the “Just in Time Inventory,” a system which, according to Connecticut CEO Josh Geballe, would use pre-planning and daily contact with providers to allocate the correct number of vaccines to each distribution center so that none were wasted. Geballe said that the National Guard could also move excess vaccines from one site to another in the rare case that a site might have more vaccines than it could use.
“I think [Lamont] put fewer rules in place than a state like New York did about who can get the doses and who can’t get the doses,” says Howard P. Forman MD, MBA, director of the Yale School of Public Health Health Care Management Program in New Haven, Connecticut. “I don’t think he scared people [distributing vaccines] by saying, ‘if you go anywhere outside these lines I am going to take you to jail.’ I think right now we need compassionate stewardship so that we get through this process as well as we can.”
Forman says the state is letting health care facilities figure out who qualifies as a phase one vaccine candidate. “If you look at New York, it’s far more prescriptive as to who is a health care worker and who is a frontline and who is a patient-facing health care worker,” he says. “I think our hospitals and health care systems have it in their interest to vaccinate health care workers and frontline health care workers first, but you also want to make sure that if you have doses around, that you are getting them out there as quickly as possible.”
An unfortunate issue coming up in many states, Forman notes, is that there’s a portion of people who are eligible to be vaccinated — particularly lower-income health care workers, he says — who are declining. “When that happens, what do you do?” says Forman. “Unless you’re going to put in place a mandate that people must get vaccinated, which is difficult to do and I think probably ethically and morally wrong, then the next step is, who is next on your list? And if you have a governor saying to you that you can’t go to anyone next on your list because you haven’t used these vaccinations for this population yet, then you run into problems where you can under-vaccinate.”
Earlier this week Lamont said that the state has launched an “aggressive public outreach campaign,” as the CT Monitor reports, focused on persuading reluctant workers to get vaccinated which include public service announcements and working with unions and staff to encourage people to get the shots.
Not everything is running perfectly smoothly. Forman points out that despite being at the largest health care system in the state, his hospital system got the same number of doses as one of the smaller health care systems. “But that’s a small quarrel,” he says. “That was an equity decision [Lamont] made at the beginning, and it’s starting to [change] now.”
Forman says it seems the state is planning for how to best target different groups for vaccination. “I think the governor has smartly relied on an advisory panel that understands the people of Connecticut and understands the communities,” he says. “It is not a monolithic state, it has lots of different communities and I think they are going to have different vaccination patterns.”
For any state to succeed, Forman says efforts to encourage vaccination need to be a top priority and that allocating funds to address vaccine hesitancy should happen soon at the federal level in order to help states meet their vaccination goals.
“What we are seeing at this stage is that it’s a lot easier to get [the vaccine] into the arms of elderly people, particularly those who are institutionalized, and it’s easy to get it into the arms of health care workers like nurses and doctors,” says Forman. “It’s a lot harder to get it into the arms of people who are low-wage, younger workers, who only know that they are going to have side effects and don’t necessarily recognize what the benefit is to them. Those are perhaps the most important people to actually interrupt the transmission chain.”
“We need to make people in this country want to be vaccinated,” he says.
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