- Matt Mignanelli
On a January 21 conference call with hospitals, the Vermont Department of Health announced an abrupt change to its coronavirus vaccination plan: It would stop allocating doses for frontline health care and emergency workers and instead reserve them for the elderly population.
The decision to temporarily close the door on Vermont's highest-priority group came as a surprise to some hospital officials, who had believed they would be able to continue vaccinating their employees and community health care workers even as the state entered Phase 2 of its vaccine rollout.
Hundreds of disappointed Vermonters were soon informed that their anxious wait for a shot had just gotten longer.
"We had to cancel the 200 people we had scheduled for [January 27] and say, 'Hold on to your hat,'" Gerianne Smart, a spokesperson for the Rutland Regional Medical Center, told Seven Days last week. Another 100 appointments were nixed at the Northeastern Vermont Regional Hospital in St. Johnsbury, according to a spokesperson there, while the cancellation of a clinic scheduled for this week at Morrisville's Copley Hospital left 400 in limbo.
The health department reversed course a week later, telling hospitals they would still receive a limited number of doses for health care workers eligible under Phase 1a of the vaccine plan. But so far, the demand has outstripped the state's supply.
The episode demonstrates the breakneck speed at which Vermont has been forced to make decisions amid the largest vaccine effort in state history, and it reflects the growing tension between vaccinating those who are most at risk of catching the virus and those most likely to die from it. Federal vaccine shipments are gradually increasing, yet state leaders still expect to have limited supplies. Every shot in the arm of another health care worker means one less for an elderly Vermonter, and vice versa.
"It's a balancing act," said Deputy Health Commissioner Kelly Dougherty.
State leaders say giving priority to elderly Vermonters is a moral obligation because they make up the vast majority of COVID-19 deaths. But there are also compelling reasons to keep health care workers at the front of the line.
Nearly 1,000 health care providers have been infected in Vermont since the pandemic began, about a tenth of the state's caseload. When these workers get sick and must stay home, Vermont's health care capacity suffers. And not only can the workers contract the virus from patients, they can spread it among them. That's why the Centers for Disease Control and Prevention says vaccinating health care workers remains a "national priority."
After receiving its first doses in mid-December, Vermont spent the next six weeks vaccinating people in the Phase 1a group exclusively. Initially that included only residents of long-term-care facilities and health professionals who work directly with patients. Hospitals vaccinated both their own employees and community-based health workers; eligible professions included home health aides, EMT staff, dental hygienists and physical therapists. The state expanded eligibility twice, first letting in cops and firefighters, then other categories of health care workers who were not caught in the first sweep.
Though the state did not allocate any doses for hospitals last week, those with enough doses on hand were allowed to continue vaccinating workers. Others had no choice but to cancel appointments.
Emily Cogan of Jeffersonville signed up for a shot as soon as she found out in mid-January that shared living providers — people who contract with the state to offer a home and other support to those with disabilities — had become eligible.
"It was such a relief," said the 42-year-old, who lives with a young man whose disabilities could leave him vulnerable to the virus. "I can't tell you how excited I was."
But then Cogan, who is also a schoolteacher, received a call from Copley Hospital canceling her February 4 appointment, and her excitement turned to disappointment.
"Almost as soon as we found out, it was taken away," she said.
Jane Trepanier, a shared living provider who lives in West Rutland, had a similar reaction after losing a January 27 vaccination date at Rutland Regional Medical Center.
"Here I was, all set. I thought I was in," she said. "It upset me. It took an emotional toll."
State officials have tried to chalk up the canceled appointments to a miscommunication, even though the health department sent hospitals a note last week explicitly asking them to "temporarily pause with the 1A group clinic planning."
At press conferences last week, Human Services Secretary Mike Smith implied that hospitals misinterpreted the guidance. Yet his own health department had confirmed to Seven Days on January 27 that hospitals were indeed being asked to pause vaccinations unless they had supplies on hand for a few weeks.
The state's stance changed again a day later, when the health department suddenly announced that hospitals could expect some Phase 1a doses, though far fewer than they previously had been receiving.
Explaining the reasoning behind the initial decision to move on from health care workers, Dougherty said the health department had always envisioned overlapping phases. But after hearing that worker vaccinations had been slowing down at some hospitals — and expecting immense demand among the broader population — the health department decided to divert all available doses to Phase 2, she said.
"We wanted, out of the gate, to be able to assure people, especially given what we're seeing in other states, that we would have enough appointments to cover all the people who fell into the 75-and-older population," Dougherty said. Once Phase 2 kicked off last week without any major hiccups, the department decided to resume vaccinating workers, she said.
There is no easy way to know just how many people in the health and emergency services professions remain unvaccinated; by one rough calculation at least 15,000 Phase 1a Vermonters — many of whom are in the health professions — still have not received shots.
At least 1,700 of those people work in one of Vermont's 14 hospitals, according to data collected by Seven Days. Of the 11 hospitals that responded to data requests, only two reported vaccination rates of about 90 percent: Grace Cottage Family Health & Hospital in Townshend (92 percent) and the University of Vermont Medical Center in Burlington (89 percent).
Five hospitals had rates of 75 percent or lower: Southwestern Vermont Medical Center in Bennington (75 percent), Rutland Regional Medical Center (72 percent), Gifford Medical Center in Randolph (69 percent), Northeastern Vermont Regional Hospital (65 percent) and North Country Hospital in Newport (64 percent). Porter Medical Center in Middlebury, Central Vermont Medical Center in Berlin and Springfield Hospital did not provide data.
Wendy Franklin, a spokesperson for North Country Hospital, reported that about 200 employees there had yet to be vaccinated. Some declined, she said, while others were waiting to see how the rollout progressed.
"The danger in that is, you don't know if it's going to be available when you come forward," she said. "I don't know if there are employees who are regretting that decision now. I imagine there might be."
About 480 employees at Rutland Regional Medical Center have yet to be vaccinated. Smart, the spokesperson, was unsure how many people were in that group by choice. But she said it was clear there was still a large demand for vaccinations among the area's health workers. "When we put out a clinic, it fills up," she said. "There's no begging. It's lines of people."
Dougherty said the state will likely offer vaccinations "in perpetuity" to people who work in the health professions to ensure that both new hires and those who decided to wait have access to shots.
There are limits on how many vaccinations can be offered to those workers, at least over the next few weeks: The state must first ensure a vaccine supply to cover the more than 30,000 appointments made by people 75 years and older, and then must vaccinate Vermonters 65 to 74 years old at a steady clip if it hopes to reach its goal of finishing that group by winter's end.
Moving forward, the health department will determine each hospital's Phase 1a allocation based on how many unvaccinated workers remain in their area, Dougherty said.
Hospitals have requested 2,727 doses for the remainder of Phase 1a, according to Dougherty, though the true need will undoubtedly prove greater. The state sent out 1,095 doses this week.
Copley Hospital has a wait list of more than 450 people that Jennifer Holton-Clapp, a hospital official, compiled. She expected the list to grow in the coming days; last Friday, one employer said it would be sending over up to 50 more names. Given this, Copley requested 300 doses for this week, but it received only 100.
Rutland Regional Medical Center requested 400 but is receiving only 250; Smart said the hospital has managed to eke extra doses out of vials of vaccine and hoped to "squeeze out as much as we can" from the latest shipment.
Other hospitals had better luck. Northeastern Regional Medical Center requested 300 doses for this week and expected to received 190, according to Laural Ruggles, the hospital's vice president of marketing and community health improvement.
"We're pretty happy with that," Ruggles said, noting the hospital has begun rescheduling canceled appointments.
Jim Hinman, a volunteer firefighter in West Burke, had mixed feelings about the snafu that forced him to miss out on getting the vaccine this week. On one hand, moving on to the next phase without first vaccinating emergency responders like him "didn't make much sense," he said. Yet the 57-year-old doesn't consider himself at high risk of dying from the illness, so he couldn't help but feel a little bit guilty about finding himself at the front of the line.
"I'm not mad about it," he said last Friday morning of losing his appointment. "I think the higher-risk 75-year-olds who are getting it now probably should get it. I don't want anybody else to die."
Still, Hinman did not hesitate when the hospital called him Friday afternoon to offer him another vaccination date, knowing it would help protect not only him but his family. He's now scheduled to be vaccinated on February 9.
After almost a year under the pandemic's cloud, he said, "I want it all to be done."