Phoebe

Phoebe Walker, director of community services at the Franklin Regional Council of Governments, serves as the only Western Massachusetts-based member of Gov. Charlie Baker’s COVID-19 vaccine advisory committee.

photo provided by PHOEBE WALKER

{child_flags:featured}State advisory board member

answers vaccination questions

{child_byline}By Francesca Paris, The Berkshire Eagle{/child_byline}

As COVID-19 vaccines sped toward emergency use authorization last fall, Gov. Charlie Baker convened an advisory committee to help determine who should get the vaccines first in Massachusetts.

The committee, which is made up of epidemiologists, infectious disease specialists, lawmakers and other stakeholders, has helped advise the Baker administration about how to shape the state’s vaccine rollout.

Among the committee’s experts, there is just one voice from Western Massachusetts: Phoebe Walker, director of community services at the Franklin Regional Council of Governments.

Walker sat down with The Eagle to answer questions about how the state came up with its priorities. This conversation has been lightly edited for clarity and length.

Q: How did you get on this committee?

A: I was invited directly by Dr. Paul Biddinger, of Mass General Brigham, the chair.

Q: What is the purpose of the advisory group?

A: It was convened to propose a prioritization rank. There is another group of people working on communications. This committee was really about trying to come up with Phase One, Phase Two and Phase Three.

We were looking at epidemiological information about who is the most vulnerable, who is dying of this disease, and the demographic information about how many people fit into each phase in Massachusetts. And we debated the purpose of the vaccine in our state.

Q: Massachusetts took longer than other states to start senior vaccinations. That’s because we chose to vaccinate more population subgroups during Phase One than other states did. What was the thinking behind that decision?

A: We really wanted to put equity first and foremost. That meant we were really thinking about who was most vulnerable, and trying to make thin slices of Phase One to make sure they didn’t get left behind.

Many states, for instance, didn’t prioritize people in prisons. But, COVID has had a dramatic impact in prisons across the country. (According to The Marshall Project, 1 in 3 Massachusetts prisoners has tested positive for COVID-19, nearly five times the rate of the general population.)

So, we included them, and other people living in close quarters with each other. People in substance abuse treatment, people in group homes. They cannot get away from each other. They cannot keep safe at home.

The other group in Phase One that was not as visible in other states was home health workers. They are at the front lines of care for the most vulnerable people. If they’re sick, they’re infecting people when they go into their homes.

Q: This month, the Centers for Disease Control and Prevention suggested moving people 65 and older up in priority, and the governor eventually decided to do so. Did the advisory committee recommend that change?

A: We explicitly decided not to. We recommended against moving 65-year-olds up, because there was not going to be enough vaccine in Massachusetts.

Q: People with two or more comorbidities will be eligible next. Some people have criticized the idea that smoking, a proven comorbidity, counts toward a person’s eligibility. How did the committee determine what should qualify?

A: We took our list from the CDC. As the pandemic goes on, we’ve learned more and more about what groups belong in that high risk. For instance, it was relatively recently that the risk to people with Down syndrome was discovered. That’s why we didn’t make a list. We said, “We’re going to use the CDC’s list.”

And that’s because this isn’t a list of the deserving. It’s a list of who is most likely to die if they get COVID.

So, a person may feel that it would be wrong for smokers to have an advantage. But, in this situation, that person would have to be a smoker and have one of the other serious conditions listed. And the reason they’re on the list is because that makes it significantly more likely for them to die. We don’t want to lose any more people in Massachusetts.

Q: There are two comorbidity lists on the CDC’s website. The first lists people who “are at increased risk,” while the second lists people who “might be” higher risk. Only people in the first list are eligible. Are you worried about people getting that mixed up?

A: I understand the website is very challenging, and we’ve requested for [the state to make it] clearer. Right now, the state’s website sends you to the CDC. If you don’t read the language on the CDC’s website, you might not understand that it’s just the top list that applies.

That’s hard for people. As that phase gets closer, it’s gonna be way more important, cause people really want to know, “Does my asthma make me eligible?” (The answer, according to the current CDC list, is no.)

Q: Was the advisory group concerned about people lying about comorbidities?

A: The state’s approach has been that this is an honor system. You do attest “under pains of perjury” that you qualify.

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It would be completely unwieldy for folks to only get that vaccine from places [such as doctor’s offices] that could confirm they had the illnesses. But, yes, the self-attestation, how you prove that you do fit into all these slices of each phase, that is a weakness in the system.

Q: Later in Phase Two, some workers will become eligible. Not all people deemed “essential workers” by the state will be eligible, however. For example, journalists are considered “essential workers” but are not listed on the state website for Phase Two. How did the committee think about who should be in that group?

A: We had a lot of discussions about how to define that, what categories to keep in that. That was tough. It was really difficult.

We agreed early on that our guiding principle was going to be to prevent death and to acknowledge the inequitable impact of COVID on certain groups of people — so, we tried to keep those two things in mind the whole time.

Q: Let’s talk about Western Massachusetts. Some people in Hampshire and Franklin counties are making appointments in the Berkshires because of a lack of clinics in their region. On top of that, the state temporarily capped shipments for individual local health departments at 100 doses of the Moderna vaccine per week due to lack of federal supply. Are you worried about vaccine availability across Western Massachusetts, especially in areas far from mass-vaccination sites?

A: Yes, I am. I understand why, for efficiency’s sake, [the state] may be trying to put the emphasis on mass-vaccination sites, but for many residents of rural Massachusetts, that’s just not an option.

I think local health departments here understood they had a vital role in getting vaccines to the most vulnerable people and people who can’t find their way easily to the state’s mass-vaccination sites. So, the sudden change was very disappointing. Some legislative action has resulted in some wiggle room, but only with the Pfizer vaccine, which is a bit more challenging to manage.

Q: What are you most concerned about in the rollout?

A: If Massachusetts had invested in local health departments like every other state, this would have gone really differently. If every community was served by a robust public health nursing function, with contact tracing and regular flu shots, if vaccination and communicable disease management were a regularly funded part of government services that cover Massachusetts residents, this would have been dramatically different. It would have been better, and it would have been easier.

Q: Is the advisory committee still meeting?

A: We did meet this week, and I believe we’ll meet next when the Johnson & Johnson and AstraZeneca vaccines get their emergency use authorizations, to talk about how to use those in Massachusetts.

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{child_related_content}{child_related_content_item}{child_related_content_style}Bio Box{/child_related_content_style}{child_related_content_title}Comorbidities listed by the CDC that qualify during the process{/child_related_content_title}{child_related_content_content}

Cancer

Chronic kidney disease

COPD (chronic obstructive pulmonary disease)

Down syndrome

Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies

Immunocompromised state (weakened immune system) from solid organ transplant

Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)

Severe obesity (BMI ≥ 40 kg/m2)

Pregnancy

Sickle cell disease

Smoking

Type 2 diabetes mellitus

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Francesca Paris can be reached at fparis@berkshireeagle.com and 510-207-2535.