Gov. Ned Lamont’s decision this week to brush aside federal and state recommendations on who should next receive the COVID-19 vaccine – prioritizing people by age, rather than by underlying medical conditions or job titles – caught many members of Connecticut’s immunization advisory panel off-guard and raised questions about the group’s role in the remainder of the vaccine rollout.
The move by the governor stunned some members of the panel’s allocation subcommittee, a group tasked with providing crucial advice on who should receive a coronavirus shot and when. Members had suggested that people 16 and older with underlying health conditions and “essential workers” such as grocery store employees and postal staff be next in line.
“The allocation subcommittee had no decision making, no involvement in this, and it is not going [to be], in my opinion, an equity approach first,” Tekisha Everette, executive director of Health Equity Solutions and a member of the subcommittee, told John Dankosky on The CT Mirror’s Steady Habits podcast.
Everette said members of the advisory group received an email from Deidre Gifford, the state’s acting public health commissioner, “moments before” a press release was circulated to the media Monday announcing that Lamont was discarding the current plan for the vaccine rollout and instead going by age. Under the governor’s new plan, people 55 to 64 can begin scheduling appointments to receive the vaccine next week, while those aged 45 to 54 can sign up starting March 22. Residents aged 35 to 44 will be eligible starting April 12, and those 16 to 34 can schedule appointments beginning May 3.
Teachers and other schools staff are an exception – anyone who works in those facilities will be eligible for the vaccine starting March 1, and special clinics will be set up to accommodate those employees.
Everette said she was left wondering what to tell people about the decision. She’s still trying to understand how equity will be a part of it.
“I would have loved a bigger heads up, because, as you can imagine, the phone started ringing, and I had no idea, no context,” she said. “I’m still looking for more information to understand better, how are we rolling out the equity part of it? … And how are we holding people accountable? I’ve already been on the record saying an age-based approach is not exciting to me. So I just want to see how this is going to work.”
Several members of the vaccine advisory group, which convened in October to provide advice on priority among residents, on the science behind the shots and on communication with the public, echoed Everette’s account.
Josh Elliott, a Democratic state representative from Hamden and a member of the panel, said he was not consulted about the decision to move in a new direction and didn’t learn about it until the announcement Monday.
“At the very least, it would seem that if they were going to do this, they would say, ‘Hey, this is what we’re thinking about,’ get some feedback, and then just say, ‘OK, thanks for the feedback’ and still do what they want. But they didn’t even come to the task force for feedback,” he said. “Why have a task force at all?”
Raymond Sullivan, another member of the panel who is also director of the Brookfield Health Department, said he was surprised by the announcement.
“It was pretty much left in the hands of the Commissioner of the Department of Public Health,” he said of the decision. “We have had no discussions about the announcement.”
At least two people interviewed by CT Mirror said they did receive an advance heads up – but only during the weekend before Monday’s announcement.
An age-based strategy alone is not going to address inequities. ”
Nichelle Mullins and Zita Lazzarini, co-chairs of the allocation subcommittee, both said they were contacted about the decision. Mullins said she was asked for her feedback but was under the impression that the administration had made up its mind.
“It was … ‘We think the governor is going to make this decision. What do you think about it?’ There was a little opportunity to provide feedback, but it wasn’t like, ‘OK let’s convene,’” she said. “There wasn’t an opportunity for us to convene a meeting of the subcommittee and say, ‘OK, let’s toss this around.’ When it was presented to me, it was presented as if the governor made this decision.”
Mullins, too, is concerned about equity in the new rollout.
“An age-based strategy alone is not going to address inequities. I understand, given the logistics of trying to figure out [who are] frontline essential workers and trying to figure out the comorbid conditions piece, it’s extremely difficult,” she said. “But we also feel like there’s other work that has to be done to address the inequities.”
Lazzarini said she was able to offer some feedback.
“They called, explained the whole range of their thought processes and what DPH had been struggling with and why the governor was coming down with what he was coming down with, and that they wanted us to know about it,” she said. “I understand how hard it would be to identify exactly who the front-line workers would be by job title, and that it might take more time. … So I can understand that, and that was basically my response.”
Gifford and Dr. Reginald Eadie, the co-chairs of the full panel, confirmed during a recent press conference that they contacted Mullins and Lazzarini but did not elaborate on the extent of their communication with the rest of the advisory panel.
“We have been working closely with our chairs on a variety of issues, who have, in turn, been consulting with members of their various subcommittees,” Gifford said shortly after Lamont made his announcement Monday. “So I think there’s been lots of consultation back and forth.”
‘I am absolutely not sure what our role is going to be going forward’
Several members of the advisory group said that despite an unwavering plan by the governor to continue the rollout by age, Lamont has not disbanded the advisory panel.
But some of them – especially those on the allocation subcommittee – are unsure what role they will now fulfill.
“It’s all up in the air,” said Sullivan, who noted that the allocation subgroup had no future meetings on the books.
The panel’s science and communications subcommittees have clearer immediate priorities – outreach to the public will remain essential, and discussion on the science behind the new Johnson & Johnson vaccine is timely (the Food and Drug Administration could grant the shot emergency authorization as soon as this weekend).
Jason Schwartz, a professor at the Yale School of Public Health and a co-chair of the science subgroup, said his committee plans to meet Saturday to review the FDA’s findings on the Johnson & Johnson immunization and discuss whether to recommend it for use in Connecticut.
“The FDA is meeting, so we’ll continue our work in that regard,” he said. “We have our particular agenda around reviewing these vaccines and vaccine candidates.”
For their part, Mullins and Lazzarini said they are awaiting word on how the allocation subcommittee is going to proceed.
Both are hoping the subgroup will become a checks-and-balances system for equity in the new vaccine rollout plan.
“There was discussion some months ago about the allocation subcommittee morphing into more of an oversight role, working with DPH to ensure the distribution plan was equitable,” Mullins said. “I have not heard much about that since. So at this point, I am absolutely not sure what our role is going to be going forward.”
If the subcommittee were to take on the responsibility of providing checks and balances, though, Mullins said there must be clear priorities and expectations for the group.
“There would have to be a very clear vision and mission about what we are being asked to do,” she said. “What I would hate is for there to be any confusion around our role, any confusion regarding expectations and outcomes. I don’t want people to feel like their time is being wasted.”