Patchwork system of Covid vaccinations leaves vulnerable Vermonters behind
November 8, 2023 | By Erin Petenko | VTDiggerNote: This story was published originally on VTDigger.org on Nov. 3. Waterbury Ambulance Service holds two more clinics in this series next weekend, Nov. 18-19, at Montpelier and Harwood Union high schools.
People line up to get flu and COVID-19 vaccines inside the Crossett Brook cafeteria. Photo by Glenn Russell/VTDigger
In a way, the vaccine clinic at Crossett Brook Middle School on Oct. 28 was a scene out of 2021.
The clinic was hosted by Waterbury Ambulance Service, an EMS service that administered Covid-19 vaccine doses at the height of the pandemic. Maggie Burke, executive director of the service, said the clinic put 1,100 shots of Covid and flu vaccines combined in the first two days of its run this year.
But this progress was belied by an unfortunate quirk. Because of the way the funding for the clinic was structured, Burke said it was unable to vaccinate anyone 65 or older.
Victoria Rhodin, a Montpelier resident, was one of the people turned away from the clinic last week. She said clinic staffers appeared to be mortified at having to explain to older people who showed up that they couldn’t get vaccinated there.
Rhodin finally got a vaccine appointment for next week after weeks of scouring pharmacy websites and calling doctor’s offices. “There’s just bunches of high-risk people walking around unvaccinated right now,” she said.
For this year’s Covid vaccine campaign, public health officials, local agencies and advocates are finding creative ways to improve access to critical vaccine doses. However, they’re struggling to keep up with demand and fill gaps in the system for the state’s most vulnerable people, particularly older, high-risk or low-income Vermonters.
During the clinic, vaccine doses are kept chilled in coolers. Photo by Glenn Russell/VTDigger
The latest Covid vaccine targets the most recent strains of the disease and is recommended for everyone 6 months and older. It’s also the first Covid vaccine to come out after the end of the federal public health emergency, meaning that it is being distributed through the conventional, commercialized health care system, rather than government-led public health campaigns.
So far, the campaign this year has fallen far behind. Only 8% of Vermonters have received the latest Covid vaccine, according to data from the state Department of Health. That’s compared with about 80% uptake of the initial vaccine and 35% of the population that received last year’s bivalent booster.
The numbers are only slightly better for those 65 and older. About 18% of that age group, the state’s largest category of high-risk Vermonters, have received the updated Covid vaccine, according to the health department.
Celeste Fetter prepares a dose of flu vaccine during a COVID-19 and flu vaccination clinic at Crossett Brook Middle School recently. Photo by Glenn Russell/VTDigger
State epidemiologist Patsy Kelso said the low figures so far boiled down to a lack of supply. The state allocation of the latest vaccine has dropped compared with previous years, so the department has far fewer doses to distribute to provider’s offices and not enough doses to host statewide walk-in clinics.
That leaves pharmacies, which can buy their vaccines on the commercial market. Vermonters have complained about limited appointments and insurance issues at pharmacies, although Burke said she anecdotally heard about more appointments opening up in recent weeks.
But advocates also say the state needs to do a better job of filling in access gaps for Vermonters with disabilities, who also tend to be at higher risk of suffering from severe cases of Covid.
Kate Larose, pandemic equity coordinator at the Vermont Center for Independent Living, is working on a grant-funded program to provide home-based vaccinations and drive-thru clinics targeted at Vermonters with disabilities and their families.
She doesn’t think it’s enough.
“We, as people who are older Vermonters and disabled folks, feel that this is a dire situation even though everyone else in a leadership capacity at the state is telling us, ‘There are no problems. Everyone has access. Super simple. Just go to the pharmacy,’” Larose said.
‘Forgotten folk’
Judy Naef, a retired nurse from Essex Junction, first noticed the signs of Parkinson’s in her husband, Frank, in 2018.
They have no family nearby and cannot afford a home health aide, so Judy cares for him despite her own health issues. The pair has been mostly stuck at home since 2019.
“We’re like forgotten folk,” she said.
Judy can barely drive due to eyesight issues, so anytime one of them needs health care, they must hire an aide to take them to the hospital at $30 an hour.
“Somebody said ‘Go to a pharmacy. There’s one up in the Northeast Kingdom,’” she said. And I live in Essex Junction. It’s not that easy for somebody like me. It’s not even easy to go to Williston or South Burlington or anywhere.”
Larose said Judy and Frank are going to be her “very first phone call” as soon as the center’s program gets up and running. But she expressed frustration that the center, a small nonprofit focused on disability rights, had to step up and fill a need that the state was not meeting.
Larose said she emailed state officials for months, asking what their plan was to vaccinate this population. She said she was told “there’s no issues” even as people called her, crying, telling her they could not get access.
“Public health is not doing what public health has their mission to do,” she said. “So we need to do it ourselves because we’re just being left in the dust.”
The center’s grant is for 800 households, compared with thousands of vaccines distributed to homebound Vermonters during the initial vaccine campaign. Details about the program will soon be available at the center’s website and Facebook page, Larose said.
If all those vaccines were given out “at a time when you couldn’t walk or drive down the road anywhere in Vermont without tripping over vaccine access … we started thinking ‘oh my gosh, what must it be like now?’” she said.
Phyllis Arsenault-Berry checks people in for the vaccine clinic at Crossett Brook Middle School on Oct. 28. Photo by Glenn Russell/VTDigger
Other states like Massachusetts still provide home-based vaccinations.
Asked about homebound vaccine access, state epidemiologist Kelso said people could try the center’s new program. She referred any additional questions to the Vermont Department of Disabilities, Aging and Independent Living, which declined to comment and referred VTDigger back to the Department of Health.
‘Vaccinators of last resort’
Zach Arvin, left, and Amanda Commoli from Waterbury Ambulance Service prepare vaccine doses during a COVID-19 and flu vaccination clinic at Crossett Brook. Photo by Glenn Russell/VTDigger
There are other programs designed to try to improve access to the Covid vaccines — and other vaccines — at low cost. One of them is the Vermont Immunization Program, a state program that buys doses with fees collected from health insurance companies, Kelso said.
But Medicare, a federal insurer, does not pay into that system. That’s why the Waterbury Ambulance clinic had to turn away people over the age of 64, Kelso said.
Kelso said they were looking into how to close that gap.
“It’s really complex because there’s Medicare, which is the federal program, which we’d need to engage with,” she said. “And then there’s also some Vermonters over 65 who still work or have other insurance plans.”
There’s also the Bridge Access Program, which provides vaccinations to people who are uninsured or underinsured. The program is available at some pharmacies and at Federally Qualified Health Centers, which specifically serve low-income and uninsured Vermonters, Kelso said.
In some cases, local health district offices can vaccinate people under the Bridge program, but they typically have to meet other criteria like not having a “medical home,” a place where they typically access health care, said Joan Marie Misek, district director of the Barre Local Health Office.
District offices “are considered vaccinators of last resort,” Misek said. She said people who believe they qualify should call their local office.
Kelso said the number of doses provided to Vermont should slowly ramp up in the coming weeks. She pointed out that the system in place this year is the same system Vermont had before the pandemic.
“The way Covid vaccine is rolling out this year is very similar to the way a flu vaccine rolls out every year,” she said.
About 18% of Vermonters have received the flu vaccine so far this year, according to the health department data. Kelso said that even if you’re struggling to get the Covid vaccine, access to the flu vaccine is not as constrained, so “go ahead and get your flu vaccine at least.”
She said she was encouraged by the demand and interest she was seeing.
“I’m confident that we’ll get there when we have more vaccines,” Kelso said.
Meggan McCusker administers a COVID-19 shot during a vaccine clinic at Crossett Brook Middle School on Oct. 28. Photo by Glenn Russell/VTDigger