To register for a vaccine appointment or get information on walk-in clinics, visit healthvermont.gov/MyVaccine or call 855-722-7878.
You will be asked to provide your name, date of birth, address, email (if available), phone number, and health insurance information (if available, but not required).
The plan to vaccinate Vermonters has been celebrated — more than 46,000 Vermonters have been immunized so far — but it has also touched off controversy.
Vermont has used age as the determining factor for who gets vaccinated first, starting with the oldest residents first and following with those with high-risk conditions. In other states, large swaths of the population have been eligible to get the vaccine right away.
“Over 70% of Covid-19 deaths have been among Vermonters 75 years or older and more than 90% among aged 65 and older,” Mike Smith, head of the Vermont Agency of Human Services, said at a recent press conference. “Given these facts and the limited number of doses that states are receiving from the federal government, we have an obligation and moral obligation to take this age-based approach.”
The state’s approach has drawn criticism from essential workers who believe they should be prioritized for the vaccine over older Vermonters and certain health care workers. The Vermont-National Education Association sent an open letter to the state, expressing frustration that ski patrollers got the vaccine ahead of classroom teachers.
“As the governor seeks to return to full in-school learning, the vaccination of school employees will be essential for the health and safety of students, educators, and the community,” union officials wrote.
But how was the decision made in the first place?
On Dec. 31, the Vermont Vaccine Implementation Advisory Committee issued recommendations to the state that broadly aligned with the Vermont Department of Health’s current plan: Vaccinate health care workers and long-term care residents and workers, and then prioritize Vermonters by age.
Details of the committee’s reasoning have not been made public. Meetings, reports, documentation and even the names of the committee members have not been disclosed, although the state posted the organizational affiliations of committee members.
Based on health department information about the committee, it appears to have included employees of several state agencies, health care providers and hospital networks across the state, and representatives of nonprofits and advocacy groups.
VTDigger was able to identify and speak with several members of the committee, but the Vermont Department of Health declined to provide a full list upon request.
Asked about the lack of transparency, one committee member said, “That’s not good.”
“It should be a public meeting convened by the state government,” said Mike Fisher, chief health care advocate for Vermont Legal Aid.
Ben Truman, a spokesperson for the Department of Health, said the committee was formed based on guidance from the Centers for Disease Control, which called for an “implementation committee to enhance development of plans, reach of activities, and risk/crisis response communication messaging and delivery.”
Based on that guidance, Truman said, the committee was an “ad hoc” group.
“As a purely advisory body with no decision-making or budgetary authority, agendas or minutes are not published, as they would be as required of a formal public body,” Truman said via email.
It’s unclear how much of a role the panel had in the final decisions. Fisher said one “positive” of the committee was that it “allowed a process for people to voice their opinion,” but it was ultimately only an advisory committee.
“They didn’t attempt to get a consensus,” he said. “It was just a forum for people to address their viewpoints.”
Dr. Tim Lahey, an infectious disease specialist and medical ethicist who was on the committee, said members weren’t part of the discussion on whether their names should be kept private. He wondered if it could be tied to safety concerns, citing threats against vaccine distributors.
The system has to operate with “public trust,” he said, and he wants people to know that conversations are happening about prioritization.
“I’ve felt reassured that nobody has all the answers, but the people are really trying hard to kind of take the national guidance … and make it work for Vermont, and along the way to be attentive to what’s possible,” he said.
How the recommendations were made
The committee’s recommendations are similar, but not exactly the same, as Vermont’s announcements so far. Its report, for example, slots age groups by 75 and over, then 65 to 74, rather than including a 70-and-older group like the state has.
It recommends that Vermonters ages 40-64 with high-risk conditions come after those slots for the oldest Vermonters, while the state has decided that all people with high-risk conditions will qualify for the vaccine after people 65 and over are done.
The report also includes frontline workers as a priority group, although seemingly placed after the older age group and high-risk conditions. The state has not said whether it will prioritize frontline workers before the general population.
Dr. Harry Chen, head of the committee and former commissioner of the Department of Health, said from the beginning, the committee was forced to consider the question of who to prioritize from different lenses: An ethical one, but also a practical one of what the state could do.
“We can talk about applying a very granular, surgical work and you can’t do it. It doesn’t work,” he said. “It has to be feasible, it has to be implementable and then finally ethical.”
Chen said the committee was given little clarity from the federal government on how vaccine distribution would happen.
“Whatever they said last week is going to be different. Obviously, it has changed today from what they said before, and then there are ever-changing allocations,” he said.
The vaccination plan, he said, has been a “challenging, extraordinary endeavor.”
“As always, there’s a lot of competing priorities, all of which have absolute merit. But in the end, everyone will get vaccinated who wants to,” he said.
The panel worked to define the highest-priority groups, starting with the first phase of the vaccination process: Health care workers and long-term care residents and staff.
Chen said the members tried to give examples of which health care workers would qualify based on “what the risks of exposure were,” along with the person’s role in important Covid treatments.
“If an ICU doctor or ER doctor is not there, what does that do to our underlying health care system and ability to take care of patients? Obviously it makes a big difference; that’s why they’re first on the list,” he said.
That group always was meant to include first responders, he said. “It’s their job is to respond to health emergencies, and fulfill their criteria of being a health care worker with patient contact.”
Asked about the recommendation to prioritize Vermonters by age, Chen echoed state officials’ argument in favor of the decision: It saves lives.
“We want to prevent illness and death, prevent infections and want to keep society going and we want to prevent spreading to others, and then kind of the three parts of helping us decide are science, what the data say, and implementation,” he said.
He said the committee didn’t intend its list to be a strict guide.
“This is kind of a general prioritization,” he said. “You can’t, can’t go through the list and say ‘we’re not going to do anybody until everyone over 75 is done.’ So there’s overlap all the way through all of these different kinds of bullets, so to speak.”
The committee reviewed CDC guidelines on the most high-risk conditions to help the Department of Health decide where to place those Vermonters on the priority list and how to classify them, Chen said. The state’s final list of conditions that qualify for a vaccine mostly follows those guidelines, although it excludes smokers, one category the CDC includes.
And finally, the committee also recommended that frontline, essential workers be prioritized after older Vermonters, Chen said, based on CDC recommendations.
At a press conference Jan. 27, Gov. Phil Scott said the state had not yet decided yet what the next steps would be after older Vermonters are vaccinated.
“There may be strategic areas that we want to focus on; we just don’t know at this point,” Scott said. “But we’re going to get through those phases first, and then reflect on where we go from there.”
Chen said the committee discussed different scenarios of where to put frontline workers on the list and invited members to comment on them, then tried to reach a consensus.
“I was trying to come up with a final prioritization that kind of made everybody a little unhappy, right?” he said. “That’s kind of the legislative process.”
Committee debate
Fisher, the Vermont Legal Aid advocate who was a member of the ad hoc group, said he was unhappy with the plan.
Fisher pushed for people in congregate living facilities — prisons and homeless shelters, for example — to be higher on the list, but they ultimately landed behind frontline workers.
In a letter to the group shared with VTDigger, Fisher acknowledged there is “no perfect answer” to the question of vaccine scarcity, but said incarcerated Vermonters have a right to good care.
“Incarcerated Vermonters are living in congregated high-risk settings and should not be denied care as a form of punishment,” he wrote in the letter. “This population should be amongst the next groups to be vaccinated. It makes sense to vaccinate prisoners and correctional officers at the same time.”
Fisher said people in congregate facilities should also be prioritized because they are not able to socially distance.
“We are asking each other to engage in some different social dynamics in order to protect ourselves and each other,” he said. “There’s some people who just can’t do that. If you’re living in a homeless shelter, you can’t do that. … Similarly, if you’re in a correctional facility, you don’t have control over the correctional officer who’s coming to the door who’s interacting with you. And so that’s sort of the frame that I entered.”
As of Jan. 26, 244 incarcerated Vermonters had tested positive for the virus, including 185 at a contracted prison in Mississippi, according to Department of Corrections data. Nationwide, about 275,000 prisoners have gotten Covid and more than 1,700 have died, The Marshall Project reported.
Fisher was also one of several committee members who advocated for measures to protect Vermonters of color. That discussion led to the only instance of outsiders reaching out to the committee that Fisher knew of: The Social Equity Caucus sent a letter to the committee, asking that the Department of Health consider people of color a high-priority group.
“We are writing to urge that the next immediate priority group — a Group 1c — be those in the known BIPOC health disparity subgroup, which has higher rates of both contracting and experiencing higher adverse outcomes from Covid-19,” the letter said.
The final recommendations did not put people of color in a specific priority group, but added an asterisk specifying that they should be targeted within each group. Dr. Mark Levine, the health commissioner, has said the state will take measures to ensure vaccine access for Vermonters of color.
State Sen. Kesha Ram, who worked on the letter, said it was inspired by “The generations of mistrust that a lot of [Black, Indigenous, and people of color] Americans have toward new medical procedures and vaccines and just the feeling that they have access to the health care system.”
The letter also points to data showing that people of color in Vermont have a far higher rate of Covid than white Vermonters. Though the data on deaths among people of color is small, national data shows that Black, Hispanic and Native Americans have a higher death rate due to Covid.
Ram said the caucus got an informal response from the committee and heard it touched off conversations within the Department of Health. She said the letter-writers “wanted to be flexible” in what they asked for, particularly in the middle of a pandemic.
“If we say they’re a priority, then what we hope is that at least they won’t be left behind,” she said.
Fisher said he feels the pain of Vermonters waiting for their turn to get the vaccine. “I’m not at all surprised that people look at who’s getting vaccinated and they wonder about the fairness,” he said.
“The right answer is we get everybody vaccinated,” he said. “The right answer is we have enough vaccine, that we don’t have months and months of rolling it out.
“And so I kind of have to carry both sides of understanding the frustration and concern from Vermonters, and also, making the best decisions possible to support people who are most likely to experience serious illness.”
To register for a vaccine appointment or get information on walk-in clinics, visit healthvermont.gov/MyVaccine or call 855-722-7878.
You will be asked to provide your name, date of birth, address, email (if available), phone number, and health insurance information (if available, but not required).
