In early March, a subcommittee charged with educating the public on aspects of the COVID-19 vaccine met for what would likely be its last time. The single-dose Johnson & Johnson shot had just been granted emergency authorization, and members discussed what kind of outreach health officials might be able to do with the vaccine.
At the meeting’s conclusion, the chairwoman said she was awaiting word from Gov. Ned Lamont’s administration on what the committee – a subgroup of the state’s vaccine advisory panel – would become going forward.
“The decision is not quite finalized at this point as to how we will use the committee,” said Sen. Heather Somers, R-Groton. “Our committee was to provide recommendations on how to communicate. Now the governor’s office has a communications arm, which is doing a great job. So how can we aid them?”
More than a month later, some members of the subgroup are still waiting to hear how to proceed, and many consider their work to be finished. The same is true for members of the main vaccine advisory panel and its two other subcommittees – one that recommended who should be prioritized for the COVID-19 shot and another that discussed the science behind the immunization.
But several members expressed disappointment that they weren’t able to contribute more or weren’t involved in key decisions. Some didn’t feel valued. And the sudden change to an age-based rollout effectively jettisoned hours of work that committee members put in when they thought essential workers and people with health risks would be prioritized for access.
“I have not heard from the Department of Public Health or the governor instructing us about any future role,” said Zita Lazzarini, a co-chair of the allocation subcommittee, which debated who should qualify for the vaccine and when. “We were originally told that it could be nine months, we could have nine months to a year of being available. But I haven’t heard anything about future meetings at this point.”
Lamont’s full vaccine advisory panel, formed in October to study the efficacy of the shots, to weigh who should receive them first and to help strategize public outreach, hasn’t met since Jan. 14. Two of its subgroups, focusing on allocation and science, haven’t convened since February. And the third, focused on communication, last gathered on March 4.
Some members consider themselves to be on standby, should the governor or the state’s public health department need advice on a new vaccine or booster shot.
Gov. Ned Lamont said members could be tapped to offer advice when coronavirus vaccines are approved for children, or when booster shots become available for already-vaccinated adults. But he gave no formal commitment on when or if the group’s expertise would be sought again.
“I think they’re definitely on standby,” Lamont said. “My instinct is that over the course of next couple months, if we find out about vaccines for younger people, if we find out about booster shots, depending on what the variants are, that group could be busy again.”
Acting Public Health Commissioner Deidre Gifford, a co-chair of the full vaccine advisory panel, did not respond to requests for comment.
As the panel sits idle, people who served on the main committee and its subgroups say the administration should launch a review of what worked and what didn’t – how some members were central to the strategy and others felt sidelined, what was considered successful and what opportunities were missed – should a similar panel be created for the next public health crisis.
“We could think about what to do in the next pandemic, even if it doesn’t mirror this one. It’s always good to do a post-analysis of what went well and what went less well,” said Lazzarini, a UConn Health professor. “I do think that between the health department and something like the allocation subcommittee, we could look carefully at the things that really worked well and the things that didn’t and make recommendations for the future.”
Shift to age-based rollout was a curveball
The first few months of the vaccine rollout were a flurry of activity for Chris DiPentima. The head of the Connecticut Business and Industry Association, who was a member of both the full vaccine advisory panel and its communications subcommittee, helped organize webinars with companies across the state, sent literature addressing frequently asked questions about vaccines and talked with employers about the latest updates.
At the virtual sessions, which brought together medical experts, state officials and dozens of business leaders, CBIA spent hours fielding questions about who would qualify for Phase 1B, a stage of the vaccine rollout that was supposed to include essential workers like postal staff and grocery store employees, along with elderly residents and people who have certain underlying medical conditions.
Then in late February, Lamont threw a curveball and abruptly switched to an age-based rollout.
DiPentima said many employers were grateful they wouldn’t have to agonize over which staff members qualified for access or how to sign them up. But frustrations were aired over the weeks spent planning for a stage of the rollout that never arrived, and having to explain to workers who were next in line for the vaccine that they would now have to wait.
“I expressed the disappointment of letting air out of the balloon with the pivot, because we had all kind of worked up to this day,” DiPentima said. “These businesses had all spent countless hours – hundreds of hours – trying to understand this next phase and what was going to be required of them. They invested a lot of time, and now we were changing the rules on them.”
On top of that, he said, “those workers who have to go into the office – the 40-year-old worker who is still going to have to go in the office every day, or go onto the manufacturing floor every day and be exposed to colleagues and circumstances where maybe the virus was prevalent – they’re going to be further down the line.”
DiPentima and his colleagues devoted a lot of time to the process, too. CBIA hosted multiple webinars, some of which drew more than 300 attendees from the business community, in the weeks leading up to when essential workers would have qualified.
“I remember, just a week before we pivoted to the age-based rollout, there was a 60-minute webinar, and we had over 70 questions we were able to answer,” he said. “We had even more questions we weren’t able to answer, because we ran out of time. … People spent so much time preparing themselves for this next phase.”
DiPentima wishes more members of the vaccine panel had been consulted about the shift to an age-based rollout. A handful of people, including some leaders of the advisory subcommittees, were asked for their thoughts just a day or two before the announcement was made, while many others were left in the dark.
DiPentima received a phone call shortly before the announcement and expressed a mix of support and concern.
“It was certainly a challenge, because there were a lot of moving pieces,” he said. “Obviously, it would have been great if the [advisory group] was part of that conversation around going to age-based.”
The Rev. Robyn Anderson, a pastor at Blackwell Memorial AME Zion Church in Hartford and a member of the vaccine panel’s communications subgroup, said once the state decided it would prioritize residents by age, she focused on helping people to not feel discouraged.
The organization she co-founded, The Ministerial Health Fellowship, conducts regular outreach in communities of color. During the pandemic, that has included everything from talking to residents about the COVID-19 vaccine to handing out educational information and wellness packages with masks, thermometers and other supplies.
“Because people of color were dying at a disproportionate rate, they really thought the [vaccine rollout] was going to be based on pre-existing health conditions, like diabetes and high blood pressure. And that wasn’t how it happened,” Anderson said. “That put somewhat of an emphasis on – here we go again, not really thinking about the fact that people of color are the ones dying in a disproportionate way. And here we are, changing the whole scope of the rollout.”
After priorities shifted, Anderson said she spent time urging people to still get vaccinated when it became their turn.
“As soon as it was available, that’s when we wanted to make sure they came out to get vaccinated,” she said. “Not to let [the change] discourage them, but using it to put even more of an emphasis on getting vaccinated.”
Victories, missed opportunities
People who played central roles in the vaccine advisory group’s work, including some leaders of its subcommittees, said they felt a sense of purpose and contribution.
Somers, who headed the communications subgroup, described a series of virtual forums she and others put together with health officials to share information and dispel myths. The forums reached a variety of audiences, including nursing home residents and workers, boards of education, municipalities and the business community.
“It’s been very successful in the uptake of people willing to take the vaccine after they’ve had an opportunity to ask questions,” Somers said.
Jason Schwartz, a professor at the Yale School of Public Health and a co-chair of the panel’s science subgroup, said he and others are proud of the work they’ve done – reviewing the safety and efficacy of coronavirus vaccines and making recommendations on whether Connecticut should embrace them. Members of the subcommittee also participated in online forums and other outreach.
“Our subcommittee really did look extensively at all three vaccines as they were moving toward authorization. We looked at hundreds of pages of filings and data and reports around each of those vaccines,” Schwartz said. “We met openly to discuss them and made formal, written recommendations to the governor and to the [main] advisory group.”
But while some members had a clear mission, others on the advisory panel and its subgroups said they were unsure about their roles or felt they didn’t have a voice.
“I didn’t feel valued, to be honest,” Anderson said. “There wasn’t really a knowledge of people who were on the committee, who could give more input in terms of what kinds of things really do work.”
Anderson said she was asked to do certain types of outreach she already had been doing through her organization.
“I think a better way of going about it would be understanding who is on your committee, why are they on the committee, and how you can leverage their work and expertise,” she said.
Anderson also had hoped to see more engagement in communities of color, especially one-on-one interactions, as the advisory group did its work.
“Not everybody goes to webinars and seminars,” she said. “You would have to have a plan to do outreach by going door to door. I felt like that piece of it lacked.”
For Josh Elliott, a state representative from Hamden who served on both the main advisory group and the communications subcommittee, the process lacked structure.
“We had some really good people who were part of the subgroups, but it never really coalesced,” he said. “It was unclear from the start what the intent and goal of the task force was. It seemed like we were searching for something to do, and we never figured out exactly what that was.”
Part of the problem, some leaders acknowledged, was the size of the committees. While the science subgroup had 12 members, the allocation subcommittee had 18 and the communications subgroup had 31. For the larger groups, discussions at times became unwieldy.
“It was obviously the first time an advisory committee like this was put together,” Somers said. “There were times during the process that some committees felt like they didn’t really have the authority to trudge forward with what they were tasked to do.”
“Some of the groups were also awfully large,” she added. “It’s a lot of people to keep engaged. To try to [help people] feel as if everybody is contributing at their highest level, that’s tough.”
On standby
With recent news that use of the Johnson & Johnson vaccine is paused while officials investigate six cases of a rare clotting condition, advisory group members say they’re available should the administration need advice.
Some members are also hoping to be consulted when booster shots are rolled out, possibly this fall. Leaders at Pfizer said recently that recipients of the company’s vaccine would likely need a third dose, six to 12 months after the first two.
“There may be issues that would be reasonable for us to address, either for boosters or secondary shots,” said Lazzarini, the co-chair of the allocation subcommittee. “It depends on how the supply of those goes, how emergent it seems, all of those things.”
Schwartz has alerted the Lamont administration that he and his colleagues are ready to provide guidance on the Johnson & Johnson vaccine. The federal Advisory Committee on Immunization Practices met Wednesday but did not vote on recommendations, meaning the pause could last a week or longer.
“At the moment, the federal health agencies … are well positioned to evaluate the evidence regarding the J&J vaccine and update their recommendations accordingly,” Schwartz said. “After we all hear from those agencies and their advisory committees in the next few days, we’ll remain available to help the state in any way that they request.”
