The vaccine is good, and it won’t solve our problems.
I spent months trying to figure out when it would be my turn to receive a COVID-19 vaccine. And like many in Massachusetts, I did not have much help in that quest from our political leadership. Governor Charlie Baker seemed downright blasé in February as vaccination efforts got off to a slow and confusing start.
Massachusetts is catching up, and I managed to get vaccinated a couple weeks ago at a CVS MinuteClinic. (Full disclosure: I have two eligible medical criteria, and the nurse delivered on her promise of a painless jab.) More residents are becoming eligible today, and Massachusetts’s vaccination strategy is also getting a boost from the federal government.
But many were still scratching their heads about February’s vaccine chaos. And there is an unacceptable racial lag as people in working class, communities of color face extra obstacles to vaccination. As of April 1, more than 33 percent of white residents have received at least one dose compared with 22 percent of Black people and 15 percent of Latinx people.
What happened? How did a state that is said to be a leader in healthcare, with a governor who ran on supposed technocratic cool and credentials from the health insurance industry, flub the early vaccination effort so thoroughly? Half of the answer is that leaders like Charlie Baker don’t really care that much about science. At almost every juncture, the governor’s office has tried to rush the re-opening: last spring when the worst was still to come, this winter when the vaccine was not even out the door, and now, in our schools, when teachers have not yet been fully vaccinated.
Even as they selectively refuse to actually “follow the science,” leaders like Charlie Baker have eagerly and successfully adopted the rhetoric of science. They have cast the pandemic as a purely biological crisis with a scientific solution. They seem to believe that this will help them manage the misery and dissent that this pandemic has exposed — that it will help them manage us.
But the problems with the Massachusetts vaccine strategy are deeply political. The last several months have been plagued by cozy powerbrokering, creeping privatization, hostility to public sector workers, and an unwillingness to address big problems with broad social programs. Even if everyone eventually receives the vaccine, these social ills will remain.
The Baker administration’s first big stumble was granting the state’s powerful hospital systems control over the earliest stages of the vaccination effort. We were told this was necessary to vaccinate healthcare workers who are in harm’s way. That is a worthy objective, but it did not go quite as planned.
According to GBH News, doctors at Boston’s Brigham and Women’s Hospital were concerned that the employee vaccination process had become a “free for all,” leaving some patient-facing workers unvaccinated while others received the vaccine. All winter, I heard anecdotal reports of hospital employees receiving the vaccine even though they work from home in functions like human resources and scientific research.
Another reason to empower the hospital systems was equity — making sure that the vaccine reaches marginalized communities, vulnerable people, and people of color. We need equity in this process desperately, but Governor Baker has used the concept as a figleaf. In late March, the governor seemed too eager to blame early delays on equity efforts. This confuses the issue and forces a false choice between equity and speed. Many, including Senator Elizabeth Warren, wondered: Why not both?
Local health authorities report that they were marginalized at the same time that big hospitals were empowered. Under-utilized public sector workers could have helped funnel vaccines to residents in a full-spectrum approach that promoted equity. Why didn’t they have a chance?
It might have something to do with the power of big hospital systems in our commonwealth. Mass General Brigham (formerly Partners Healthcare), for instance, is the largest employer in Massachusetts and a gold-plated medical brand with clout on Beacon Hill. These organizations are technically non-profits , but they still seek revenue and generate piles of cash. Mass General Brigham is perennially ranked the most expensive health provider in Massachusetts, with a huge impact on total healthcare costs. These private entities have their own, often surprising, definitions of the public interest. Last year, The New York Times named MGH as a prime example of hospitals that overcharge for care.
Big hospitals were positioned to get what they wanted in the vaccine effort, but they quarterbacked a very slow first quarter. By the second week of February, even the Baker administration seemed to realize that the hospitals were not delivering and curtailed their doses. After loud complaints from Mass General Brigham and others, the flow was restored.
Since then, it’s become even more clear that this process is shaped by the governor’s belief in health privatization. Burned by the hospitals, Governor Baker began touting the speed of temporary mass vaccination centers. However, facilities like the one at Gillette Stadium were spun up as give-aways to startup companies. Firms such as CIC Health — founded seven months ago by the celebrity surgeon Atul Gawande — received no-bid contracts potentially worth millions of dollars to run mass vaccination sites.
At the same time, Baker abandoned a mass vaccination plan that public health officials had been refining for twenty years. That strategy would have leveraged the expertise of local health departments that had clear procedures for running vaccination centers. Instead, as The Boston Globe quoted Dartmouth public health director Christopher Michaud, the Baker administration “took the playbook, threw it in the dumpster, and privatized the whole thing.” Contrast that with Virginia and other states that “have kept outside contractors from operating vaccine clinics, relying instead on local health departments and public workers.”
The governor is not only dismissive of public health workers; he also went to war with teachers who want a chance to receive the vaccine before returning to the classroom. The Baker administration was fine with police officers having a crack at the jab before many senior citizens, even though police appear highly hesitant to being vaccinated. Teachers are ready to do their part, but the governor dismissed their calls for dedicated vaccination clinics (like those made available to police) and a slightly delayed return.
As the nurse dosed me last week, I thought of the millions of people around the world who were doing this with me, and millions more who might never have the chance. I thought about the deep economic problems and racist oppression that the pandemic has laid bare. The vaccine is good, but as it went into my arm, it seemed silly to think of it as the solution to anything at all.
The vaccine is an amazing breakthrough and a big part of the way forward, but it won’t cure the ills that made this pandemic so destructive. Those problems demand that we state our moral priorities. Will we raise enough money and invest in the permanent infrastructure it takes to care for each other? Will we finally build a publicly-funded system of universal healthcare or just let self-styled technocrats like Charlie Baker privatize our public health?
I was optimistic about politics at the beginning of the pandemic. Embracing our duties and finally achieving universal healthcare will take a mass mobilization of citizens fighting with and for each other. There were hints of that last year — in the Bernie Sanders campaign, the extraordinary unemployment insurance boost, and the powerful protests against white supremacy. But those moments passed. As a modest $15 minimum wage dies in Congress, it seems that leaders in both parties are telling us that a social democratic answer to this crisis is off the table.
The United States and Great Britain responded to the Great Depression and World War II by building their safety nets. As we emerge from our own crisis, I’m struck by how little government did to protect poor people and to help workers keep their families safe.
The vaccine has a funny role in that. It’s the supposed scientific fix that political leaders told us to wait for while they low-balled economic aid and ultimately failed us. Instead of bailing out restaurant workers and paying high-risk folks to stay home, they told us to pin our hopes on the jab. In the rush to re-open, the vaccine was painted as a techno-utopian “solution” to everything.
We need to make the vaccine accessible and affordable to everyone, but we cannot abandon other basic precautions. And we cannot let the vaccine become a massive political sacrament — a mystifying ritual in which Americans shrug and simply accept the way we were led this year, silently reaffirming the order of things. It’s not a utopian exit from political mobilization nor an excuse to ignore the questions swirling in our own commonwealth.
Like the CVS nurse told me, it’s just a shot.