Days after the Mass General Brigham hospital network began vaccinating its employees, healthcare staff have raised concerns the distribution system has been chaotic and inequitable. The problems, they said, stem partly from scheduling challenges and allowing hospital personnel to “self-police.”
Doctors at Brigham and Women’s Hospital, one of the nation’s most prestigious hospitals and part of the Mass General Brigham system, called the roll out a “rat race” and a “free for all.”
They said the system left some people who work directly with COVID patients unvaccinated, while others who have little or no contact with COVID patients have received vaccinations.
“After working for 10 months in this pandemic, this feels like a slap in the face,” said one doctor at Brigham and Women’s who requested anonymity for fear of retribution. “It feels like they don't care about us.”
“It makes me feel awful that anyone feels anything less than fully valued,” said Paul Biddinger, the medical director for emergency preparedness at Mass General Brigham. In an interview with GBH News, he acknowledged the challenges and missteps in rolling out a vaccination program for an organization with more than 80,000 employees. Biddinger is also chair of Gov. Charlie Baker's Vaccine Advisory Group.
“There are a lot of lessons to be learned in the communications and the roll out plan that we absolutely need to address,” he said Sunday. “We have been working on this very, very hard in the last couple of days, with changes coming starting tomorrow.”
For several weeks before Mass General Brigham received nearly 9,000 doses of the vaccine, it was busy preparing. Leadership sent a series of emails to the staff outlining the plan to distribute vaccines to its thousands of healthcare workers. They shared infographics to explain the roll out strategy and they hosted virtual town hall meetings.
Employees would be eligible to receive the vaccine in waves. The first workers to receive the vaccine — those in “Wave A” — included those who come into direct contact with COVID patients as part of their work. Mass General Brigham emphasized that this wave included not just doctors and nurses but also cleaners, transport personnel and others. These essential workers would verify their wave in an app called COVID Pass where you could sign up for a vaccine appointment.
But, when the first vaccines came, the app crashed, and doctors started criticizing the hospital network's communication, as well as a core tenet of the distribution plan: an honor code in which employees simply answer a few questions in the app to confirm which wave they would be in.
On Wednesday, the COVID Pass app — the same mobile app used throughout the pandemic by employees to attest to their lack of COVID symptoms before coming to work — crashed because so many employees were trying to schedule appointments simultaneously on the day before the vaccinations were set to begin.
When the system came back online the next day, employees at various hospitals within the network were allowed to sign up at different time slots. Yet employees were upset that communication regarding the new rolling sign-up system, as well as the windows to sign-up, were sent out when many night shift workers were asleep and many of those on duty could not easily access their phones. They said the result was that many of them missed the short window when appointments were available.
For example, Brigham and Women’s Hospital sent out a communication regarding the new system at 8:46 a.m. Thursday, and their window for sign-up began at 3 p.m. that day. At 3:10pm, an email was sent saying there were “no more vaccine appointments available via online scheduling at this time.”
“It absolutely did create a frenzy, which is the opposite of what we want to do with this system,” acknowledged Biddinger. He said hospital leaders are working on a new system that will address these scheduling problems and that they are running the proposed solutions past those who have reached out with concerns.
Even for the staff members who were awake and available during the sign-up window, there was concern regarding a system that was described in internal emails as one in which healthcare personnel “self-police.” The idea was to rely on the “personal integrity” of employees in prioritizing those most at risk.
Emily Moin, a doctor at Massachusetts General Hospital — part of the Mass General Brigham network — took to Twitter to air her complaint.
“A first-come first-serve scramble for vaccination appointments explicitly disadvantages people who work more," she wrote. "This isn't sour grapes that I didn't get as ‘lucky’ as my colleagues who were able to get vaccinated.”
“This was entirely predictable," she wrote. "This system was doomed to fail and designed — whether by ignorance or incompetence — to exacerbate inequities in our system. But it's being touted as a success because people are still getting vaccinated.”
A physician at Brigham and Women’s Hospital who asked not to be identified for fear of retribution described not getting an appointment online and, after a shift caring for COVID patients, walking to the vaccine clinic and convincing a person giving the vaccines to give them a shot. This doctor reported watching as others were vaccinated, including surgeons who typically only see patients after they’ve received a negative COVID test.
Biddinger said the honor code system was necessary. “It's actually relatively complex to figure out who is working where because of the complexity of an academic medical center. We have staff who move among our hospitals and work in different roles in different hospitals,” he said.
He said leaders are aware of concerns that those who should not have been in the first wave signed up anyway. He said they are reviewing data to determine how often this actually happened and that some staff members contacted his office to apologize for signing up too early and said they had misunderstood the system. Going forward, he said, there will be clearer questions to help employees determine their most appropriate wave.
Concerns about how hospitals have distributed vaccines have surfaced elsewhere in the country. In California, medical residents — doctors who recently graduated from medical school — at Stanford Medicine were not initially included in the algorithm to allocate vaccines. After residents protested, Stanford apologized and reversed course.
Mass General Brigham expects to receive more doses of the vaccine this week. It anticipates vaccinating all eligible medical personal within about eight weeks.