In Massachusetts, many young, healthy people who work remotely have been rolling up their sleeves to get the COVID vaccine. Meanwhile, many at-risk seniors have waited on the sidelines, not yet eligible for the shots.

This situation has infuriated many older adults. Carol Halberstadt, 82, is one of them.

She has been locked in her apartment just outside Boston since the beginning of the pandemic. Nobody comes in. Nobody goes out.

“I have become more and more despairing and lonely,” she said.

Halberstadt has a long list of complex medical conditions. The most urgent one, she said, is her failing eyesight. She said she’s in desperate need of eye surgery, but in order to be in a hospital safely, she needs to be vaccinated.

“A vaccine would change my life. It would give me a future,” she said.

For weeks, she has been trying franticly to get the vaccine, reaching out to doctors, organizations and state officials who she hopes can help. But, to no avail.

Halberstadt has watched as seniors in many other states – including Connecticut, Maine, New Hampshire and Vermont – have become eligible for the vaccine. She’s studied the Centers for Disease Control and Prevention data, finding Massachusetts is in the bottom half of states in per capita vaccinations.

On Monday, Gov. Charlie Baker announced that people in Massachusetts ages 75 and over will be able to get the COVID vaccine starting Feb. 1, and that residents over 65 will move up in line, possibly being eligible sometime later in the month.

While this was welcome news for many seniors, some have been wondering what took the state so long – and why those young, healthy individuals have gone before them.

“We're seeing just a huge number of people get vaccinated, who I think should, frankly, be way down the line,” said Michael Mina, a professor at Harvard’s School of Public Health. “These are people who have nothing to do at all with COVID or with patient care or really with the hospitals.”

How did this happen? It is partly because Massachusetts is a medical hub with giant hospitals. And it also stems from decisions made at the federal, state and individual levels.

First, federal distribution.

The federal government has distributed vaccines to the states based on their total populations. Yet, at the same time, the federal government is suggesting states prioritize specific groups, such as frontline healthcare workers and older adults.

The result is that, if states follow the federal guidance, they will progress through the vaccination prioritization groups at different rates. Places with older populations, such as Maine, will take longer to get to the general public compared to states with a younger overall population, such as Utah.

Because Massachusetts has so many large hospitals and medical centers, the state has a higher percentage of health care professionals per capita. These workers are in line to get the shots before others.

“It effectively means that the elderly and vulnerable people who might need the vaccine first will, generally, be pushed back,” Mina said.

Second, state and hospital decisions.

Hospitals and medicals centers have played a major role in helping Massachusetts distribute vaccines. In the state’s first priority group — known as Phase One — the shots have been given to frontline healthcare workers and others including first responders, residents of long-term care facilities and those in shelters and correctional institutions.

The state — and the hospitals they’ve distributed the doses to — have decided that the “healthcare workers” category should include all of hospital employees and not just those working directly with patients.

This means hospital administrators working remotely, recent college grads working in research labs affiliated with a hospital, those working in Human Resources and many others hospital employees are getting the vaccine in the first group. This puts them ahead of seniors and people with medical conditions who are at higher risk of having a severe case of COVID-19.

This is a particular issue in Massachusetts because medical researchers and hospital managers make up a bigger chunk of the workforce in Massachusetts than in any other state.

Mina said nobody has explained to his satisfaction why this is okay.

“[The state officials] have cover for it. They say, ‘OK, the government, the federal government, the vaccine prioritization list has said hospital employees go first.’ So, they just go with that,” Mina said. “They can just say, ‘Oh, you know, it's not on us.’ ”

Andrew Karson, the Chief Medical Officer at UMass Medical in Worcester, said Baker told hospitals to vaccinate administrators and those working remotely because they are critical to ensuring smooth hospital operations and can be called up on short notice.

“Human Resources has been helping us staff the field hospital,” Karson said, “And without our Human Resource administrators, our finance administrators, our facilities, maintenance, construction personnel, we would not be able to serve the very ill patients that we're caring for at our medical center.”

And, Karson added, with vaccines on hand, they didn’t want to delay getting them into people’s arms as they waited for guidance from the state on who would be inoculated next.

Third, individual responsibility.

Medical centers in Massachusetts have struggled with hospital employees making vaccine appointments but then missing them. The result is a last-minute scramble to try to find someone — anyone — to take the prepared doses before they expire and need to be thrown away.

The Dana Farber Cancer Institute sent out a mass email on Jan. 20. It started, “We have had far too many researchers not show up for COVID-19 vaccinations over the past week.”

The email begged the researchers to, at a minimum, take the time to cancel the appointment if they are not going to show up, so that the doses are not readied and, ultimately, wasted.

These issues alone do not explain why Massachusetts — which is often seen as the medical center of America — has lagged so far behind other states in per capita vaccinations. The rollout has struggled with numerous challenges, including technical glitches, communication missteps, vaccine hesitancy among some healthcare workers, and a later start to nursing homes vaccinations compared to many neighboring states. State officials have also acknowledged that hundreds of thousands of doses have been sitting unused in hospital and pharmacy freezers, prompting them to temporarily stop sending more vaccines to these locations.

At a press conference on Monday, Baker defended the choice to prioritize the state’s healthcare workers and hospital employees in the vaccine rollout ahead of older individuals.

“I do believe at the end of the day, we made the right decision out of the gate,” Baker said. “I get the fact that by choosing a number of very targeted communities and populations that we felt we should start with, that would create a slower roll out and a slower ramp up than you would see where you just took big groups by age and said, ‘Go.’ ”

But this logic did not convince 82-year-old Halberstadt. Instead, she has concluded that the officials in charge of the Massachusetts vaccine rollout are, “either totally incompetent or they don't care.”