2021-03-23 00:00:00 - Joint Committee on Covid-19 and Emergency Preparedness and Management
2021-03-23 00:00:00 - Joint Committee on Covid-19 and Emergency Preparedness and Management
(Part 1 of 4)
SHOW NON-ESSENTIAL DIALOGUE
Yeah,
Here. All right.
SEN COMERFORD - Good morning. And welcome to the second public hearing of the Joint Committee on COVID 19 and Emergency Preparedness and Management. Today we continue our focus on the Covid vaccine rollout. Since the first hearing in February, colleagues and I have uncovered a number of concerning issues that have left us with more questions than answers. I'll name just three first, no defined equity goals. I cannot forget. The last hearing is Gladys Vega from La Collaborative and Chelsea Race the committee through her building so that we could see what she saw. A community in crisis without a workable vaccine plan. We saw it, but Governor Baker did not. After his very unfortunate characterization of the rollout as lumpy and bumpy, the governor left to announce the return of baseball at nearly the same moment that Gladys was begging us for help. The administration created the Vaccine Equity Initiative painfully late after being pressed by the medical community, lawmakers and advocates to target communities hardest hit by Covid 19.
But the statistics remain startling as of March 17th in Chelsea, where 60% of the population is land necks, just 4% of Latin X residents have been fully vaccinated, compared with 24% of white residents in Holyoke, Worcester, Springfield, Lawrence and many others. It's the same story. Governor Baker doesn't mention these percentages when he's touting the state's rankings. We want to know110 today how the administration is elevating its Vaccine Equity initiative, the metrics for success and the benchmarks sex, faulty planning With regard to the website, the Baker administration has played a painful game of catch up, reacting to129 public public outrage and bad headlines and scrambling when painstaking preparedness was needed. Work around the call center follows the same pattern.
The administration didn't announce a hotline constituents could call with questions until almost two months after the first vaccine doses arrived in the Commonwealth. The Boston Globe reported yesterday that the scramble to get this done has154 cost already 4.2 million, and that figure is still rising. Today. We need to know why the administration didn't plan for the Web and call center infrastructure necessary to execute a statewide vaccine distribution plan. Why did why did it take massive public outrage to generate solutions and lasted number three rushed to privatised website and call centre contracts aren't the whole picture. The Baker administration awarded McKinsey and Company a no bid contract, just five days after the state of emergency was declared a contract for core government services.
At least eight extensions since then have paid out about $18 million to the very same company That was just court ordered to pay the Commonwealth $13 million for its role in quote turbocharging the opioid epidemic. But by far the crowning achievement in the Baker privatization marathon are the mass vac sites we will hear this morning that hundreds of millions of taxpayer dollars have been invested in painstaking emergency planning and training since 9 11. We'll hear about intensive emergency dispensing site drills and system updates across the Commonwealth, occurring as late as the fall of 2020 so that regions would be ready to administer the covid 19 vaccine to their people. To our constituents, these plans were all but discarded in lieu of millions of dollars worth of contracts executed with private companies.
Can you imagine where we would be now as a commonwealth? If the Baker administration had invested these same millions in our communities to fortify local public health? No one doubts the intensity of this time, where the grueling pace and pressure of this work no one doubts the dedication of public officials engaged in this work. But we seem to have put private corporations ahead of public health, and that has led in part to today's hearing. So we need to understand what's happened in the rollout to help those still in line for the vaccine and to ensure Massachusetts is far more prepared for the next public health emergency. Thank you very much. And over to you, Mr Chair.
REP DRISCOLL - Thank you Chair, Comerford. Good morning, everyone. And welcome to our Joint Committee second oversight hearing on the Massachusetts Covid 19 vaccine rollout Today. We've invited testimony from local and regional public health officials, practitioners and emergency management and preparedness and other officials elected and appointed. We will again be performing our duties in an oversight function regarding the vaccine rollout and today, with a particular focus at times on the planning and structure of the rollout, coordination and vaccine distribution, allocation and administration here in the Commonwealth. Well, it can be said that there wasn't much of a playbook. We're dealing with the Covid 19 pandemic prior to March one year ago and that no one knew how the novel virus was going to behave.
The same cannot be said when it comes to dispensing lifesaving medication in a time of national crisis. Playbooks and plans have not only been developed, but they've been tested, exercise and iterated on by dedicated professionals around the Commonwealth. For years, we do have playbooks.368 The ground book. The groundwork had been laid and paid for with state and federal money. Now, with the Covid 19 Pandemic and the Moonshot vaccine development, the moment has arrived.382 And yet there are real questions about what aspects of those playbooks and plans have stayed on the shelves. What are the reasons, logic and planning assumptions being utilized for the ongoing rollout operations of today? And what changes can we expect in one, as the vaccine allocation and administration continued, there is public health and emergency management infrastructure that we pay for and invest in year in and year out with state funds and federal grants to plan, prepare and to be there for us
When the Commonwealth is419 in trying times as vaccine supply levels rise, will we increasingly rely on mass vaccination sites where we build capacity and capability in our regional and local public health infrastructure that we know can deliver doses in line with our regional438 and racial equity objectives. I hope that these questions and answers today will help the committee and the public understand where we are in terms of utilization of Massachusetts emergency management and public health emergency infrastructure at the local, regional and state levels. Our oversight hearing today will involve tough but fair questions. Massachusetts has assumed the leading role in some of the metrics when compared to our peer population states the number of doses administered. We know here at home this process has been anything but smooth. Well, we477 haven't had any additional website crashes for which we're all thankful for. The committee has questions about how things are currently working.
Each of us continues to hear from colleagues or local officials or constituents about the continued local challenges, with vaccine allocation being inconsistent or regional sites with bandwidth to do more but not a clear picture of path as to when they will be asked to do so. We'd like to understand the administration's thinking regarding how the presence507 of more transmissible variants could change our510 posture with regard to the future phasing in and out of restrictions and or the vaccine prioritization prior to reaching herd immunity here in519 the Commonwealth, we hope to also highlight considerations for future plans. Your lessons learned are areas that need improvement.527 Currently, committee members always have an eye on how the Legislature can support public health and emergency preparedness and management. Today, in this event and going forward, our future challenges, we look forward to a productive and constructive hearing today.
SHOW NON-ESSENTIAL DIALOGUE
Thank you, cider.
Thank you, Mr Chair. And thank you again to. Committee members will now admit the preparedness panel. Please let me welcome Tom Carboni, Director of public health in and over. Sean O'Brien, Regional Emergency Planning Committee coordinator in Barnstable County. Dr. Mathilde Castile, Commissioner of Health and Human Services in the city of Worcester. And Don Carmine, Cyber Executive director, Massachusetts Health Officers Association. Um, Mr Carboni, will you begin?
THOMAS CARBONE - TOWN OF ANDOVER - Thank you. Good morning. Uh, again, Thank you for the opportunity to appear before you to represent local public health. Local health and its community partners have been planning for the operation of Mass vaccination sites for 20 years. Since work on vaccine development started a year ago, we have been reviewing and refining these plans in anticipation of operating these clinics for our communities. While acknowledging that the amount of vaccine available has been limited, local health firmly believe that our oldest residents are best served by being vaccinated in our communities by people familiar to them in easily accessible locations. It's a well known fact that vaccination efforts are more successful when we make it easier for the target audience to receive it.
For instance, last week The Boston Globe reported that only 70% of state troopers were vaccinated at the three sites set up for them across the state. In communities like Andover we've seen the vaccine ease. I'm sorry. We've seen the vaccination rate of first responders exceed 90% because we offered the vaccine at clinics held in our police and fire stations. According to last week's vaccination dashboard published by the state, 78% of the Commonwealth's residents over the age of 74 years have received at least one dose of vaccine. That means 22% of the residents in that group have yet to get their first dose. In our public health coalition of eight communities it's estimated that there are more than 5500 residents in this category who still need to be vaccinated, and that's seven weeks after they became eligible.
Many of these people have told me that they will not be getting the vaccine because they cannot or will not make the trip to a large capacity site and this is a missed opportunity for vaccination. We also plan to efficiently immunize 1500 school and municipal staff here on site. Expecting that we would receive vaccine we planned the following. We practiced drive through models in the fall to determine how best to operate them in the spring, we held weekly meetings with town departments to discuss needs, resources and action plans. We worked with our local fire729 department to ensure that the EMTs and paramedics were ready to be deployed as vaccinators. We established a call center for senior residents to make appointments with us.
We scouted dozens of indoor and outdoor locations to find the ideal spots for targeted clinics. We designed ways to expand use of the high school field house as vaccine availability expanded. I believe we could move 250 to 300 persons per hour through that space. We expanded our regional medical reserve761 corps from roughly 200 members to 300 with another 100 persons in the pipeline. These are people ready to serve for free but are not being called. This is only a sampling of missed opportunities to establish efficient and responsive clinics for the community. I again thank you for the opportunity. And I'm glad to answer any questions you have.
SHOW NON-ESSENTIAL DIALOGUE
Thank you so much, sir.
790 Mr. O'Brien, would you like to offer a statement?
Yes, I would. Thank you very much, Senator. Mm.
SEAN O'BRIEN - BARNSTABLE COUNTY - Okay. Uh, first, good morning, all. Thank you for this opportunity to offer testimony regarding the regional and local public health response to uh, the COVID-19 vaccine rollout in Barnstable County. We do things a little differently at Barnstable County when it comes to emergency management and public health crises we work in a regional fashion. Long825 ago, we established a regional emergency planning committee and have worked tirelessly to make sure these, uh, this regional approach benefits all the towns and more importantly, all of the people who live on Cape Cod. One of the things we developed through these years of regional planning is local emergency dispensing site plans, which would allow us to mobilize quickly to vaccinate our population. We used them in 2010 with much success during the H1N1 pandemic.
Unfortunately, during the COVID response, the state opted to ignore these plans, which proved to be very frustrating. Instead, we then adopted a regional dispensing plan setting up sites at strategic locations across the Cape. Early on, in this pandemic, we developed a consortium with with Cape Cod Healthcare, Outer Cape Health Services, uh, Community Health Center of Cape Cod, Cape Cod Community College and all 15 of our communities here on Cape Uh, and with these to respond to this emergency. we now use this consortium to support regional mass vaccination sites and local efforts to vaccinate less mobile and shut in citizens. When the state tells us that it is able to supply more vaccine, we tell them to send it. Um, we are always ready and able to put shots in arms.
While this is currently working well, the state's decision not to use local emergency dispensing site plans caused confusion. Obviously, there's been, confusion has reigned throughout the state's process. Confusion about how to register for a vaccine appointment. We had to establish and staff a phone bank to help people answer questions and help them register for clinics. Without dedicated staff and our large contingent of skilled volunteers, this would have been impossible. These folks were on the front lines, taking calls from a very frustrated public, and that frustration lies at the feet of the state's registration process. Barnstable County now has one of the highest vaccination rates among people of 75 and over. We also have the highest elderly population per capita in New England.
So uh, so this is progress, but it doesn't mean we have to, we should take our eye off the ball. The state's registration process also revealed deep problems when it comes to access and equity. It's no secret that asking an elderly population to use an online system to register did not work. Also, computer only access was a problem for many lower income folks. It's also a problem in underserved populations such as those who are non English Speaking. In Barnstable County, the COVID infection rate in two of our towns jumped to be the highest in the Commonwealth last week. We believe this is happening within a population that may distress the registration process or have a problem with accessing it.
The state has responded by stepping up testing in this area, and for that we are thankful. But if barriers to access and equity are removed, it will help prevent further increases altogether. I want to take a moment to thank the people from DPH who have responded to our needs in Barnstable County. There have been many late night phone calls on Saturday conferences. They're working hard. I also want to thank state Senator Julian Cyr and state Representative David Vieira for their support, as with the rest of our delegation. All of their hard work on these, uh, COVID related issues is much appreciated. Lastly, I wanted to1038 say that the health agents and assistant health agents on Cape Cod have been working around the clock for more than a year. There are no weekends. There are no nights off. They're not being paid more for this time, and they aren't getting hazard pay. They're just good men and women doing a ridiculously stressful job to help everyone stay healthy, and they deserve our recognition. Thank you.
SHOW NON-ESSENTIAL DIALOGUE
Thank you so much, Mr O'Brien. Dr. Castillo, We'd love to hear from you.
Thank you.
MATILDE CASTIEL - WDPH - Thank you, Senator Comerford for the opportunity to speak1071 today regarding the city of Worcester and our emergency preparedness to respond to an emergency such as the COVID-19 pandemic. I'm not here to criticize anyone or anything I'm here to talk about our emergency, our Worcester Department of Public Health and our emergency preparedness that we were fit to be able to handle the COVID vaccinations here in1092 Worcester. Like many other communities within Massachusetts, the city of Worcester has been actively engaged in public health emergency preparedness work for the past 20 years.
After the events of 9/11, state and federal grant funding opportunities were established. And while their names and some deliverables have changed over the years, their primary charge of preparing for and responding to public health emergencies has not. The Worcester Division of Public Health has been the sponsoring organization for well over 15 years, providing emergency planners to support 74 boards of health and 10 hospitals. It is known as the Region 2 Public Health Emergency Preparedness Coalition. Millions of dollars have passed through Worcester Department of Public Health specifically to purchase equipment, regional asset trailers, annual drills and extensive training to respond to public health emergencies.
Specifically, our boards and hospitals are trained in the incident Command System and National Incident Management System, shelter operations and providing input into all hazards planning, nuclear, chemical, biological, natural and radiological events. Emergency dispensing site plans also have included extensive planning and training on supporting those with access and functional needs. Our public health nurses who conduct communicable disease investigations are familiar with our refugee and immigrant communities and have built rapport and trust on medication compliance and case management. We're not using annual flu clinics to simulate pandemic response as done by many public health department during H1N1 in 2009.
Local public health is participating in exercises to fine tune a public health response to all kinds of real world scenarios, including active shooter, rail derailments with hazardous rail derailments with hazardous chemicals. To support these robust plans, many local health departments, including the city of Worcester created federally recognized medical reserve corps which utilizes medical and non medical volunteers to assist in a1227 health emergency. Additionally, large communities like the city of Worcester, with a myriad of academic partners, including the medical school or other college nursing programs, tapped into this resource to assist with the first responder emergency dispensing site in January 2021. For the better part of the last two months, the Worcester Division of Public Health would support from emergency management, stood up a regional emergency dispensing site, vaccinating the various eligible phases.
The five contiguous community, supported by Worcester DPH, became accustomed to our process and utilizing our local senior center as a vaccination access point. The city's Emergency Operations Center was activated to support the clinic with extensive support and planning,1277 operations, logistics and financial tracking. This is what1281 we trained for and what we are able to do. We have spent years training and drilling our local plans using CDC money backed by Mass DPH, which required clear and prescriptive deliverables to have plans and demonstrated execution which clearly worked during the H1N1. Our familiarity with the strategic national stockpile includes plans for local delivery points of vaccine and PPE. Local residents know and trust their local leadership.
Moreover, it is important to note that the city of Worcester is home to various culturally diverse communities. These black, brown and immigrant communities were the ones who have been hit the hardest by COVID-19. We know that the Latino and the black populations are twice as likely as their white counterparts to test1330 positive for COVID-19, and they have been hospitalized at significantly younger ages. For these reasons, we have worked in collaboration with UMass Medical School to organize, facilitate and participate in a number of different town halls for the community. I have personally participated in 17 different events for various communities since the start of 2021. Through these efforts, we have been in constant collaboration with community organizations that serve black, brown, Asian and immigrant communities.
During the past two months, we have continued to partner with these trusted organizations to reach vulnerable populations through our mobile vaccine clinic, where we set up two or three different vaccination sites per week in different locations. Through targeted outreach with community partners and agencies, and with intentional and accessible vaccination clinic sites we have successfully been able to vaccinate every homeless shelter in the city, all of Worcester's senior housing authorities, three different churches to date, along with other side partners such as the YMCA and YWCA and with more to come. Nonetheless, the mobile vaccine clinic worked in tandem with the senior center to provide for our community.
Participation in these grants over the years afforded us the opportunity to develop robust plans that served as the foundation for us to rapidly respond to the COVID-19 pandemic, including the setup of fixed and mobile vaccine clinics. As evidenced by our yearly emergency dispensing site drills our stockpile of supplies and our hosting of the Worcester Regional1418 Medical Reserve Corps, we have the training, the provision and relationships with volunteers and community partners necessary to effectively treat our residents. While the clinical and operational requisites for such an undertaking are great, so too, is enthusiasm of our city family.
As you may know, the city of Worcester and the Central Mass Regional Public Health Alliance was the first in Massachusetts to receive public health accreditation. The spirit of innovation drive and collaboration is what keeps us going to bring the best possible care for our community and drives others in the City Department to step up and assist. Unfortunately, COVID-19 is not the first public health emergency we have had to face. From virulent flu strains to a Hepatitis A outbreak we've all had a significant amount of experience working with our communities in response to health crises. Each time municipalities have effectively and efficiently responded. We are certainly able to do this. Thank you.
SHOW NON-ESSENTIAL DIALOGUE
Thank you, doctor, and appreciate your service and everyone's service. Miss Cyber, would you like to offer your statement?
Thank you.
DAWN SIBOR - MHOA - Good morning Senator Comerford, Representative Driscoll and members of the committee. I am grateful for the opportunity to speak with you today. I am the executive director of the Massachusetts Health Officers Association MHOA for short. We are 50 plus year old organization with more than 600 members, many of who are active and retired local public health officials. We provide training, support and advocacy for local public health in Massachusetts. Since the beginning of the1520 pandemic in March 2020 MHOA has served1522 as an affiliate organization and we have been an integral part of the response and coordination. Prior to joining MHOA I served for 12 years as the coordinator of emergency preparedness with Brookline Health Department. And I, too, developed a medical reserve corps with more than 300 volunteers.
Along with my local public health colleagues who were on the telephone and across the Commonwealth I spent years working on emergency preparedness plans, participated in drills exercises and multiple trainings to make certain that my community was prepared for any type of an emerging public health emergency. As you have heard so eloquently from my colleagues during this webinar, the last 20 years local public health has prepared for emergencies through trainings, drills and exercises. We have recruited and trained thousands and about 9000 I have heard volunteers to be ready to dispense medication or vaccinate the residents of a community1582 at an emergency dispensing site.
Just so you know, an emergency dispensing site is a designated location in a community for the purpose of dispensing medication or administering vaccines during a public health emergency. These locations have been pre screened and have detailed plans on how to1602 operate. This work has been and continues to be funded through hundreds of millions of dollars of federal and state funds and is overseen by the Mass Department1613 of Public Health the Office of Preparedness and Emergency Management or OPEM. As others have alluded to during our work in H1N1 OPEM and DPH led our response using the plans and structure, we in public health had developed. OPEM and local health works1628 in cooperation with the Mass Emergency Management Agency, or MEMA, who maintains and operates the State Emergency Operations Center.
The results of utilizing the pre established plan with what had been written, exercise and drilled was implemented and used effectively and efficiently. While local public health in Massachusetts is uneven, underfunded and understaffed, Everyone I know in the local public health has worked tirelessly since March 2020 to protect the health of the public. After local health had been told they would not be involved in vaccinating at all until Phase 3 when it's open to all, they were asked two weeks before Christmas to make plans for vaccinating emergency responders in early January, which they happily did. The Command Center and DPH told local health that they could then continue to vaccinate priority group residents as vaccine was available, but then changed their minds and plans.
During the vaccine rollout for COVID-19, the inconsistent and ever1686 changing messages from the Command Center around the availability of vaccine at local health departments has caused unnecessary confusion, fear and increased vaccine hesitancy among our residents. Local public health fully understands the limits of COVID-19 vaccine availability, and that support and assistance from others might be needed to implement our1704 emergency dispensing site plans. But the plans are scalable. The structure was and is solid. The plans have been tested and should have been and still should be used as a basis by which to distribute vaccine in the Commonwealth. The Command Center, however, has not chosen to use these plans.
The administration, instead has spent hundreds of millions more taxpayer dollars to hire consultants and private organizations to run its clinics while ignoring the plans and capabilities available from local health departments. After years of emergency preparedness planning, hundreds and millions of dollars spent to have local health departments have scalable plans for emergency I ask why has the administration spent hundreds of millions more dollars for private organizations to do this work. hat is being done so that when they close up shop, our local health departments will have more infrastructure for the next emergency?
Will there be best practices and systems left for us to move forward and integrate with our plans. This can be an opportunity to build our local public health infrastructure to prepare for the next pandemic measles outbreak or severe flu season. I hope that moving forward years of planning by hundreds, if not thousands, of local public1785 health professionals in Massachusetts and using hundreds of millions of dollars will be considered a valuable asset to the Commonwealth. Thank you.
SHOW NON-ESSENTIAL DIALOGUE
Thank you so much for that statement. Mr. Chair apologized for the panel began. We were We were scheduled to introduce our wonderful colleagues, and that was my error. Just for the record, everybody. Uh, So if it's okay with you, I'll welcome my Senate colleagues and then kick it to you. Sounds good. Um, thank1820 you. And thanks for the for parents. Um, please let me welcome today. Vice Chair to the committee. Cindy Friedman and Senators Cronin, Sear Lesser and O Connor. Um, over to you, Mr Chair. Thank1830 you. Chair. Commerford, uh, joined on the house side of this joint committee today. I have my vice chair. Rep. John Santiago. We have our ranking minority member. Rep Paul Frost. We're also joined by Rep Rob Consalvo. Rep. Mindy Dom, Caroline Dogma Replicas Somalia Christina Mencucci Wrap Orlando Ramos Rip China Tyler and finally, uh, rep, David Vieira.
Thanks, Mr Chair. Did you want to do any housekeeping? I think just a quick couple of items here quickly, um, would move into questions after this. But there is an option for the public to provide a written testimony to us via email electronic submission So that email addresses joint committee dot covid Dash 19 at m a legislature dot gov. So it's joint committee dot covid dash 19 m a legislature dot gov Today's testimony that we'll be hearing, uh, we've been invited various folks, as I mentioned earlier to come in. Um, and all of your testimony will be written for today's proceeding. Back to you, Chair. Thank you, Mr Chair. So I'll start with the first question, and then, like we did in the last hearing, we're going to go back and forth. Senate, House, Senate house.
SEN COMERFORD - Um, so Mr. Carbone I wanted to start with you, Uh and I want to make sure and others in the esteemed panel also referenced this. I wanted to make sure I understood the structure, as you understand it, that's currently in place. So we have the Office of Preparedness and Management or OPEM and underneath OPEM, um, are what are called health and medical coordinating coalitions or HMCCs. I understand there are six of those and then underneath HMCCs are 16 public health Emergency Preparedness or PHEAP coalitions. Is that your understanding of the structure as well?
CARBONE - As far as the grant goes, Yes, Um, we, uh, initially were answering directly to, uh, the predecessor of OPEM. A few years ago the because of the CDC guidance, the HMCCs were formed. They're designed to help coordinate operations across a number of different public health and in private health entities. So the hospitals, local public health, and along with our long term care facilities and the like.
COMERFORD - Thank you. That's helpful. Um, and my understanding is that this year, I believe for the first time, uh, the PHEAP coalitions went through a period of non concurrence with CDC funding. So they did not concur with the Baker Administration's plan for that funding. And I believe if I'm correct, that Andover was part of a coalition which did not concur.
CARBONE - Uh, there have been, uh, different years2039 that various groups within the coalitions have chosen not to concur with the, uh, with the working plan that, uh, Department of Public Health put together. This year nine out of 16 of those coalitions across the state have voted to not concur with the operating plan. And there were various reasons why but I think the most basic is that we've spent 20 years managing this, putting these plans together, being ready for it. And the state2073 has decided to go a different route. There's really some frustration among the members as to why we're going to continue doing what we're doing, if that's not the plan anymore.
SHOW NON-ESSENTIAL DIALOGUE
Thank you so much. Um, I'll leave it here. I'll actually see some minutes back over into the pool of my colleagues and go to you. Mr. Chair, take a check. Comerford, I'd like to invite rep Dykema to ask a question now.
REP DYKEMA - Thank you, Mr. Chairman and thank you to my my fellow colleagues and of course, all of our presenters today. I greatly appreciate all the information. And my question, um has to do with, um the integration of our public health departments and local public health resources with our I guess,2128 MEMA and emergency response at the town level um, in a broader sense. So I have in front of me now, what is a comprehensive emergency management plan which was provided to me by one of my communities. And my understanding, as I read, that plan is that it is, um, coordinated by an emergency management director, which I imagine is similar for most communities.
And then that individual sort of coordinates all of the response within the community. Um, including emergency management, um, first responders And underneath that same umbrella seems to be the Department of Public Health, um, or the local public health, um, responders. And I guess I'm just wondering from your perspective, um, how did you expect that our local public health departments or your public health department would integrate, um, into this, um, emergency management plan? Uh, integrate with MEMA and specifically with respect to sort of, um, chain of command. You know, how has information about emergency response um, come down from the state? Has it come down through the emergency management director to you? Is there another line of communication? And2204 how did you expect all of that communication to happen based on the planning that you've been doing for the last 20 years?
SIBOR - I'm happy to offer a statewide perspective and perhaps my colleagues will talk about their individual communities. But we have prepared. Um, yes Each city and town has emergency management director, often the police chief2245 or the fire chief. Um, and in certainly in Brookline and the communities with whom I work public health works directly with them and there was a whole team that works on the planning for an emergency such as this. And H1N1 as we've all referred to that was how this this was rolled out. And we have worked with MEMA through their I think it's 16 or 17 support functions, and we coordinate with MEMA on on every response. Um, this response has been very different. The only direction that I've gotten, um, and perhaps my other colleagues can share as well is from the Command Center.
Um, I have not heard of the, or the statewide Operation center being, um activated. And I have had very little if any correspondence from OPEM who has led our thoughts of preparedness emergency management, who led our H1N1 response. So typically, we coordinate with MEMA and through our town's system, um, whether it's we need supplies, um, or we need to open dispensing sites. And this is this has occurred with this, with this emergency, all direction has come2317 from the Command Center. And we have operated in our usual regional structures.
We have a new I mentioned at the beginning we are an affiliate. And at the beginning of this emergency, the state was divided into affiliates. Uh, and we represent 225 communities, districts and big cities, and that's how we have been getting out directions. The health and medical care coalitions are also working, but they've been working primarily on supply and helping2346 with supplies. And, um, my colleagues2348 can talk a little bit about specifics on the Cape or in Andover and Worcester. But that's sort of the general, the way things have worked in the past for other emergencies. But not for this COVID-19.
O'BRIEN - Yes. If it's okay, I might be able to add representative, besides being the emergency preparedness coordinator for Barnstable County, I'm also the director of the Barnstable County Department of Health and Environment. And we're one of the only regional health departments within the Commonwealth. There are a couple of other ones, but we, uh what we've always done is we've2385 provided support, provided a support mechanism to the 15 communities here on the Cape for both emergency management and for public health emergencies and crises. So we actually take a little bit different of a model here. Um, all of our 15 health departments have been very involved in emergency management issues, whether it be sheltering or this planning, Uh, this public health planning that we have done over the years.
Our job for the last 18 years has been to coordinate these plans with local boards of health. And that's really the role of what we do. We don't take over for the local board of Health. We have 15 boards of health. We have 15 emergency managers. We have 15 health agents here in Barnstable County. So what we do is we try to support them on all of these efforts. And one of those was actually coordinating the development of these, uh, emergency dispensing site plans or EDS plans as we like to refer to them. And we've gone through and we've exercised them over the years and and everything else. Um, now, normally, when there's an emergency, um, you know, the statement is all emergencies are local. But when we see a large emergency happening, we actually take more of a regional approach to it here on the Cape.
Um, and that's really how we've fallen into with our 15 communities as well with the response to COVID-19. We had a little bit of experience with this back in2471 the back during the H1N1 which was basically, we help these 15 towns even deploy these EDS plans and get out there and put shots into arms of people back in 2009, 2010. And we're you know, and we found ourselves in that role as well. We're constantly speaking to our colleagues were constantly relaying information and bringing information to them, whether it be from Mass DPH. And they're always on the calls as well, but also sharing with them this unique consortium that we have within the county as well made up of Cape Cod Healthcare, uh, who in one way we have a very strong healthcare, but one company here on the cape which has provided so much support in our community health centers.
So as a part of this, um, as a part of this, we've kind of stepped in and we've been able to assist the towns with, you know, doing this regional response with setting up testing sites across the cape. And then assisting them along with our delegation, of trying to get Home Bound and other senior populations when it comes to vaccinations as well. Um, it's a little different. Uh, you know, we're kind of all in this geographically on the Cape. It's just the way we are. There's, you know, there's a canal and two bridges that separate us. So we have had a lot of experiences working together.
SHOW NON-ESSENTIAL DIALOGUE
thank you so much. Presented and panel. I'm going to turn now to Senator Cindy Friedman.
SEN FRIEDMAN - Thank you, Madam Chair. Um, and thank you to all of you for being here today. I have to say that, um the word that comes to mind when I hear your testimony is damning. And I certainly wish at this moment that we were in person and that the governor was sitting with us so that, uh, he could hear this, um, in person. Um, and I just can't thank you enough for all of the2590 work that you've done and your sticktoitiveness and, um, your, uh, dealing with a level of frustration I can't even imagine. Um my question is this, um, I've heard from the administration that this is a unique vaccine. That, you know, it takes special refrigeration. It takes two doses. This is very complicated. And that's one of the reasons why it's, um, why it doesn't fall into the category perhaps of the pandemic that you have all been very laboriously planning for. Can you answer that2629 for us? Can you tell us how you know what does that jive with your ability to prepare or has it affected it, or is there some truth there? Can you respond to that?
O'BRIEN - Well, I think if I would respond to it from from a Cape Cod point of view on that, well, that's really we've gone out. We've purchased the ultra cold freezer, and so that's something that we could work to distribute things out. Our model would be able to assist with that and2664 to be able to get out vaccine to the local health departments if they were, you know, when they were running their clinics as well. It's something. It's something that had the, you know, the possibilities there. I think, though, that when you think about that, though, you also have to look at the piece of software that goes in it. And unfortunately, some of the tools that would have been able to make that work a little bit better just weren't necessarily there.2692
Probably the biggest thing with us and scheduling clinics and just and just for information sake, as a department, we've probably done over 18,000 vaccinations here in Barnstable County just from our offices alone. Um, but the PrepMod just hasn't necessarily been the tool that we've we've needed. Um I mean, yes, it does scheduling and it does that, but not in a very equitable way. But also one of the big logistical2718 challenges to this and is the fact that you have to schedule a second dose for at least two of these vaccines that are manufactured. And so some sort of software, and it sounds like it's in the works, uh, to be able to do second doses probably would have been able to alleviate that. And I think you know, one thing that we've learned across the Commonwealth is that a lot of the larger departments are there to assist the smaller departments. And, you know, whether it be Worcester, whether it be Springfield Lawrence, whoever it may be. And so those things I think logistically could have could have been handled.
CARBONE - If I could just jump in there as well. We, um, there There are multiple health departments that are capable of handling this vaccine. We have refrigeration, we have freezers2767 already because we do vaccinations. While the Pfizer vaccine had some, uh, specific or has some specific storage and transport issues it's nothing that can't be overcome. Uh, it requires some dry ice. It might require a partnership with, say, a hospital that has the ability for us to go over and pick that vaccine up every day. It has to, before we can put it into arms anyways.
FRIEDMAN - Thank you. I think that, um, that's really good information. Because I think this is one of the things that we certainly in the legislature have been hearing that this is very complicated and nobody knew how to how to do this and etcetera, etcetera. But as, uh, as usual, it sounds like you all know what to do. And if we had, um, just allowed you to plan earlier or given you resources before the rollout of the vaccine, this would be something that you could just basically take and stride. So thank you, madam Chair.
SHOW NON-ESSENTIAL DIALOGUE
Thank you, Senator. Over to you, Mr Chair. Take a chair. I would invite rap Malia two, Ask the question.
Right. Mount Molly, are you on the line?
Yeah. All right, well, we'll come back to Somalia. We can't hear you at the moment, but instead Rep. Dome, if you have a question. Yes.
REP DOMB - Thank you, Mr. Chairman, and greetings to my colleagues and so much heartfelt appreciation for the public health officials who are joining us today Um, and speaking your truth to power in terms of your efforts to respond to your communities. I'm really grateful, as I'm sure my colleagues are for all of your efforts. And I'm, um, riveted by your testimony. I have two kind of flip side of the questions,2902 so I just want to throw them out and whoever would like to respond, that would be great. The first one is just I'm wondering if you were involved with any planning around the rollout between August and January. We focus a lot on the time period of when the vaccine hit Massachusetts. I'm curious about your engagement with planning before, and I'm also curious if you've been, um, if anyone's reached out to you from the administration to engage you in what you should be doing after April 19th and how to plan for the general public2937 being eligible.
Some of you have mentioned that the lack of local sites might have contributed to some vaccine hesitancy, and I've seen the2945 flipside when local sites are giving vaccine how engaged and happy the community is to be able to be there and, um, see each other and, you know, after a long year of being separated. But2961 I'm wondering, for those of you who mentioned vaccine hesitancy, if you could elaborate on what the lack of local sites, um does in terms of contributing to potential vaccine hesitancy, that then is going to have to be addressed in the future. So thank you. So2977 there's two questions your planning, participation and vaccine hesitancy. Thank you very much.
SIBOR - I can address one part of the question and I'll let my local colleagues address the rest. I have been asking, um, the administration for about a month what the plans are when we have a lot more vaccine. I attend a meeting every it's now every other week with the3005 White House Task force on vaccine on the COVID vaccine rollout. Um, that has been a lot. I've been allowed to attend because of, uh, MHOA's involvement with the National Association of City and County Healthy officials. We are, it's state affiliated and they've invited state directors on these calls. And I heard Dr. Messinye from CDC and she said very clearly about a month3031 ago states need to be prepared for when there is a lot more vaccine.3035
I have been asking, um, I think that people at DPH have been tired of hearing my question, and the answer I have gotten is that basically nothing is going to change that. It appears that the backs the mass back sites are not at capacity right now, and they will then the at capacity, I assume, with adding the general public. Um, I have been asking specifically whether or not local health will be called up to help. Um, and I have just gotten the answer that at this3065 point, nothing is going to change from the plans that are happening now. I know no more details, but as I said, I have been asking, and tonight there is another one of those vaccine calls, and I plan to ask a little, get some detail on when that vaccine they expect is really going to ramp up. Um, and I will continue to ask the question3090 because I think it's a very important question, but my colleagues can address a little3094 bit more about the local hesitancy issues better than I.
CARBONE - I'd like to talk for a moment about the preparation working up to this.3102 You asked the question about engagement over the3104 summer and into the fall. I don't recall hearing anything like that. However, we've all been very busy in a number of different ways, so I didn't necessarily worry about vaccinating until the vaccine was approved in November. And we3119 started asking questions. How are we going to plan to put this onto people's arms? How are we going to be involved? What the what the vision was going to be. When I think it was February 17th, when the governor announced that we would no longer be doing local clinics except for select wider scale sites. Um, we started to talk about how coalitions could be formed to kind of concentrate our work.
One of the things that has been put out there for us to consider is whether or not we're in a vaccine desert. So, uh, we were, for the most part, told by the Department of Public Health, don't call us, we'll call you if we think you're in a desert. I can speak to the fact that Amesbury and the area up there was somewhat in a desert. They recognized that, uh, there's six or eight communities up there that have banded together and are doing tremendous work in their region. So some of it is happening. Some of it isn't. We're still prepared to stand up our sites if, uh,3200 that need occurs.
O'BRIEN - For us most of most of our initial planning. Um, you know, I cannot recall exactly when we started talking to DPH but I know some of it was with, um, our response to first responders here in Barnstable County. We took that as a regional approach. We had two towns that had provided one town, the town of Sandwich provided vaccinations for the upper Cape Towns. Town of Barnstable took care of their five fire departments and police department. And we handled all vaccinations for first responders from Yarmouth down to Provincetown. Um, you know, and that was some discussion and what we looked at doing and what we started to discuss internally was taking a hybrid approach to how we're going to respond to this.
And so what we've been able to do is look at our regional locations across the Cape. We had to take into consideration that we may have populations that can't necessarily drive or be able to3261 go to one clinic site in the middle of the Cape or before that even happened, sending people off to Gillette. And again the concerns we had was, you know, as I mentioned before, we3273 are per capita age, the oldest county in New3276 England. So during wintertime, having seniors drive off Cape to go up to Gillette, especially even looking at some of the days, though not a serious winter but some serious driving conditions was a little bit concerning. So what we were looking at doing was initially in our planning of this we wanted to have a hybrid approach, but something that was expandable and contractable.
And so we identified regional locations across the Cape. So we have the outer cape, covered the mid cape covered in the upper cape, covered. And then also look at ways to use and to have the local boards of health to be able to provide those vaccinations you know, to the more to the more concerted effort uh, to the to the senior population, et cetera. But unfortunately, uh, we had to take a little bit of a change on that. And we started working with our community health centers in Cape Cod Healthcare to start getting that vaccine. Because as a county, we were only receiving early on, maybe 1000 or 1100 doses, which wasn't going far. And so we had to start to focus in our planning was to focus on getting these vaccinations out. And honestly, a lot of this help came from Senator Cyr as well, developing this consortium, uh, that we've had. But were able to make it more formal when it came to vaccines and being able to spread things out.
And right now, our locals are really, um, working and providing lists to these community health centers and to Cape Cod Healthcare and and going out. And and they're making calls and scheduling people et cetera to get them in, uh, to get vaccinated because they all have their own sources of vaccine. Um, we do. Now we we see a lot of discussions with Mass DPH, but but early on um, it was it was kind of a guessing game until we saw what was going to happen when the when the vaccine came out. Uh, and I don't know if that was as much the state or just administration. I don't know.
SHOW NON-ESSENTIAL DIALOGUE
Thank you, Chair. Thank you so much. Mr Chair.
COMERFORD - I just want to note that Dr. Castile was called away, but Senator Friedman, she had an answer to your question, which is that in Worcester they're able to store vaccines and have been giving3416 Moderna and Pfizer without problems. I just wanted to close that loop. Um, and thank the doctor for her testimony.
And now3425 Senator Cronin, please.
SEN CRONIN - Thank you, Madam Chair. Uh, I have a question for Mr. O'Brien. Um, we now know that the Baker Polito Administration made two very consequential decisions. And the first is, as we understand, that they decided not to use the playbook or the plan that had been built3443 and drilled over the last 20 years since 9/11 and a great public expense. And most importantly, I think was understood among public health officials like you. Uh, and number two after the Baker Polito Administration created these mass sites it has continued to favor them over the regional and local infrastructure that that you've built and that has3465 the capacity to deliver more shots today. Um, so my question is, can you help us understand the consequences of those decisions as you see them specifically has it affected the commonwealth's ability over the last 90 or 100 days of vaccine rollout to serve our most vulnerable populations and reach them, uh, and distribute the vaccine equitably.
O'BRIEN - Well, uh, first, I will say this. I do know people on the cape, and there were a lot of folks on Cape Cod that the drove folks up to up to Gillette, and that was good. And that was it was nice to see our citizens these heroes bring people up there for vaccine. Um, but I think what it what it did for us, unfortunately, was just make a really difficult situation. Um, first, when we were dealing with in phase 1 and going to phase 2 , we did not get a lot of a heads up as to when we were going to see those phase changes. And really, what ended up happening was we saw as we were trying to get phase one done and first responders done3534 physician done we saw we saw things, uh, then be announced that we're going into phase 2 and 75 year olds and plus.
And then what happened, unfortunately, is it put everybody into the same feeding frenzy for lack of a better3548 term of trying to get. It was almost like the Daytona 500 people trying to get appointments down here, which meant a lot of folks weren't getting appointments. And I think there was a delay in getting vaccine out to that 75 plus population. And then anybody who may have been a first responder as a part of phase one, um, was then into that mix, and they and it took a while to be able to get them and even non COVID facing physicians and medical folks their vaccine as well. And then as it moved, um, you know, as things moved to 65 and above, it just it started, and the comorbidities it just the timing and I think, where where it just really affected us, was it just took too long to get everybody vaccinated.
And as I mentioned, we were only seeing, and please, we we know that on a national level, we're not seeing the amount of vaccine coming into the area or coming into the state. We we understand that I remember days back in H1N1 where we would maybe get 50 doses a day. Um, you know, we we understand that many of us went through it. Um, but I think as we were not seeing as many things here, a lot of our population it took a while to get them. And still, I don't feel comfortable with the number of 65 plus that are out there that haven't been vaccinated yet as well. And I think a lot of folks, I think the concern was it's like, Okay, we have, you know, we have this regional site in3641 Foxborough. But here we are on Cape Cod with the oldest population in the state. Um, why aren't we seeing more effort down here, since this is the group you're trying to go after as well. And that kind of limited us because we were only seeing so much so I think, if anything, um, I think if anything, it was it was delays.
SHOW NON-ESSENTIAL DIALOGUE
Thank you, Mr O'Brien. And Madam Chair of your back. Thank you.
Thank you, Senator. Over to you, Chair. Thank you. Chair. I would invite, uh, rep Malia to ask a question. Somalia.
Right, Molly A We cannot hear you yet if you're trying to speak.
REP DRISCOLL - Alright, Chair. I think we're still having some technical difficulties. I'll just ask a quick question to follow up on some of the earlier testimony. Uh, particularly from Ms. Sibor . MHOA, um, you know, to start with you, Miss Sibor but then for the group or the panel before us, um, are we leaving any money on the table at this point uh, federally in terms of Cares Act or Rescue Act money that could be used to3750 either build capacity now or thinking in terms of well, we may be able to get now to help our actually roll out that we could then use two years, 10 years down the line, thinking about, you know, like the freezer durable goods, for example. Are there things like that that we're maybe needing on the table at the moment.
SIBOR - I think that through the Cares Act, it's been like public health in Massachusetts is. And even many community has been3780 able to purchase things and and really help their infrastructure some have not. Um, there's also been some public health trust money from, um from the administration. So back in March, um, when the pandemic began, the first the thing that the affiliates did was give out along with the big cities and districts, $9.5 million to locals. Because at that point, the governor was thinking, I believe that the locals would be doing the contact tracing. And then the plan changed, and he made the contract with partners in health for the collaborative. So there has been money given for that and then some additional funding. So there is some funding. And3820 then right now there is the Public Health Excellence grant, which the Legislature has, uh, given $10 million for next year to local health to begin to look at some infrastructure issues.
So there is There is some funding available. Not everybody has access to it. Um, because again, we have a very uneven system. But we're working to try to make our system full. Um, so I think that I think that there's funding3848 there could there could always be more. The issue that comes up a lot is that we're understaffed in health departments, and it's getting staffing and finding staff. It's been a tough year. Local health has, um, really taken it from local while they're3863 enforcing regulations with businesses and residents and threats and and all kinds of things. So it's been a It's been a tough year. And so, um, but I think there is funding, and I think the legislative $10 million has been really, really helpful will be really helpful, Um, as3879 well.
So, um, and I and I believe there is still Cares Act money to be given out. Um, that wasn't all spent since the administration has, Biden Administration has extended this spending through December. Um, but But they're always could be certainly more funding, and Tom or Sean might be able to address some of the areas that they need, uh, funding for as well. I think it's more a matter of we have plans and they have never been except, like on the Cape and other places where they've been able to utilize some of them where they've been able to be utilized to assist3921 in this when this effort of vaccine roll out.
CARBONE - As far as, uh, leaving money on the table, I don't know. I don't have specifics on that, but I can tell you that over the last3936 20 years, we have spent a lot of money buying things, buying stuff that we are now using in our clinics.3944 There's no doubt about that having that material to roll out signage, crowd control kits, tables that's there. I would like to3955 just pick you back on what Don talked about as far as personnel. 20 years ago when was this program was being kicked off my thought was that we were already a3969 profession that was understaffed. And, uh, several of us felt that we needed to invest in that infrastructure before we invested in things. Um, that didn't work out that way. Uh, we've lost a lot of our colleagues over the last year to the pressures of this job, and I'm hopeful that as they have stepped away to take care of themselves that they'll be back to help us. Um, in the long run, we need to better staff our health infrastructure, whether that's locally, regionally or at the state level.
DRISCOLL - Just chair just one, just follow up on that, um, around the funding for staff in particular. Um, how4020 is this traditionally funded for your agencies or within the state? Are we talking about you know, CDC dollars FEMA or is it state dollars? Could you just give the committee a sense of how people are funded. Again we continually hear this fact that, you know, things are underfunded and kind of wanted to understand where it's coming from now so that we can try and see how better to bolster it.
SIBOR - The local health departments are pretty much funded through local through local health. I mean, through the towns and cities in the, um, in the commonwealth. So depending upon that's one of the reasons we have such an uneven public health structure is because depending upon the community, uh, you may have a community of 20,000 with two people in the health department you may have, can you 20,000 with eight people so we have great health inequity in the commonwealth. And there is some other funding so4082 the funding that comes for the preparedness the PHEAP money, uh, sometimes comes directly to town. It used to come more to cities and towns directly. There were deliverables for that That comes through DPH4094 however.
Um, and there are tobacco programs as well. So cities and towns might have other funds, but, like from from tobacco or from PHEAP or some communities have gotten really good at writing grants and and do other kinds of things to be able to have their community, more staffed, substance abuse grants and other types of things. But primarily the funding comes from from the city or town. This is the first time in my memory, um, with the legislature approving the $10 million that there has been state money to be used to help fund local public health.
O'BRIEN - Um, if I if I can add from from our aspect, we're actually county funded, Um uh and we receive about $140,000 a year for our HMCC4150 grant. Uh, and that is actually used to support the towns on the Cape and the Islands. So if you figure we've been doing this for about 18 years, were probably between $2 and $3 million of grant money, and that was to be used for the development of these EDS plans and to exercise them as well. We, um we actually use the money for two things. Number one we we, uh, bring on board contract nurses that work with the 15 Excuse me, the 23 communities on the Cape and the Islands to develop and refine and exercise these plans. And then what we also do is we support our medical reserve corps out of that money. And that is CDC money that's passed through the Commonwealth of Massachusetts.
SHOW NON-ESSENTIAL DIALOGUE
Thank you,4197 Chair. Thanks, Mr Chair. Thanks. Panel over to Senator Senior, please.
SEN CYR - Thank you Chair Comerford. Thank you all for being with us. Uh, this morning and into the afternoon. Uh, certainly as we're learning more and more, um, the fact that the Commonwealth spent nearly 20 years, uh, planning with municipalities with local health partners, uh, to provide vaccine. Um, And then at some point, uh, somewhere along in this pandemic, we think in the in the sort of December January time frame they threw that playbook out, and went with something different is deeply concerning. So what you're telling us today is very helpful. You know, the conversation of staff, right? I think back to the early retirement incentive program that was one of then newly elected, newly inaugurated Governor Baker's key priorities.
Um, you know, when we talk about staff talking about how local health is so underfunded. Well, you know, really, we had a a similar effort happened at the Department of Public Health, and I was there then. Um, I was one of the mid level bureaucrats at the Times that are left left trying to pull together the pieces. But I think of the staff, I think the program I was in, you know, the associate commissioner, the deputy director of the program two program directors, the financial person, Um, all were gone in a matter of in a matter of weeks. Um, and a lot of those were the people who were liaising directly with local health. And I think, um, you know that that has really been on top of mind as I have been listening to your testimony today.
What I'd like to get into is to be a little prospective, right, because, um, you know, we've sort of lived through and trudged through, uh, what has been, um, not an ideal vaccine rollout. But I continue to be really concerned about how do we reach vulnerable people, particularly as the dates are flying by in the calendar, more and more folks are eligible. Um, So what do you think4324 local health can do to reach? You know, I'm thinking about how do we reach those homebound seniors who still haven't gotten a vaccine, right? We know from a Barnstable County perspective, you know, we know a number of folks have been able to get vaccine, but there's still people we're trying to find.
And4342 now that you know, a number of essential workers are now eligible, you know, I'm really wondering All right. How is the dishwasher at the Lobster Pot going to get a vaccine, right? How is the meat packer or the stocker at Stop and Shop going to get access to the vaccine? And how do you think? How do you think local, if you can have a magic wand what role could local health play in reaching those most vulnerable people who continue to be left out by this vaccine rollout? What is the role for local health moving forward I'm talking about in the next few weeks and months. And what should we as a committee and legislators be pushing for for you all to get the resources you need to reach those people? You know, our local health, you know, Are you all the entity or entities who can reach, you know, reach vulnerable people who are being left behind. And I should say thank you for all your do.
SHOW NON-ESSENTIAL DIALOGUE
And on a lighter note, I do want to note that Mr. Carbone and Mr. O'Brien, but by some happen sense of fate happened to be college roommates. So grateful the two of you went into this profession. Thank you for all your hard work. It's go u mass. We were, uh, made friends there and then, uh, roommates afterwards.
CARBONE - Um, Your question actually comes right from a conversation I had this morning. Our region gets together weekly. Tuesday morning is our call. And4428 we were talking with my counterpart in Lawrence about their operations And how they're looking to access and their vaccine and, uh, get their people vaccinated. And one of the things we talked about today was getting vaccine to the workplaces. We know throughout all of this, we were getting calls daily from Lawrence about particular businesses where we were seeing transmission. Uh, one of my goals later today is to make a phone call to a local food warehouse to4468 talk to them about the possibility of us somehow setting up a clinic there.
Whether it's something that Andover does whether Lawrence brings out their mobile clinic to that site. Uh, there are opportunities for us to bring this, uh, to where these people are. Those are the ones, if we can control what's happening in the cities among our, um, our most at need people, I think that's4493 going to help throughout the Commonwealth is going to help a community like the one I work for. Public health is great. We help each other out. We, It doesn't matter where our border is. I don't know how Sean would like to respond too.
O'BRIEN - Well, I would say this, senator, and this is from working with 15 communities here in Barnstable County local health departments know their populations. They know who the people are. They know, you know, and they they see many of those folks every year4529 when it comes to flu shots, they see them. Um, they see them all throughout the year coming into their department. They know their businesses. They know their, uh they know the things that are going on in the community. And, you know, and I think that's an area where local Board of Health is going to be so important because, um and continue to be important because they know how many people are working at that Stop and Shop and maybe how to get vaccine to them, or ways of trying to get information out for regional vaccines to them, whether it be through their licenses or whatever.
And so I see a strong, um, I think that's going to be the key with us. It's, you know, it's looking at the folks that are working in food service or markets or whatever. But looking at transportation workers looking at DPW workers. And the other organizations that are out there as well that, uh, that it's probably we can try to either get the vaccine to them or uh, to them at the workplace or to have, um, specific clinics for them as well and specific ways of getting them vaccinated as well. Um, maybe you know, at a site where you know you have three or four different transportation agencies come in and have that vaccination have that happen. It's important to think outside the box.
But I do want to take a moment for a second here, too, and just say, I mean, you know, towns for years have used4615 their flu clinics as great ways of exercising all of4617 these plans and getting to know their communities. And one of the things that happened and it was a previous administration we saw a lot of flu shots start to move out and start to go towards private concerns private organizations. And it took away a lot of the ability of local board of health local boards of health to to still be able to gauge the health of their community. I use as an example we have a health agent down here who has been an agent for over 40 years Bruce Murphy. And Bruce knew his community, and when you watched him work that flu clinic every4656 year, he knew what he was doing. And he knew these people, he would talk to them. He'd take a few minutes, he'd explain things.
And then all of a sudden, a local pharmacy is giving these shots, and his number of doses is going down. So he's not exactly getting to know what's going on out in his community. And he still does but maybe not as many people, because4675 more people are moving over towards you know, these these private concerns. Um, public health departments have have really taken some hits over the few years the last few years, and I think this is a really important thing. I mean, these folks are dedicated, we're dedicated. We're trying to, you know, we want to make sure that we know our community and the people out there. Um and so and so I'll leave it at that. Sorry. Just a bit of a soapbox. But, um, you know, it's just a concern I've had.
SIBOR - Could I just add one quick thing4709 up to this, um, local public health, um, has been planning, as everyone has now said numerous times for 20 years. And we have worked with a lot of partners in our planning um, and we've gotten to know our communities really, really well. And I think in most communities, um, what would be done is the emergency management team would get together and put together a plan with the public health department in the lead for how to get the most vulnerable in their communities vaccinated.
I think public health nurses who we have not said enough about they are our true heroes and heroines on this, uh, COVID-19 vaccine rollout contact tracing, which nobody knew about before COVID but what they've been doing for many, many years with all kinds of outbreaks. So, um, so it is really, really, uh, something that local health can do Um, as Tom had said. Going to going to workplaces, mobilizing If there are bands in cities and communities using what we have. We have built this structure and again, not every community, but the communities that have. We know, our communities and we can do that kind of work if we are allowed to with vaccine.
SHOW NON-ESSENTIAL DIALOGUE
Thank you all. Thank you, Senator. Um, if you heard the dings in my phone, it was the the folks in the essential workforce in the Hampshire Franklin Worcester district and the elder advocates saying thank you to local public health for going the distance. I think that was a really exquisite trio of answers around how complicated it is and how willing and able you are and how you have a track record of mobilizing. And I will say that communities are weighing in from across the Commonwealth about the cohorts still remaining and how vulnerable they are, including the seniors who have not yet been picked up and the kind of work and intensity it's going to take to be able to get these seniors vaccinated. And it's not going to happen at a mass HVAC site, right? It's going to happen door to door, home, visit to home, visit, um, with a lot of love and attention. So I really appreciate that4845 over to you, Mr Chair. Thank you, Chair. All right, so I have read Malia's question in writing. I'll try one more time to see if, uh, Somalia, your microphone is working. Now, if you'd like to ask a question, I'm trying again. Can you? Here you are.
It's so embarrassing to be, um, from a refugee from the New England home for the bewildered trying to use technology. So thank you for your patients. I really appreciate
REP MALIA - I really find the current focus of the conversation particularly interesting for myself because I have, I represent a Boston district, the 11th Suffolk District and have a large percentage, I believe, of my constituency, a large enough constituency base that are undocumented. And that's been where some of my questions have been. Um, I've also been in the Legislature for 27 years, and I've really been tuned into the fact that when budgets are good, um, public health doesn't do too badly. But when we've been in tight budget times, public health really gets dropped off the edge. And it's it's one of the real concerns that I have now while we're in this pandemic, you know, for the most part, a lot of us hadn't thought about how do we reach? How do we reach parts of our our communities that, um we just hadn't put a theoretical bubble around it.
But suddenly, I mean, I do remember and know a little bit about drug resistant4940 TV. And I know that there's here in Jamaica Plain. There's the public health lab is here, and they've done an incredible amount of work with very few resources. But I'm really concerned about where we fit that population in when we're when we're attempting to get, um, a broad based coverage of vaccinated, you know, folks. And that, um, you know, again, I don't know if there's an easy answer, but I suspect that it's4967 a concern that if we have a potential population that's not being reached or brought in, um, health wise and public health issues as far as public health issues go, where we've got a problem there.
O'BRIEN - Um, one thing I can say we're doing here on here in Barnstable County, what we've done is4991 we've established a vaccine equity subcommittee. Uh, we are looking at this committee to assist us with trying to do just that to try to get that, um, to get those vaccines out to the, you know, to populations that may have language barriers, but also who may not be reticent to go in and be able to get a shot because there is documentation that goes along with it. And so we're trying to work on ways that we can try to work around that. One of the things that we've been trying to do, uh, here on the cape is embrace our clergy, embrace our churches and and bring those organizations in as a part of this as well. Because maybe a church is a good place to give a vaccination, especially with outreach. Because, um, so So I know that's part of the effort that that we're we're trying to do. Uh, here in Barnstable County.
CARBONE - I would say that weekday clinics right now work because we, the target groups that we're looking at, are really retired people they're able to go. Uh, as we get deeper into this roll out, it's going to require us to have evening hours it's going to require us to have weekends because, especially again, the people that have been hit the hardest by this can't afford to take that day off to go get vaccinated. The the businesses that they work for don't necessarily have the ability to let them go during that day because they don't have people to backfill. Uh If it's going to take you two or three hours to go get vaccinated, it's not going to work. I think Sean's right on the money with the idea of5101 going to our houses of worship. Uh, we're going to see as the weather warms up, uh, changes in how this happens, whether it happens with us or it has to happen at the larger capacity sites. We're going to have to be able to adapt to allow these other people to make it there.
MALIA - I guess my real concern is what's happening? How do we begin to reach that part of the community who are people who are undocumented, who for reasons of fear or misunderstanding or just lack of understanding of what's happening Um, we're not going to be able to reach through our normal channels? And, you know, again, I think that's not a huge population, but it's definitely a population that's at high risk. Um, there are a lot of the people who work in our direct service providing areas and, you know, again, what kinds of measures are we taking to try to really reach them Ah, in an effective manner?
SIBOR - The state has the program that they are rolling out with public health ambassadors for the 20 equity communities, the ones that have been hit the hardest, so that I don't really know exactly what that entails and I'm not sure it's really rolled out Uh, well yet, but they are focusing on that. Um, I know, as I was part of a communications committee there have been ads targeted at those, um, vaccine hesitancy from folks who may not speak English as a first language. Um, and, uh, trusting physicians. It's a physician that you may have seen the ad that was physicians mostly. Um, and I think that we do have to think outside the box as we do, um, for lots of other things in local and local public health. And as both Sean and Thomas said, using houses of worship or physicians or practitioners, people who are trusted sources.
We have to look at those trusted sources. And we have to be a partner with DPH and and and do that. Um, it's it's complicated. It's going to be hard. There is a level of distrust. Um, and I think that, um, Tom said we have to be flexible and do it at people's locations or when people are available and can be vaccinated. I think that houses of worship are really a really good partner for many communities. And, um, I am not sure what DPH is doing. Perhaps it's a question um, Secretary Sudders could answer later today on how that program is actually rolling out. But it's a program that could be also used as a template for other communities as well. But if we're going to be doing that and encouraging houses of worship and perhaps vaccine at houses of worship, we have to be allowed to have vaccine to do that. And right now that's not allowed. So we can help get people. But getting vaccine hesitant people to a large site when they may not have transportation, um, is a challenge.
O'BRIEN - and if I can add just one thing, sometimes you have to take the government out of certain things. And I think this is one of those instances where you have to consider that. And mainly because in some ways, whether it be, uh, you know, health department or a representative from a town or a representative from the state those are the areas that may be concerning to these populations. So I think what's really important too is to bring in many of these, uh, community groups that are out there working with these groups as well and working with them on the planning. I think it's it's so important.
And maybe at that point top maybe that's an area where our community health centers come in. Um, our community5359 health centers on the Cape have a pretty again are a group that have a pretty good idea of the population out there because they provide a lot of the medical support, uh, for the community. So, um, you know, this just is one of those times where you know, we definitely need help from the community and people that may have, uh, those direct connections to the community that, um, you know I can provide that link to us.
SHOW NON-ESSENTIAL DIALOGUE
Thank you, everyone.
COMERFORD - Thank you Representative Malia. Uh, this was a really rich discussion. I just want to point just because it's a public forum to the fact that thanks to the speaker and to the Senate President, we have passed will be passing, um, for the governor's signature um, emergency paid sick leave for the purposes of being able to get vaccines for the purposes of caring for a loved one or caring, restoring one's own5412 health. So that's an important provision that the Legislature partnered with the Baker Administration to put forward.
SHOW NON-ESSENTIAL DIALOGUE
Um,5419 I'm just gonna turn it over now to Governor Baker. I'm sorry to, uh, Senator Lesser Governor Baker's later.
Good afternoon. Can everybody see me? Okay. Can everybody can hear me? OK, okay. Great.
SEN LESSER - Well, first, I just really want to thank you all for joining us today. And I really want to thank what each of you and your teams for what you've done over the last year. I know it's been mentioned a little bit, but it can't, could not have been easy to be5457 running a local public health department. It certainly is never easy, even in the best of times, but especially now and everything you've had on your plate over the last year and certainly in the months ahead. I was wondering if you could just offer just some top line feedback for us just zooming out a second because we've spent5474 so much time over the last hour or so talking about the really meticulous planning and investment over so many years that was put into your departments for contingency planning, particularly contingencies around, you know, medical distribution sites, mass vaccination campaigns, pandemic preparedness.
And I just wanted to get your top level feedback about the decision to move the focus away from that existing infrastructure and towards these mass vaccination sites and the millions of dollars that was shifted. Because, in theory, those contracts could have been directed to those dollars could have been directed to all of you to scale up operations. So I'm wondering if we could just kind of go around and just get your kind of top line feedback as a threshold matter of the decision to move the focus to those5526 mass vaccination sites.
CARBONE - I'll start. Um, I think that most of us envisioned that there would be a wide array of providers who are going to be giving vaccine out not just the local communities, but also the hospitals, the doctors offices, the pharmacies. The pharmacies have actually been doing an incredible number of vaccines far more5555 than I really envisioned that they'd be able to do. Uh, but we also envisioned that there would be a need for these large regional sites as well. We can't all do it5569 alone, but we can all do it together. And I guess, I would if I had it to do over again, I'd5576 have hoped that we would have started small with the amount of vaccine we're getting locally. And then, as we were expanding vaccine availability5587 and the larger population that we would be moving towards these large scale vaccine sites.
O'BRIEN - I would agree, Senator, I would agree with my colleague, um, Tom. What I look at with this is that, um, you know, we probably would have covered a lot more people at a local level, uh, and had a lot more equity out there. I5617 think we would have had a better opportunity to get out to those populations that were more vulnerable. Um, you know, I think putting everything into this mass vaccination clinic and this software unfortunately just created such a problem where if you had a fast computer or you're really a tech savvy person, you got an appointment. And I think that was one of the things that, um, you know, was always concerning. So I personally feel on that hindsight 2020 thing, we would have I think if we had to go out to the local levels and as I've mentioned, local health departments know their5654 populations, they could have got out to that vulnerable crowd a little bit quicker.
SIBOR - So, um, yes, I agree with my my colleagues completely. Um and I am concerned, um, about what we're going to be left with when, um, the mass vaccination clinics closed their doors as I said in my opening testimony. Um, I'm wondering what is going to be given back to the commonwealth so that we can improve the public health infrastructure, which needs it. Um, And I I don't I don't have an answer for that. Um, maybe you I would hope, as the legislative committee could get answers to that. Um, this is an opportunity to help public health. And, yes, the millions of dollars that have gone into some of the large scale clinics and other things that could have certainly been very helpful to municipalities in building up their their local public health departments.
Um, local public health as I've heard from most most all of my colleagues knows their, as everyone has said and people over 75 are not necessarily going to get into their car. They may not drive and go too. And it has been very disturbing to local health who have been working very closely with their senior centers on all of this. Um, they've been really involved to see some of the exploitation of of elders. Um, when the order was put out, that, uh, would be accompanying those who are over 75 could also get a vaccine. Um, so there are a lot of things, but my hope is that what has been done there were plans left for local health from the contact tracing collaborative to these mass sites. Something that we can use going forward.
SHOW NON-ESSENTIAL DIALOGUE
Senator lesson. And you did,
uh, is there time for a brief follow up question. Um, Mr Chair, is that5788 okay with you? Well, technically. Okay. Thank you. Yes, please.
LESSER - So I guess just a quick follow up on this is one of the arguments that's been given to us. And one of the cases that have been made for the mass vax sites is that the state could basically keep a closer eye on the distribution. They've kind of made this claim both publicly into us5818 to the committee that there's more accountability through the mass vax sites. So I just kind of wanted to ask about this. And just can you kind of run us through what your process is in terms of information sharing with the state about the vaccines that you do get and also what your kind of safeguards or processes for making sure the vaccines you do get are going to the right populations as quickly as possible.
CARBONE - I don't know a public health nurse or a health director or5845 health agent who hasn't lost sleep over that. Uh, you know, honestly, I haven't had to worry about these clinics, I've actually slept past three in the morning a couple of times now. Uh, we have safeguards in place. Our refrigerators have alarms on them so that if something goes wrong, we know before we lose the vaccine. Uh, we are very careful about who we're opening things up, to. I can tell you that there was at least one person I had to call when they pre registered for one of our clinics who wasn't 75. And I said, I'm sorry we need to take you off. There are opportunities to do that. At the end of the day, we're losing just as much energy trying to find the appropriate arms to put any extra vaccine that we have. Out of 100 doses we've had clinics where we've drawn up extra seven or eight or nine vaccines, and we're trying to find the most appropriate people to put those into.
SHOW NON-ESSENTIAL DIALOGUE
Um Oh. Sorry, Sean. Okay, I'll be I'll be quick.
SIBOR - I am not in a local health department, but I have, um, as Tom has said, the local public health, um, nurses and, uh, directors have been doing clinics for years. Um, there is a system where they put the5940 data into the MIIS system now, um, it goes in. The PrepMod was supposed to help, and I think it has helped in that way speed things up. So that that is happening. Um, local health is, um So I just want to tell you a very brief story about a larger clinic that was told to5960 me by a public health department. If you heard this at the last hearing, I apologize. Um, I don't know whether or not anybody said it prior to, but it's about oversight.5972
So one of the large dispensing sites called, I believe the fire chief in a surrounding town asking if they could use 200 doses of vaccine because they had defrosted too much and it had a limit. You know, it has a limit of time. So quickly he or she I don't know, called to the health director who is she and they found people to, I think was 250 doses. They found people to6003 come in age appropriate within a period of an hour or two and have the vaccine. They went and picked it up, or it was delivered to them. But they were appalled that there was this this huge amount of vaccine, and this was near closer to the beginning. And they were told that they could by this clinic, keep the vaccine until, say, five o'clock. Uh, and the health director and the public, the health director did the math according to when they had defrosted and said, That's absolutely incorrect. It needs to be used by four o'clock, and they were able to use not all but most of the vaccine.
So in terms of oversight, I don't know how oversight may have improved at this particular site, and I hope it's much better at all sites. But I can tell you, having worked with local public health nurses and worked in a public health department and worked with my colleagues across the Commonwealth for almost 30 years, they are incredibly diligent and know how to oversee the vaccine management. And if they didn't and they don't and they don't have the capacity, they won't do it. They will say no and I think that's important. They are not in it for anything other than taking care of their residents, and they will not vax if they don't feel that they are competent and confident in their skills. And there are some people who6089 have chosen not to.
SHOW NON-ESSENTIAL DIALOGUE
thank you so much. Sean, do you want to? And
O'BRIEN - I was just going to add quickly Um, we are, our public health nursing division is, uh is always we are a6104 vaccine depot. So we have all of the assurances and thank the Lord for smartphones. So I actually have a camera in our freezer, which is right outside the door behind me, uh, to be able to see these on a 24/7. But we are the same. We're very conscientious. We want to make sure. And to date, as far as I know, we have not wasted a dose here in Barnstable County. Everybody, you know, everything that we have done and our public health nurse is so conscientious about making sure that we have the right number out for the clinic that we have. Um, this stuff is gold. It's vital. We got to make sure it's getting into arms and not into wastepaper baskets.
COMERFORD - Uh huh. Thank you so much. Thank you, senator. And I'll just say I visited a dispensing site in my district and they were inventory they were doing an inventory on needles. They counted the doses from every single vial. They had a chart and they had a call bank going at the same time. So if they got an extra dose out of a vial, they picked up the phone and got someone who was eligible in the room. And it6172 was a science. A meticulous science.
SHOW NON-ESSENTIAL DIALOGUE
over to6174 you, Mr Chair.
DRSICOLL - Thank you, Chair and before I pass to Rep Consalvo, Um, for a question, I just wanted to say I picked up on a few of the comments and, uh, certainly around I think it ties into the underfunding understaffing issue. But I just want to make sure that, uh, everybody on the line today and your colleagues across the state in public health are taking care of themselves. I know you have all been flat out for now more than a year and we're unfortunately not done with this, as you all know, better than I. And I just want to make sure that, you know, burnout is6213 obviously real. If you've never experienced it, uh, you may be soon will, and so I want to make sure that you're okay. But also I think it highlights Uh, Senator Comerford for just the idea of we have this great capacity and capability, but not if folks are leaving the profession or if they are going, uh, go down from burnout or otherwise. So I want to make sure that we were thinking about that as we continue to look at our processes here.
SHOW NON-ESSENTIAL DIALOGUE
Thank you, Mr Sarah. I couldn't agree with you more. Right, Consalvo? Thanks.
REP CONSALVO - Thank you, Mr. Chairman And thank you to the Senate chair as well for having this hearing and for your leadership on this issue and thank you again to the Panelists for6257 being here and taking your time. Um, I want to thank Senators Cyr and Rep Malia for asking the question, Uh, the6262 same line of question that I had around How do we ensure we're reaching out to all of our populations and so that everybody understands how they can get vaccinated? But I want to just piggyback on that and expand a little further as it relates to making6276 sure that all people have access to information as well. And what I mean by that is we're still getting calls from6283 people who want to know how they can get tested. What's the difference between the vaccines?
I only want this vaccine versus that vaccine where are the sites in my neighborhood? Um and so the last6292 hearing the information piece was a real big theme during the hearing. And I'm looking at my notes that talked about making sure we personalize outreach, giving information to the public that's culturally competent and making sure we're interacting with6304 trusted messengers and creating better access to information. And so my legislative aide and I and several members of the community were actually out going door to door last weekend, dropping flyers in people's doors to let them know where6317 they could get the state's vaccine.
Or in my district there is two vaccine locations in Hyde Park and in Roslindale. I represent the Southwest part of the city, Roslindale Reedville Hyde Park and West Roxbury. Um, so how do we do better and making sure, because there's still a lot of questions out there. People are hungry for information that we can get them the information they need to make those decisions. Make sure that it's culturally competent, make sure that we're reaching every part of our districts and what does the state need to do better to help us do that on the local level.
O'BRIEN - I would Representative, I would say that for us we realized early on we had to develop a very good communications strategy when it came to dealing with this. And first and foremost, we had to look6366 at our resources internally, um, to be able to, uh, develop a strong communications division to start updating as much as we could our website and then also we have the formation of COVID Response Task Force here in6381 Barnstable County as well. And that group also having a very strong website for them. We have found that it's been really important for us to do a wide, a varying, uh, or a wide bunch of things. Um, we have found that number one, we still keep employed a call center, and that call center is available for people that have any questions about the vaccine.
That is one of the tasks of our medical reserve corps is to take care of that call center. So it's actually retired medical professionals in many cases who are answering those phones and being able to share that information, Um, or what may be needed when it comes to vaccines. We also are using a strong social media presence as well. Now, I'm not the social media person to be quite honest with you, but our staff has sat back and they've looked and they've said Okay, what can we do to start to go across all the different, uh, all the different groups here in the Cape. and we realized right off the bat to have a strong Twitter, a strong Facebook presence was really important to get that information out along with really developing our website, and and that was key6456 for us.
So things that things that we6460 look are resources. I mean, we're always looking for things that may be translated. Or just the information that comes out of Mass DPH has been very good for us that we can share put up on our website. But we have also developed a lot of our of our own as well. And we've also had to look at things a little outside of the box too being seaside communities. Developing proper beach signs, Um, you know, dealing with social distancing and things6486 like that. And so you know, as6488 an example, and that's and that's where getting the community and is so important. But I found that for us being able to look at all of these, look at all ways, methods of communication was just so important for us to really get that to really get that information out there.
But also to be available when the specific call came in that we didn't necessarily have the answer for or we didn't necessarily have the information for up on our website. And, you6521 know, one of6522 the things that we had to do was quite honestly produce our own video is how to use PrepMod and and make that video available on6531 our website. We have two fantastic staff people here that sat back and said, one weekend a weekend, Um, we're going to come up with a video on how people can sign up and how to troubleshoot some of those areas that people would get lost in in PrepMod. And and that was that was done by our communications department, and that was taking taking that up.
So I hope I was able to answer your question. The things that we look at, you know, I think DPH has been doing a great job getting us resources, getting us things that are translated. We've developed our own things when it comes to translations. And quite honestly, you6571 know, if a lot of this, too the county has taken such an important role. And I mean, we even have beach signs that we made, uh, you know, and that's and that's where our commissioners have come in is to be able to give us funding to be able to do that. But I think resources, um uh, like that are going to be important.
SIBOR - So can I just, um, contrast some of the wonderful things that Sean is doing? Because he has a lot of resources because he's a county and he's one of he's a great example of why we need to share services across the Commonwealth because he is able to do so much more than just one stand alone department. And we have worked very well together in sharing services. One thing that's happened, that came about at the beginning of the pandemic was the Academic Public Health Volunteer Corps, which is a program, um, with the 13 institutions academic public health institutions in the Commonwealth, which I am a co-lead. And we have been able to place students to help, I think students and Alum some 800 to assist health departments.
And much of the work is in translation. Um is helping get culturally competent messages out to local health through social media um, in ways that most health departments not Sean's because he's got he has some people to do this, But most people don't have that. So we have been able to provide that. It hasn't been enough but, um, we we've helped 130 boards of health, um, through this program with a variety6663 of things. But communication is the largest request because unfortunately we have I will say yes we've gotten some really good information from the Department of Public Health, as Sean said, but unfortunately, the state COVID website I can never find what I need. Um, I feel lucky when I found something. And so we have been trying very hard to get information to our locals so that they can put that information out there.
The other part that has been that is hugely helpful in many communities and I mentioned this before the senior centers. They have become very involved and are working with some of the most vulnerable folks. And if they have translation services available, it's been really helpful. But they since the beginning made calls to check up on people, and now they are helping people understand all of those things you asked before, testing the difference of vaccines. They are using information that the health departments are providing and helping people actually make appointments. Because even if you're tech6723 savvy, it can be very, very challenging to use the state system. So the senior centers are involved and again in some cases certainly houses of worship and community health centers.
Community health centers are another really important tool, um, to help get the most vulnerable. But this is This is a question that that we asked in our health department all of the time. Um and I think it's It's certainly something that again health departments can work together with other organizations within their community, in Sean's case,6758 he's got you know, within within the county, uh, to work together. And I think that I know that's been happening across the commonwealth.
CARBONE - I think it's unfortunate that Dr. Castile had to leave us because I am willing to bet that you'd hear some great things coming out of the city of Worcester. And I am quite confident that our cities, especially the 20 that are priority cities right now have some great ideas on how they're going to make that outreach happen.
SHOW NON-ESSENTIAL DIALOGUE
Thank you all. Thank you, Representative. Mr. Chair, if it works for you, I think the committee will recess.
Uh, I think it works for the chair. Let me just say to the panel heartfelt thanks from chair Driscoll and myself for your service. Thank you to our colleagues. I can't help but think as you talk about the ways that you stretch a dollar, um, that we really need to look into the tens of millions of dollars going into these mass vac sites, um, that are paid for start up costs and operating. And they have, um, seemingly no end of funding coming their way while you guys work miracles with very, very little. So With that, we will recess. The committee6841 will recess until two. PM with our thanks to the first panel and we will come back and focus on I t and tec. Thank you so much. Thank you. Thanks very much.
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