If you tried to get a Covid-19 vaccination at the CVS on Bradford Street last Wednesday, you would have been turned away.
A pharmacist there told an Independent reporter on Sept. 3 that the chain was bound by a state law that requires pharmacies to secure approval from the Centers for Disease Control (CDC) before administering vaccines.
That same day, the Mass. Dept. of Public Health issued an order allowing pharmacies to administer the updated Moderna, Pfizer, and Novavax shots and boosters to all who are eligible.
Now, essentially anyone over the age of five, provided they haven’t received a Covid shot in the preceding two months, can get one by booking online or walking in at all CVS locations and Stop & Shop pharmacies from Orleans to Provincetown.
Clinicians at the Outer Cape Health Services Provincetown and Wellfleet clinics are also administering the updated Covid vaccines, CEO Damian Archer told the Independent. The state’s decision to recommend them, he said, “gives me hope in these very, very challenging times that we’re going to figure it out in Massachusetts.”
Working Around the CDC
The DPH order came after a change at the federal level limiting access to Covid vaccines.
The Food and Drug Administration had on Aug. 27 approved new Covid vaccines for the coming year — but only for people who are 65 or older or have an underlying health condition that makes them more vulnerable to severe illness.
The CVS chain then determined that its hundreds of pharmacies in Massachusetts could not administer the shots here — even for people who were eligible or had a prescription.
That was because the state is one of 16 with laws that require pharmacies to secure approval from the CDC’s Advisory Committee on Immunization Practices (ACIP) before administering vaccines. And even though that panel has in recent years recommended updated Covid shots as early as June, this year the ACIP wasn’t scheduled to meet about those recommendations until Sept. 18.
The new vaccine rules at the state DPH and Div. of Insurance are intended as a workaround to that law. Gov. Maura Healey also proposed legislation in August that would give DPH greater authority to purchase vaccines in bulk according to independent standards.
A Burden Shifts
“For Covid, we’re talking about seasonal protection for the circulating Covid strains that exist,” Mass. Commissioner of Public Health Robbie Goldstein told the Independent on Sept. 5. “As we go into respiratory virus season, we think about three vaccine-preventable infections: Covid-19, flu, and RSV.”
The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have also recommended that children under two and pregnant people get seasonal shots, Goldstein added — two groups for whom the CDC would no longer recommend Covid shots, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. said in May.
On Sept. 4, Healey announced that the state would take access to such seasonal vaccines into its own hands. That day, the DPH updated its policies to allow pharmacists to administer any routine vaccines recommended by the commissioner, such as those for flu and RSV, as well as for measles, chickenpox, and Hepatitis B, without the CDC’s input.
“I had hoped that we would never get to a point where we would have to shift responsibility from the federal government to the state,” Goldstein said. “But I think we are in a moment where we can’t necessarily trust the information that is coming out of ACIP and the information that will eventually be signed off by Secretary Kennedy.”
The state is also requiring insurers in Massachusetts to cover vaccines recommended by DPH regardless of federal recommendations. “People in Massachusetts will continue to have the ability to get these life-saving vaccines no matter what happens at the federal level,” said Goldstein at the governor’s Sept. 4 press conference.
People with out-of-state insurance plans may still need to pay for the shots, Goldstein said, as the state cannot regulate out-of-state insurers. He recommended that people who are uninsured or underinsured seek vaccines at community health centers like OCHS, which has some options such as sliding fees to cover costs for income-qualified patients that pharmacies don’t have.
Goldstein also said that the state policy changes on vaccine coverage have significant implications for how future vaccines are regulated.
For routine shots, such as for Covid and the Jynneos vaccine for Mpox, he said, the state could rely on broad and established evidence from scientific, professional, and regional organizations to recommend the vaccines. For novel vaccines emerging on the market, he said, gathering that evidence would require “a tremendous amount of work.”
For now, Goldstein said, the DPH is relying on the Mass. Vaccine Purchasing Advisory Committee and regional collaboration with other states and professional organizations to help guide recommendations.
“We’re in an unprecedented time, and we’re going to have to be very thoughtful and intentional about how we set up a system that is different than how we’ve regulated and recommended vaccines for the last 50 years,” Goldstein said.
A Few Days of Confusion
At the Sept. 4 press conference, Healey said pharmacies in the state could begin administering vaccines to anyone who qualified “starting tomorrow.” Immediately following that announcement, though, the new rules appeared to generate confusion at Outer Cape pharmacies about who could get a shot.
Over the next several days, the Independent tested online signup forms and visited the three CVS pharmacies and two Stop & Shop pharmacies in Provincetown and Orleans to ask for the shot, with varying degrees of success.
On Sept. 5, pharmacists at the Stop & Shop in Provincetown said they could begin taking walk-in appointments later that afternoon, pending a vaccine shipment. But that same day, staff at the Stop & Shop in Orleans said customers wouldn’t qualify for a Covid shot unless they were over 65 or had an underlying health condition, citing the FDA’s rules.
At the CVS on Main Street in Orleans, a pharmacist told an Independent reporter on Sept. 5 that a shot could be available on a walk-in basis within the hour. But down the street, pharmacists at the CVS at Skaket Corners turned the same reporter away, citing the requirement that those receiving the vaccine have an underlying health condition.
On Sept. 8, scheduling online at CVS still required attesting to having one of the underlying health conditions for which the FDA approved Covid vaccines.
“We’re working to clarify the updated Massachusetts guidance for our pharmacy teams and to adjust the language on the digital scheduler,” said CVS spokesperson Amy Thibault in a statement that day.
By Sept. 9, that online scheduling language had changed. Patients need only say they “would like to receive the Covid-19 vaccine and are eligible” and confirm that they haven’t received a shot in the last two months to schedule one at CVS online.
Booking systems and walk-ins at all Outer Cape CVS and Stop & Shop pharmacy locations appeared to be working smoothly by Sept. 9.
