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Update from Michigan Medicine on Vaccine Prioritization

We received an FAQ from Michigan Medicine leadership as a response to our questions on vaccine prioritization.

We have asked many questions about Michigan Medicine's process and rationale for the way they are determining who gets the COVID vaccine and when. We have received the following FAQ from Michigan Medicine leadership in response. It answers some of our questions, but not all, and we still have concerns.

The HOA does not agree with how Michigan Medicine has made decisions around this process.

We do not agree with the prioritization plan, but we do recognize that the university increased communication, expanded hours, and communicated the plan to vaccinate phase 1a tier 1 within three weeks. It is our view that all of these positive changes were a direct result of the dissatisfaction expressed by our members, and our continued discussions with leadership.

Please see the FAQ from Michigan Medicine Leadership below:

1. Why did the COVID Vaccine Task Force develop the prioritization of vaccines the way that they did?

First, the Vaccine Prioritization Subgroup developed its protocols based on the CDC and MDHHS recommendations:

https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/COVID-02-Dooling.pdf

https://www.michigan.gov/documents/coronavirus/MI_COVID-19_Vaccination_Prioritization_Guidance_710349_7.pdf

The State guidelines explicitly describe how to prioritize within Tier 1 of Phase 1A: “Keep critical health care infrastructure open and functioning (i.e., hospitals, critical care units, and emergency medical response systems).”

Following the guidance of U-M Infectious Disease specialists, ethicists and others who serve on the Prioritization Subgroup, we decided that the most equitable process would be to include in Priority Tier 1 ALL CLASSIFICATIONS who were located in what was identified as the areas where staff were most likely exposed to COVID-19 patients or those under investigation:

  • ICU
  • Emergency departments
  • Inpatient and short-stay unit staff
  • Patient care areas with patients known or suspected of having COVID-19 infection

To determine who at Michigan Medicine (and the University) fits into Priority Tier 1, a questionnaire was developed asking respondents to self-identify by answering specific questions.

We also decided that individuals with CDC-recognized risk factors for severe COVID who fall within Phase 1A Tier 1 (those 65 and over or with co-morbidities) deserve additional consideration. Thus, we are working hard to prioritize them first because of the scientific evidence that there is more morbidity and mortality associated with COVID-19 infection in these groups.

Beginning Dec. 21, more than 900 appointments are being scheduled daily. If Michigan Medicine continues to receive the quantity of vaccine doses needed, we expect to complete the Tier 1 vaccinations on or before Jan. 11.

This allocation and prioritization plan was discussed and vetted by Michigan Medicine’s Scarce Resource Allocation Committee, a multidisciplinary group which serves to make necessary allocation decisions in the event of a shortage of services, supplies, or staffing.

2. I am in Tier 1 and have completed a BlueQueue questionnaire and have not received an invitation to schedule. When will I get an email?

Invitations are going out on a rolling basis weekly commensurate with our vaccine allocation. We have been sending out invitations based on the amount of vaccine we know we will have on hand. We have begun scheduling appointments based on the amount of vaccine we are expecting in order to ensure that we are executing on this as quickly as possible. If we don’t receive vaccine and individuals have appointments scheduled, we will notify those people and they will be able to reschedule within a few days.

3. I know people who received a vaccine that should not have been in Tier 1. How did that happen?

Because of the complexity of our health system, it is impossible to determine which individuals would fall within Tier 1 without asking them. For example, some environmental service workers may work in the ICU, while others do not. In addition, we are not allowed to ask - nor would it be appropriate - about individual factors that may increase the risk of severe disease. Thus, we decided to put trust in the respondents’ self-report, and move forward to expedite the vaccination process. That could mean that someone made it through that did not fit the criteria. We believe that is a rare occurrence, and it was of greatest importantance to expedite the scheduling of vaccinations while supporting and trusting our employees.

4. I heard that other health systems are vaccinating entire departments at once. Why wasn’t that done here?

The vaccine, particularly the second dose, may cause fever, chills and other side effects that would require an absence from work. The Task Force, based on guidance from the CDC, did not want to impact the majority of people in any one department, potentially crippling patient care. This also may be unfair to employees who were not present/working at the time. In addition, coordinating availability for the second vaccine would be very difficult with this type of scheduling. We determined that a randomized approach was both safer and more just.