As state health officials rolled out Missouri's plan to distribute the coronavirus vaccine, decisions were informed by a group called the Advisory Committee on Equitable COVID-19 Vaccine Distribution.
For the first time, at 1 p.m. Thursday, the public will be allowed to observe the committee's discussions.
It's unclear how often the committee has previously met. There is no evidence on the Department of Health and Senior Services' website about its makeup or previous meeting agendas and minutes.
An agenda for Thursday's meeting was posted on the state health department's website for the first time on Tuesday, with a link to where the meeting will be virtually held.
Following questions from The Missouri Independent, the department's spokeswoman released a list of members Wednesday. In subsequent interviews, those members said they were notified this week that the meeting would be open to the public.
On Thursday, the department provided slide decks from four previous meetings in December.
With the vaccine rollout entering a critical stage, those who serve on the committee praised the newfound transparency.
"I don't know of anything we talk about in there that shouldn't be open to the public, and I always think that public input's not a bad thing," said Scott Clardy, the assistant director of the Columbia/Boone County Department of Public Health and Human Services who attends meetings on behalf of the Missouri Center for Public Health Excellence.
Tyler McClay, executive director and general counsel for the Missouri Catholic Conference who serves on the committee, said with the vaccine's roll out to the wider public on the horizon, "this is probably a good time to make these calls more public."
The committee is made up of an assortment of health care organizations, advocacy groups and state officials, including the Missouri Hospital Association, Missouri State Medical Association, Missouri Nurses Association and Missouri Health Care Association, which represents long-term care facilities.
Groups that work with minority communities and vulnerable populations are also included, like the Missouri NAACP, Urban League of Metropolitan St. Louis, Casa de Salud in St. Louis and Missouri Catholic Conference.
A slew of state agencies are also included, from the Missouri Veterans Commission to the Missouri Department of Corrections. The meetings are led by Adam Crumbliss, director of DHSS' Division of Community and Public Health, and at times by Robert Knodell, who serves as Gov. Mike Parson's deputy chief of staff.
Members reached by The Missouri Independent said they were invited by the state health department to attend.
First responders
Larry Jones, executive director of the Missouri Center for Public Health Excellence, said the committee's goal is to ensure the vaccine is fairly distributed and reaches groups throughout the state.
"We're trying to make sure that we're not doing something that is going to disenfranchise a group," Jones said, "or that we're inadvertently not reaching a group."
According to those who serve on the committee, the group's influence on the rollout can be most recently seen in a decision on whether to include first responders in the first wave of groups eligible to get the vaccine.
On a call with vaccinators late last month, Crumbliss said the committee had recommended that first responders and behavioral health facilities be among those prioritized.
First responders are currently part of "Phase 1B," but committee members interviewed by The Independent said the department will soon announce they will move up to "Phase 1A" - which previously was limited to groups like frontline healthcare workers and long-term care facility residents and staff.
Clardy said first responders are often the first health care worker in contact with a patient, and the committee felt because of that they needed to be included within Phase 1A.
"And there didn't seem any opposition to that," Clardy said. "It looks like they're being moved to 1A as a result of work of this committee."
Scott Frandsen, chief of the Mid-County Fire Protection District in Camdenton and president of the Missouri Association of Fire Chiefs, said his understanding is with emergency medical services bumped to Phase 1A, firefighters will soon be able to receive vaccinations as a result.
The idea appears to have been in the works for a few weeks. A Dec. 29 meeting presentation provided by DHSS lists emergency medical services as "Group E" within Phase 1A.
Lisa Cox, a spokeswoman for DHSS, did not respond to a request for comment confirming first responders are now included in the first phase.
David Pennington, chief of the Springfield Fire Department, said the decision would be "a tremendous relief." He anticipates vaccinations beginning for the department as early next week. In a survey of the department, a little over 50 percent said they would receive a vaccine, Pennington said.
'Sounding board'
Ron Fitzwater, a committee member and CEO of the Missouri Pharmacy Association, said the group acts as a "sounding board" to provide thoughts on tiers and whether to tweak federal guidance to be Missouri-specific.
Diego Abente, president and CEO of Casa de Salud in St. Louis, which is a member, said the meetings have helped ensure information about a complex and unprecedented vaccination campaign is communicated top-down from the state, but also bottom-up from communities themselves.
Casa de Salud provides health care services to uninsured patients, with an emphasis on immigrants and refugees.
"And we just want to understand why these adjustments are happening," Abente said, "and how those adjustments affect downstream all the other groups."
On previous calls, organizations would share what they had encountered, like private practice doctors struggling to get the vaccine, and suggestions for how to improve the distribution process, said Heidi Geisbuhler Sutherland, the director of government relations for the Missouri State Medical Association.
Slide decks provided by the department note the committee is purely advisory.
"The State maintains the final say in all distribution decisions," it notes.
Jones, with the Missouri Center for Public Health Excellence, said the committee "should never work in a vacuum" and that when major changes to the state's vaccine distribution plan are made, clearly communicating that to the public would help residents better understand and trust in the process.
"If you want the vaccine, you want to know why somebody else got moved ahead of you," Jones said.
The more transparency, the better, said Jeff Howell, the executive vice president of the Missouri State Medical Association. However, he said he understands if the state is hesitant to provide greater insight into the decision-making processes, as it's a "sticky wicket" when trying to distribute vaccines if input is from people "whose ideas are not in tune with modern public health."
"It's not going to be a smooth road. And everyone's not going to get what they want," Howell said. "So you just kind of got to do the best you can and take input from all sides and plow forth."
Fitzwater said the state has been open about soliciting input in the face of moving parts as details and federal guidance change day to day.
Opening up the committee's calls puts power behind the "equity" in the committee's title, Abente said.
"That is the charge that the committee has," Abente said, "to open it up and to allow for a truly diverse conversation that leads to equity."
The Missouri Independent is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.