Hospitals have been severely criticized for their participation in the chaotic launch of the COVID-19 vaccine. This is because, in the rush to distribute the vaccine quickly, many hospitals sent more vaccine than expected and fewer employees took it than expected. As a result, hospitals accumulated a surplus of vaccine and offered it to their low-risk graduate students and young administrative workers who work from home and are now struggling to figure out what to do with the rest. The answer should be simple: give it to older members of your community, but a recent letter from the American Hospital Association cited a number of important barriers to effective vaccine distribution, including the lack of coordination and guidance from the federal, state and local governments .
In an attempt to figure out how to better manage surplus vaccine, some hospitals called the state health department just to be told to simply insure the supply. Most states do not want to deal with the logistical complexity of transferring supplies, and even worse, many hospitals are now concerned about the negative repercussions of states if they speak out against their guidance. Some hospitals are even concerned that if they don’t use their vaccine stock, they won’t get paid anymore. These petty games are hurting ordinary Americans, some of whom are easy targets in this war against the virus.
Many solutions have been proposed, including lotteries or single dose strategies to dispense all available vaccine doses. Biden’s new administration has also supported efforts to move the vaccine as quickly as possible, but there are obstacles at all levels. So, what needs to be done to reach the goal of vaccinating millions of Americans as quickly as possible? Here are some steps we should take now:
1. Ignore complicated guidelines and just immunize the elderly
The confusion over the complicated classification of priority vaccine groups is putting hospitals in a decision paralysis. A simple age-based allocation strategy is easy to understand and would translate into a much faster vaccine distribution. Hospitals should be allowed to bypass the complicated CDC, state and local guidelines and immediately offer the surplus vaccine to older and vulnerable people in the community. In fact, many hospitals have a process in place to offer flu vaccine every year to all clinics and hospitalized patients.
2. States must get out of the way
States with a requirement that a nurse must administer the vaccine must change this immediately to any healthcare professional. Pharmacists, medical assistants and other health professionals must be allowed to vaccinate people.
Some states are wasting a lot of time figuring out whether community immunizations are best done in pharmacies and grocery stores, rather than hospitals. Pharmacies and supermarkets are the ideal environment, given their extensive experience with mass community vaccines. But in the meantime, hospitals must act on the surplus of the vaccine and administer it wisely. Hospitals must strive and show leadership in helping the most vulnerable members in their communities.
3. Use big data
Hospitals and healthcare systems have data on who is most vulnerable through their electronic medical record infrastructure. They must harness the power of big data to find people with age and comorbidities that put them at greater risk of mortality. The fatality rate for COVID-19 ranges from 0.001% to 20%. Finding those most at risk for COVID-19 mortality is a difficult challenge for pharmacies and supermarkets to face, but hospitals are in a strong position to address it. In the same way that hospitals reach people individually with their data when it comes time for their mammogram, colonoscopy or other health checks, hospitals can also help identify those who are most at risk and most difficult to reach.
4. Addressing vaccine deserts
Regional hospitals must redistribute vaccine doses to eliminate these geographic and socioeconomic disparities in health care. While vaccines were being launched, the CDC advisory committee on vaccine prioritization and other similar groups came together to consider how best to distribute the vaccine. Unfortunately, the recommendations were issued late (weeks after the initial authorizations were granted by the FDA), after the trucks were loaded with vaccine doses and hospitals secured freezers for storage. This late guidance encouraged procrastination on the part of hospitals because their plan was “Well, let’s wait and see what the states say” and the states said “Well, let’s wait and see what the CDC says”. The states and the CDC had nine months to develop an allocation strategy. Tragically, mired in bureaucracy, the government delayed the vaccination allocation planning party by two weeks.
Not only was the formal orientation delayed, but it also failed. First, it failed to stratify America’s 23 million healthcare professionals and instead placed someone as a healthy 34-year-old dermatologist specializing in botox in the same priority group as a 64-year-old ICU nurse with diabetes and asthma. Algorithms that tried to pinpoint priority groups backfired, leaving community-based providers and some private clinicians in the dark. The chaos of internal strife, as well as the continuing stories of wealthy board members and spouses of hospital administrators who gained access before others, resulted in vaccine deserts (predominantly rural areas where the vaccine is not available or scarcely available to groups of first priority). A Texas country club even announced its application for the vaccine to club members on January 11, 2021.
5. Show leadership now
Health is one of the most regulated industries in the world, with incredible supervision and bureaucracy. As a result, many hospital leaders are reluctant to question guidelines or challenge authority, but with the increase in cases and deaths and an exhausted workforce, now is the time for bold thinking and innovative ideas. We hope that the leaders of our hospitals will step forward in this difficult time. We need bold leadership to replace the timid approach that many hospitals are taking in following inadequate government guidance. Hospitals need to lead, not follow.
Governments and the medical community are famous for their nuanced debates. But to fix the current vaccine launch disaster in the country, let’s stop arguing about the ideal philosophy and be realistic. Hospitals need to show leadership in rapidly developing a pragmatic plan B strategy that works. We need to focus on giving the vaccine to elderly people at risk quickly, starting with the older members of our community – a simple strategy that would save the largest number of American lives.
The opinions of each author do not represent the opinions of any organization or institution.