But he is not sure if he will have a chance to use it, as health officials have yet to say when private medical offices will receive the vaccine.
“I am very angry,” said Carroll.
Not only are doctors having trouble getting the vaccine to patients, but many of the community doctors and medical staff who are not hired by hospitals or healthcare systems also report mixed inoculation results. Some have already had their vaccinations, others are still waiting, although health professionals who provide direct care to patients are in the high priority group at the United States’ Center for Disease Control and Prevention.
Many of these doctors say they do not know when – or if – they will receive doses for their patients, which will soon become a bigger problem as states try to vaccinate more people.
“The reason this is important is that patients trust their doctors when it comes to the vaccine,” said Carroll, who complained on social media that his county has not yet released plans on how primary care doctors will be informed.
Collectively, county doctors could vaccinate thousands of patients a day, he said, and could attract some who would otherwise hesitate if they had to go to a major hospital, amusement park or other central location.
His concern arises because, nationally, the vaccine’s launch is starting more slowly than expected, falling far short of the initial goal of giving 20 million doses before the new year.
But Dr. Jen Brull, a family doctor in Plainville, Kansas, said her rural area made good progress in the first phase of vaccination, crediting close working relationships formed well before the pandemic.
This fall, before any doses were made available, the local hospital, health department and doctor’s offices coordinated an enrollment list for health professionals who wanted the vaccine. So when their county, with a population of 5,000, received the first 70 doses, they were ready to go. Another 80 doses came a week later.
“We will be able to vaccinate almost everyone in healthcare who wanted it in the county,” said Brull recently.
Launch gaps
But that is not the case everywhere.
Dr. Jason Goldman, a family doctor in Coral Gables, Florida, said he was able to get vaccinated at a local hospital that received most vaccines in his county and oversaw the distribution.
In the weeks that followed, however, he said that several of his frontline employees still “do not have access to the vaccine”.
In addition, “a tremendous number” of patients are calling their office because Florida has relaxed distribution guidelines to include anyone over 65, Goldman said, asking when they might be able to get the vaccine. He asked the authorities to distribute vaccines through his office, but received no response.
Patients “are frustrated that they have no clear answers and that I am not getting clear answers to provide them,” he said. “We have no choice but to refer them to the health department and some of the hospital systems.”
Another point of concern for Goldman, who served as the liaison between the American Academy of Family Physicians and the panel of experts who drafted the CDC’s distribution guidelines, is the enormous variation in how these recommendations are being implemented in the states.
The CDC recommends several phases, with frontline health professionals and nursing home residents and staff in the initial group. Then, in the second part of this phase, there are people over 75 and frontline workers who are not in the health field, who can include first responders, teachers and other essential workers.
States have the flexibility to create their own distribution schedule and priority groups. Florida, for example, is offering doses to anyone 65 and older. In some counties, the elderly were told that vaccines were available on a first come, first served basis, a change that resulted in long lines.
“To say now, over 65, when you haven’t even properly vaccinated all health professionals, is to deny phasing,” said Goldman. “There needs to be a national standard. We have these guidelines. We need to do some supervision.”
On Thursday, the American Hospital Association echoed that concern in a letter to Health and Human Services Secretary Alex Azar. Hospitals – along with health departments and large pharmacy chains – are doing most of the vaccinations.
Calling for additional coordination by federal officials, the letter outlined what would be needed to achieve the goal of vaccinating 75% of Americans by the end of May: 1.8 million vaccinations every day. Noting that there are 64 different deployment plans from states, cities and other jurisdictions, the letter asked whether HHS “assessed whether these plans, as a whole, are capable of achieving this level of vaccination?”
Making it work
The lack of direct national support or strategy means that each county is essentially on its own, with the success or failure affected by the resources available and the experience of local authorities. Most state and local health departments do not have enough resources and are under intense pressure because of the growing pandemic.
Still, the success of vaccination efforts depends on planning, preparation and clear communication.
In Lorain County, Ohio, with a population of 310,000, local authorities began practicing in October, said Mark Adams, deputy health commissioner. They set up mass flu vaccination clinics to study what would be needed for a Covid-19 vaccination effort. How many employees? How would the traffic flow? Can patients be kept 6 feet away?
“It gave us an idea of what is good, what is bad and what needs to be changed,” said Adams, who had previous experience in coordinating mass vaccination efforts at the municipal level.
So when the county received its first shipment of 500 doses on December 21, Adams had his plan in place. He called the fire department to invite all emergency medical technicians and affiliated personnel to an ad hoc vaccination center set up in a large entertainment venue with his health team. Upon arrival, people were greeted at the door and directed to spaced “banners” where they would take the pictures and then to a monitoring area where they could wait 15 minutes to make sure there was no reaction.
Just after Christmas, another 400 doses arrived – and the makeshift clinic was reopened. This time, the doses went to doctors, dentists and other medical professionals based in the community, 600 of whom had already signed up. (Hospital staff, nursing home staff and residents are receiving vaccines through their own institutions.)
As they move on to the next phase – beneficiaries include residents over 80, people with developmental disabilities and school staff – the challenges will increase, he said. The county plans a multifaceted approach to notifying people when it’s their turn, including using a website, local media, churches, other organizations and word of mouth.
Adams shares the concerns of medical service providers across the country: he receives only two days’ notice of how many doses he will receive, and at the current rate of 400 or 500 doses per week, it will be a while before most residents of the county have a chance to take a chance, including about 33,000 people aged 65 and over.
With 10 nurses, your clinic can inject around 1,200 people a day. But many other health care professionals have offered to administer the injections if he receives more doses.
“If I ran three clinics, five days a week, I could do 15,000 vaccinations a week,” said Adams. “With all the volunteers, I could do almost six clinics, or 30,000 a week.”
Still, for those in the latter public group, those aged 18 or older with no underlying medical conditions, “it could be summer,” said Adams.
KHN (Kaiser Health News) is a non-profit news service that covers health issues. It is an independent KFF (Kaiser Family Foundation) editorial program that is not affiliated with Kaiser Permanente.