by Marty Makary and Kavita K. Patel
Hospitals have come under sharp criticism for their part in the chaotic COVID-19 vaccine rollout. That’s because in the rush to get the vaccine out quickly, many hospitals were shipped more vaccine than anticipated and fewer staff took it than anticipated. As a result, hospitals accrued a vaccine surplus and offered it to their low-risk grad students and young administrative staff working from home and are now scrambling 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 a lack of coordination and guidance from federal, state, and local governments.
In trying to figure out how to best steward their vaccine surplus, some hospitals called their state’s department of health only to be told to simply hold the supply. Most states don’t want to deal with the logistic complexity of transferring the supply and, worse yet, many hospitals are now concerned about negative repercussions from states if they speak out against their guidance. Some hospitals are even worried that if they don’t use their vaccine supply, that they may not receive more. These petty games are hurting everyday Americans, some of whom are sitting ducks in this war against the virus.
Many solutions have been proposed, including lotteries or one-shot strategies to dispense all available vaccine doses. The incoming Biden administration has also supported efforts to move vaccine as quickly as possible, but there are hurdles at all levels. So what needs to be done to achieve the goal of vaccinating millions of Americans as soon as possible? Here are a few steps we should take right now:
1. Ignore complicated guidance and just immunize seniors
Confusion about complicated tiering of vaccine priority 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 rollout. Hospitals should be allowed to bypass the complicated CDC, state and local guidance, and immediately offer their vaccine surplus to the oldest and most vulnerable people in the community. In fact, many hospitals have a process in place to offer the flu shot each year to every clinic and hospitalized patient.
2. States should get out of the way
States with a requirement that a nurse must administer the vaccine should immediately change this to any health professional. Pharmacists, medical assistants, and other health care workers should be allowed to vaccinate people.
Some states are wasting too much time pontificating as to whether community immunizations are best performed at pharmacies and grocery stores rather than hospitals. Pharmacies and grocery stores are the ideal setting given their broad experience with mass community vaccinations. But in the meantime, hospitals should act on their vaccine surplus and dispense it wisely. Hospitals should step up and show leadership in helping the most vulnerable members in their communities.
3. Use big data
Hospitals and health systems have the data on who’s most vulnerable through their electronic health record infrastructure. They should harness the power of big data to find those with the age and co-morbidities that place them at greatest risk of mortality. The COVID-19 case fatality rate ranges from 0.001% to 20%. Finding those at greatest risk of COVID-19 mortality is a challenge that is difficult for pharmacies and grocery stores to address, but hospitals are in a strong position to solve it. In the same way that hospitals reach out individually to people in their data when it’s time for their mammogram, colonoscopy or other health screenings, so too can hospitals help identify those at highest risk and hardest to reach.
4. Address vaccine deserts
Regional hospitals should redistribute vaccine doses to eliminate these geographic and socioeconomic disparities in health care. While vaccines were being rolled out, the CDC advisory committee on vaccine prioritization and other similar groups met to consider how best to allocate the vaccine. Sadly, the recommendations were issued late (weeks after the initial authorizations were granted by the FDA), after trucks were loaded with vaccine doses and hospitals had secured freezers for storage. This late guidance encouraged procrastination by 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.” States and the CDC had nine months to develop an allocation strategy. Tragically, mired in bureaucracy, the government was two weeks late to the vaccine allocation planning party.
Not only was the formal guidance late, it was flawed. First, it failed to stratify America’s 23 million health care workers, and instead placed someone like 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 attempted to accurately identify the priority groups backfired, leaving community-based providers and some private practice clinicians in the dark. The chaos of infighting as well as continued stories of wealthy board members and spouses of hospital administrators obtaining access before others has resulted in vaccine deserts (predominantly rural areas where the vaccine is not available or sparsely available for first priority groups). One Texas country club even announced its vaccine signup for club members on Jan. 11, 2021.
5. Show leadership now
Health care is one of the most regulated industries in the world, with incredible oversight and bureaucracy. As a result, many hospital leaders have been overly reluctant to question guidance or challenge authority, but with cases and deaths surging and a burnt-out workforce, now is the time for bold thinking and disruptive ideas. We hope that our hospitals’ leaders will step up in this trying time. We need bold leadership to replace the timid approach many hospitals are taking in being followers of poor government guidance. Hospitals need to lead, not follow.
Governments and the medical community are notorious for their nuanced debates. But to fix the nation’s current vaccine rollout debacle, let’s stop arguing about the ideal philosophy and be real. Hospitals need to show leadership in quickly developing a pragmatic plan B strategy that works. We need to focus on giving the vaccine to at-risk seniors quickly, starting with the oldest members of our community on down — a simple strategy that would save the greatest number of American lives.
The views of each author do not represent the views of any organization or institution.
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Marty Makary M.D., M.P.H. is a professor at the Johns Hopkins University School of Medicine and Bloomberg School of Public Health. He is editor-in-chief of Medpage Today and author of the SABEW 2020 Business Book of the Year, “The Price We Pay.”
Kavita Patel M.D. M.S. is a nonresident fellow at the Brookings Institution and a practicing primary care physician. She was previously a director of policy for The White House under President Obama and a senior adviser to the late Sen. Edward Kennedy.
