December 2020 Politico; States struggling to prioritize who should receive the initial coronavirus shots are handing off those critical decisions to health care providers, giving them less than two weeks to decide how to ration the scarce doses among their own employees.
An expert panel advising the Centers for Disease Control and Prevention on Tuesday overwhelmingly recommended that the first doses go to health care workers and residents of long-term care facilities, given their heightened risk for contracting the deadly virus. However, those recommendations aren’t binding, with the Trump administration giving states leeway to divide up the initial batches of life-saving shots.
And now some states are shifting the responsibility to the health care industry to make those challenging determinations, arguing that hospitals are better equipped to figure out who should be first in line.
“They know who is most at risk,” said Kentucky Gov. Andy Beshear, a Democrat, during a Thursday press conference. “There are a limited number that we can include in this very first shipment.”
Some argue that governors are better off deferring decisions on vaccination priorities to providers, given the scarcity of the first doses and limited time to sort out thorny ethical and logistical questions. But others worry the patchwork approach could undermine the effort to transparently and equitably distribute the vaccine.
“It’s pretty chaotic right now,” said Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. “Bottom line: Things are going to be very messy.”
Kentucky, along with Mississippi and New York, have instructed hospitals to devise tiering systems to determine which employees should receive the first vaccinations. Other states, including Arkansas and Minnesota, are holding off on making decisions until they receive guidance from their own advisory panels.
The first shipment of coronavirus vaccines expected later this month won’t include enough shots for the 21 million health care workers and 3 million residents of nursing homes and long-term care facilities. The U.S. is aiming to ship enough doses for 20 million people by the end of the year, assuming shots from Pfizer and Moderna are both authorized soon. Both of those vaccines requires two doses, administered over several weeks.
The specialized handling requirements for Pfizer’s vaccine, which must be kept at ultralow temperatures, is also complicating matters. Once the vaccine is thawed, there’s limited time to get the shots into people’s arms. Hospitals will need to quickly determine who’s receiving vaccinations to avoid wasting the supply. Some state health officials have suggested hospitals could look to vaccinate others not on the priority lists to ensure doses don’t get wasted.
“If the hospital is vaccinating all their health care workers, and they’ve got some vaccine leftover, I would love for them to vaccinate high-risk patients that they have or the EMS people that are there,” Lance Frye, the interim head of Oklahoma’s health department.
Some hospital leaders said they are better prepared than state officials to decide which employees should get the first vaccines. “I don’t believe any state can get down to the micro-level,” said Mark Jarrett, chief quality officer at Northwell Health, New York’s largest private health system. “It’s just easier to let it go to the local people.”
Ultimately, he expressed confidence that more vaccines will quickly be rolled out after the initial shipments. The head of Operation Warp Speed, the government’s vaccine accelerator, on Wednesday projected that 30 million more people could receive shots in January, followed by 50 million more in February.
“If they accidentally do this group first instead of this group first, I don’t think it will make a difference,” Jarrett said.
States in recent days were informed of the number of doses they’ll receive once the Pfizer vaccine gets FDA’s greenlight, according to Claire Hannan, the executive director of the Association of Immunization Managers. An FDA advisory committee will review the Pfizer shot on Dec. 10, with authorization expected to come in the following days.
But officials in at least one state, Pennsylvania, told POLITICO they haven’t been told how many shots to expect, although federal officials insist that states have been able access the information for weeks through a new data platform the federal government built to support the mass vaccination effort. The episode indicates how glitches and miscommunication could affect the complicated distribution of the vaccine, especially in the first few weeks.
One of the more difficult decisions is how to apportion shots between health workers treating Covid patients amid the pandemic’s worst stretch yet and long-term care facilities that have been ravaged by the virus. Over 100,000 Americans are now hospitalized with Covid-19, and there’s again increased spread inside long-term care facilities.
Governors are facing competing demands from powerful health care interests lobbying for top priority.
On Thursday, a major senior care lobby asked governors to prioritize their residents and staff ahead of frontline health care workers in hospitals. The American Health Care Association and National Center for Assisted Living said expedited shots are crucial as facilities experience a surge of Covid-19 in their communities, arguing that a one-month delay could cost thousands of more lives.
The Trump administration has partnered with CVS and Walgreens to provide shots to most of the nation’s 15,000 nursing homes and 29,000 assisted-living facilities. Details of the vaccination effort will vary by state.
States can choose when to begin vaccinating nursing homes, provided they have enough vaccine to cover everyone in the building. If they have enough shots, those may be sent to other elder-care facilities. But that would still lead to critical decisions of which facilities get immunized first.
To avoid rationing shots inside a long-term care facility, the pharmacies plan to vaccinate all residents willing to receive the vaccine before moving onto the next location. “There should not be a situation of only certain residents will receive it and others will not,” AHCA said in a statement.
Chris Cox, who is CVS’ liaison to Operation Warp Speed, said the company wants to reach every nursing home “within three to four weeks” of states telling them to begin vaccinations.
“Everybody, obviously, can’t get it the first day,” said Ohio Repubican Gov. Mike DeWine on Friday, adding that consideration will be given to risk factors. “Some will be first and some will be second.”