Hospitals have been harshly criticized for their part in the chaotic rollout of COVID-19 vaccines. That’s because in the rush to get the vaccine quickly, many hospitals have received more vaccine than expected and fewer staff took it than expected. As a result, hospitals have built up a surplus of vaccines and offered it to their low-risk graduate students and young administrative staff 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 identified a number of significant barriers to effective vaccine distribution, including a lack of coordination and guidance from federal, state and local authorities.
In an effort to figure out how best to manage their vaccine surplus, some hospitals called their state’s health department to be told to just hold on to supplies. Most states don’t want to deal with the logistical complexities of transferring supply and, worse, many hospitals are now concerned about states’ negative repercussions when they speak out against their guidelines. In fact, some hospitals are concerned that if they don’t use their vaccine supply, they might not get more. These little games hurt everyday Americans, some of whom are ducks in this war against the virus.
Many solutions have been proposed, including lotteries or one-off strategies to divide all available vaccine doses. The new Biden administration has also supported efforts to move the vaccine as soon as possible, but there are hurdles at all levels. So what must be done to achieve the goal of vaccinating millions of Americans as soon as possible? Here are a few steps to take now:
1. Ignore complicated counseling and immunize seniors
Confusion over the complicated ranking of vaccine priority groups is leaving hospitals in decision paralysis. A simple age-based allocation strategy is easy to understand and would translate into a much faster vaccine rollout. Hospitals must be able to bypass complicated CDC, state and local guidelines and immediately offer their vaccine surplus to the oldest and most vulnerable people in the community. In fact, many hospitals have a process of offering the flu shot to every clinic and hospitalized patient every year.
2. States must avoid
States that require a nurse to administer the vaccine must immediately change it to a health professional. Pharmacists, medical assistants and other health professionals should be allowed to vaccinate people.
Some states waste too much time pontifying whether community vaccines are best done at pharmacies and grocery stores rather than hospitals. Pharmacies and supermarkets are the ideal environment given their wide experience of mass community vaccinations. But in the meantime, hospitals should respond to their vaccine surplus and distribute it wisely. Hospitals need to take more action 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 is most vulnerable through their electronic health records infrastructure. They need to harness the power of big data to find people with the age and comorbidities that put them at greatest risk of death. The death rate with COVID-19 ranges from 0.001% to 20%. Finding those at the highest risk of COVID-19 death is a challenge that is difficult for pharmacies and supermarkets to tackle, but hospitals are in a strong position to solve this. Just as hospitals individually contact people in their records when it is time for their mammogram, colonoscopy, or other health screenings, hospitals can also help identify those who are most at risk and the most difficult to reach.
4. Tackle vaccine deserts
Regional hospitals need to redistribute vaccine doses to address these geographic and socio-economic disparities in healthcare. As vaccines were rolled out, the CDC Vaccine Prioritization Advisory Committee and other similar groups met to consider how best to allocate the vaccine. Unfortunately, the recommendations came out late (weeks after initial FDA authorizations were granted), after trucks loaded with vaccine doses and hospitals secured freezers for storage. This late guidance encouraged hospitals to procrastinate because their plan was “Let’s see what the states say” and the states said, “Well, let’s see what the CDC says.” States and the CDC had nine months to develop an allocation strategy. Tragically, the government, entangled in red tape, was two weeks late in planning the vaccination allocation.
The formal guidance was not only late, but also inadequate. First, it failed to stratify America’s 23 million health 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 IC nurse with diabetes and asthma. Algorithms that attempted to accurately identify the priority groups failed, leaving community health providers and some private practices in the dark. The chaos of infighting and the continuing stories of wealthy board members and spouses of hospital administrators who gained access before others had access to vaccine deserts (mainly rural areas where vaccine is not available or scarce for first-priority groups). A Texas country club even announced its vaccination for club members on January 11, 2021.
5. Show leadership now
Healthcare 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 soaring cases and deaths and a burnt-out workforce, now is the time for courageous thinking and disruptive ideas. We hope that the leaders of our hospitals will rise during this difficult time. We need courageous leadership to replace the shy approach that many hospitals take as adherents to bad government guidelines. Hospitals should lead, not follow.
Governments and the medical community are notorious for their nuanced debates. But to resolve the current national vaccination debacle, let’s stop discussing the ideal philosophy and be real. Hospitals must show leadership in rapidly developing a pragmatic Plan B strategy that works. We need to focus on administering the vaccine to high-risk seniors promptly, starting with the oldest members of our community, a simple strategy that would save the greatest number of American lives.
The views of any author do not represent the views of any organization or institution.