Hospitals have been heavily criticized for their role in the chaotic launch of the COVID-19 vaccine. This is because, in the rush to get the vaccine out quickly, many hospitals received more vaccines than expected and fewer employees received them than expected. As a result, hospitals have accumulated a surplus of vaccine and offered it to their low-risk 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 Hospitals Association cited a number of important barriers to the effective distribution of vaccines, including a lack of coordination and guidance from federal governments. , state and local.
In an attempt to find out how to best administer their vaccine surplus, some hospitals have turned to their state’s health department just to be told to simply have the supply. Most states do not want to deal with the logistical complexity of transferring supplies, and worse, many hospitals are now concerned about the negative repercussions of states if they speak out against their guidance. Some hospitals are even worried that if they do not use their vaccine, they may not receive more. These petty games hurt Americans every day, some of whom are ducks in this war on the virus.
Many solutions have been proposed, including lotteries or one-shot strategies to distribute all available doses of vaccine. The receiving Biden administration has also supported efforts to move the vaccine as soon as possible, but there are obstacles at all levels. So what needs to be done to achieve the goal of vaccinating millions of Americans as soon as possible? Here are some steps you should take right now:
1. Ignore complicated guidelines and immunize only the elderly
Confusion over the complicated leveling of priority vaccine groups puts hospitals in a state of paralysis. A simple age-based allocation strategy is easy to understand and would result in a much faster vaccine launch. Hospitals should be allowed to bypass complicated CDCs, state and local guidance, and immediately provide the vaccine surplus to the oldest and most vulnerable people in the community. In fact, many hospitals have a process to offer the flu vaccine every year to every clinic and inpatient.
2. States should get out of the way
States that have an obligation for a nurse to administer the vaccine should change them immediately to any healthcare professional. Pharmacists, nurses and other health care workers should be allowed to vaccinate people.
Some states waste too much time pontificating on whether community vaccinations are best performed in pharmacies and grocery stores, rather than in hospitals. Pharmacies and grocery stores are the ideal setting, given their extensive experience in mass community vaccinations. But in the meantime, hospitals should act on their vaccine surplus and release them wisely. Hospitals should step up and demonstrate leadership in helping the most vulnerable members of their communities.
3. Use big data
Hospitals and health systems have data on who is most vulnerable through their electronic medical records infrastructure. They should harness the power of big data to find the elderly and the comorbidities that place them at the highest risk of mortality. The fatality rate of COVID-19 varies from 0.001% to 20%. Finding those at highest risk of mortality with COVID-19 is a difficult challenge for pharmacies and grocery stores, but hospitals are in a strong position to address it. In the same way that hospitals address people individually in their data, when it is time for mammography, colonoscopy or other health screenings, so hospitals can help identify those most at risk and most difficult. accessible.
4. Address vaccine deserts
Regional hospitals should redistribute vaccine doses to eliminate these geographical and socio-economic disparities in health care. While the vaccines were being launched, the CDC Vaccine Prioritization Advisory Committee and other similar groups met to discuss how best to allocate 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 provided freezers for storage. This late guidance encouraged hospitals to postpone it 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, surrounded by bureaucracy, the government was two weeks late at the vaccine allocation planning party.
Not only was the formal guidance delayed, but it was wrong. First, it failed to stratify America’s 23 million health care workers and instead placed someone as a 34-year-old healthy dermatologist specializing in Botox in the same priority group as a 64-year-old nurse with diabetes and asthma. Algorithms that have tried to accurately identify priority groups have failed, leaving community-level providers and some GPs in the dark. The chaos of the fighting, as well as the ongoing stories of wealthy board members and the wives of hospital administrators who gain access before others have led to vaccine deserts (especially rural areas where the vaccine is not available or not available to premium groups priority). A country club in Texas even announced the registration of the vaccine for club members on January 11, 2021.
5. Demonstrate 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 too reluctant to question guidance or challenge authority, but with growing cases and deaths and a burned workforce, now is the time for bold thinking and disruptive ideas. We hope that the leaders of our hospitals will step up at this difficult time. We need bold leadership to replace the timid approach that many hospitals take to be adherents of weak government guidelines. Hospitals must lead, not follow.
Governments and the medical community are known for their nuanced debates. But to fix the current disaster of launching the nation’s vaccine, let’s stop arguing about the ideal philosophy and be real. Hospitals must demonstrate leadership in the rapid development of a working pragmatic plan B strategy. We need to focus on the rapid administration of the vaccine to at-risk seniors, starting with the oldest 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 views of any organization or institution.