Hospitals have received strong criticism for their role in the chaotic launch of COVID-19 vaccines. This is because in the rush to get the vaccine out quickly, many hospitals were sent more vaccines than expected and fewer staff were taken than expected. As a result, hospitals amassed a surplus of vaccine and offered it to their low-risk students and young administrative staff who worked from home and are now busy figuring out what to do with the rest. The answer should be simple: give it to older members of your community, but in a recent letter from the American Hospital Association they mentioned a number of important barriers to the effective distribution of vaccines, including lack of coordination. and guidance from federal, state, and local governments.
In trying to figure out how to better manage their vaccine surplus, some hospitals called their state health department just to ask them to simply have the supply. Most states do not want to deal with the logistical complexity of supply transfer, and even worse, many hospitals are 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 the vaccine supply, they will not receive more. These little games hurt everyday Americans, some of whom are sitting in this war on the virus.
Many solutions have been proposed, including lotteries or one-run strategies to dispense all available doses of vaccine. The incoming Biden administration has also supported efforts to move the vaccine as quickly 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 we should take right now:
1. Ignore complicated guidelines and only vaccinate the elderly
Confusion over the complicated levels of priority vaccine groups puts hospitals in a paralysis of decisions. A simple age-based allocation strategy is easy to understand and would result in a much faster vaccine release. You should allow hospitals to avoid complicated CDC, state, and local guidelines and immediately offer their vaccine surplus to older and vulnerable people in the community. In fact, many hospitals have an established process for offering the flu vaccine each year to each clinic and hospitalized patient.
2. States should get out of the way
States that require a nurse to administer the vaccine should change it immediately to any health care professional. Pharmacists, nurses, and other health care workers should be able to vaccinate people.
Some states waste too much time pontificating about whether community vaccines are best done in pharmacies and grocery stores instead of hospitals. Pharmacies and grocery stores are the ideal setting given their extensive experience in mass community vaccinations. In the meantime, hospitals should act on their excess vaccine and dispense it with caution. Hospitals should be strengthened and show leadership to help 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 health record infrastructure. They should harness the power of big data to find those with age and comorbidities that put them at greater risk of mortality. The mortality rate for COVID-19 cases ranges from 0.001% to 20%. Finding those most at risk for mortality from COVID-19 is a difficult challenge for pharmacies and grocery stores, but hospitals are well positioned to address it. Just as hospitals reach people individually in their data when it comes time to have a mammogram, colonoscopy, or other health tests, hospitals can also help identify those who are most at risk and the most difficult. to arrive.
4. Address vaccine deserts
Regional hospitals should redistribute vaccine doses to eliminate these geographical and socioeconomic disparities in health care. While vaccines were being deployed, the CDC Advisory Committee on Vaccine Prioritization and other similar groups met to study 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 doses of vaccines and hospitals had secured the freezers to store them. This late guide encouraged hospital procrastination because its 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, embroiled in bureaucracy, the government delayed the vaccine allocation planning party by two weeks.
The formal orientation not only came late, but was flawed. First, she failed to stratify the 23 million American 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 attempted to accurately identify priority groups, and left community-based providers and some private practice clinics in the dark. The chaos of internal struggles, as well as the continued stories of wealthy board members and spouses of hospital administrators who have gained access before others, has resulted in vaccine deserts (predominantly rural areas where vaccine is not available). or is scarce for first priority groups). A Texas country club even announced its enrollment in the vaccine 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 too reluctant to question orientation or challenge authority, but with increasing cases and deaths and a depleted workforce, now is the time for bold thinking. and of disturbing ideas. We hope that the leaders of our hospitals will increase at this difficult time. We need bold leadership to replace the timid approach that many hospitals are taking to be followers of government misdirection. Hospitals need to lead, not follow.
Governments and the medical community are famous for their nuanced debates. But to fix the current debacle of the country’s vaccine launch, let’s stop discussing the ideal philosophy and be real. Hospitals must demonstrate leadership in the rapid development of a working Plan B pragmatic strategy. We need to focus on giving the vaccine to at-risk seniors quickly, 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.