Hospitals have been sharply criticized for their part in the chaotic COVID-19 vaccination. In a hurry to get the vaccine out quickly, many hospitals were vaccinated more than expected, and fewer staff took it than expected. As a result, hospitals have built up a surplus of vaccines and offered them to their low-risk students and young administrative staff working from home and are now trying 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 cites a number of important barriers to effective vaccine distribution, including a lack of coordination and guidance from federal, state- and local governments.
In an effort to find out how they can best control their vaccine surplus, some hospitals have called their health department and just told them to just keep the stock. Most states do not want to deal with the logistical complexity of the transfer of supply, and worse, many hospitals are now concerned about negative consequences from states when expressing their guidance. Some hospitals are even worried that they may not receive more if they do not use their vaccine supply. These little games hurt Americans daily, some of whom end up in this war against the virus.
Many solutions have been proposed, including lotteries or one-off strategies to issue all available vaccine doses. The incoming Biden administration has also supported efforts to get the vaccine moving 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 need to take now:
1. Ignore complicated guidance and immunize only the elderly
Confusion over complicated breeding of the priority groups of vaccines puts hospitals in a decisive paralysis. A simple age allocation strategy is easy to understand and can lead to a much faster vaccination. Hospitals should be allowed to bypass the complex 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 of offering the flu shot every year to every clinic and hospitalized patient.
2. States must fall out of the way
States with the requirement that a nurse administer the vaccine should immediately change it to any healthcare professional. Pharmacists, medical assistants and other health professionals should be allowed to vaccinate people.
Some states waste too much time thinking about whether community immunizations can best be done at pharmacies and grocery stores rather than hospitals. Pharmacies and grocery stores are the ideal environment, given their extensive experience with massage community vaccinations. In the meantime, hospitals need to act according to their surplus of vaccines and distribute them wisely. Hospitals need to act and show leadership to help the most vulnerable members in their communities.
3. Use big data
Hospitals and health systems have the information on who is most vulnerable through their electronic health record infrastructure. They need to harness the power of big data to find those with age and co-morbidities who are at greatest risk of death. The mortality rate of the COVID-19 case ranges from 0.001% to 20%. Finding those at greatest risk of COVID-19 deaths is a challenge that is difficult for pharmacies and grocery stores, but hospitals are in a strong position to solve it. In the same way that hospitals individually reach out to people in their data when it’s time for their mammogram, colonoscopy or other health examinations, hospitals can also help identify those with the greatest risk and the hardest to reach.
4. Address desert deserts
Regional hospitals need to redistribute the doses of vaccines to eliminate these geographical and socio-economic disparities in health care. While vaccines were being deployed, the CDC Vaccine Advisory Committee and other similar groups met to consider how the vaccine could best be administered. Unfortunately, the recommendations were issued late (weeks after the FDA granted the initial authorization), after trucks were loaded with vaccine doses and hospitals secured freezers for storage. This late leadership encouraged postponement by hospitals because their plan was “Well, let’s wait 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, trapped in bureaucracy, the government was two weeks too late for the vaccination planning party.
Not only was the formal guidance late, it was flawed. First, America’s 23 million health workers could not be stratified, placing someone like a healthy 34-year-old dermatologist specializing in Botox, in the same priority group as a 64-year-old nurse from the ICU with diabetes and asthma. Algorithms that attempted to accurately identify the priority groups have fallen back, leaving community-based providers and some clinics in the dark in practice. The chaos of infighting as well as continuing stories about wealthy board members and spouses of hospital administrators gaining access before others has led to vaccines (mainly rural areas where the vaccine is not available or is barely available to first priority groups). One foreign club in Texas even announced its vaccination for club members on January 11, 2021.
5. Now show leadership
Healthcare is one of the most regulated industries in the world, with incredible oversight and bureaucracy. As a result, many hospital leaders were too reluctant to question leadership or challenge authority, but with increasing cases and deaths and a burnt-out workforce, now is the time for courageous thinking and disruptive ideas. We hope that our hospital leaders will increase during this difficult time. We need courageous leadership to replace the timid approach that many hospitals follow from poor government leadership. Hospitals must lead, not follow.
Governments and the medical community are notorious for their nuanced debates. But to rectify the country’s current explosion debacle, let’s stop arguing about the ideal philosophy and be real. Hospitals need to show leadership to quickly develop a pragmatic plan B strategy that works. We need to focus on quickly giving the vaccine to the elderly at risk, starting with the oldest members of our community – a simple strategy that would save most American lives.
The views of each author do not represent the views of any organization or institution.