The urgency of vaccinating residents of old age homes is evident from the numbers. The COVID-19 pandemic claimed the lives of more than 136,000 residents and employees of long-term care institutions in the U.S. alone, accounting for nearly 40% of all U.S. deaths associated with the disease.
Given the urgency, Alex Azar, secretary of health and human services, declared in mid-December: “We can have every nursing home patient in the United States vaccinated by Christmas.” But by Christmas, most states had barely begun.
Other states were still far behind when West Virginia became the first state to complete the first one of the two-dose vaccine series in nursing homes on Dec. 30.
What did West Virginia do differently?
The numbers tell a story. As a professor specializing in the management of health care operations, I believe they contain important lessons for other states and the rest of the vaccination.
The pharmacy’s math problem
The first important point is that West Virginia has opted for a federal partnership program that relies on the giant pharmacy chains CVS and Walgreens to deliver vaccines to nursing homes. Instead, the state relies on a network that consists mostly of local pharmacies.
West Virginia was also praised for how it used the time between the authorization of the first vaccines and the first doses to plan the deployment.
The big difference is in the numbers. Under the federal partnership program, CVS plans to have about 1,000 pharmacies as vaccination points to serve about 25,000 nursing home facilities across the country, a CVS official told The Wall Street Journal in early December. Similarly, a Walgreens official said his business would have 800 to 1,000 Walgreens pharmacies to serve as a hub for about 23,000 nursing home facilities.
This means that each CVS and Walgreens pharmacy, on average, plans to serve about 25 nursing homes.
West Virginia chose to mobilize independent and chain pharmacies, rather than relying solely on CVS and Walgreens. More than 250 pharmacies have offered to vaccinate people at 214 nursing homes. In other words, each nursing home is served on average by more than one pharmacy.
Vaccination of old age homes is a very labor intensive operation. Getting permission from residents and staff is time consuming and confusing. Some people also refuse the vaccine. By January 14, only about a quarter of the vaccines distributed to nursing homes by the federal program had reached people’s arms, while West Virginia began vaccinating new groups and administering the second doses.
Incentives are another matter
Except for the skewed math, there is a story of incentives.
Under the contracts signed with the U.S. Department of Health and Human Services, CVS and Walgreens essentially gained the right to vaccinate approximately 99% of U.S. nursing homes registered with the program. They had little incentive to connect a large number of pharmacies and workers to the daunting task of vaccinating people in nursing homes.
In West Virginia, however, there were hundreds of local and other chain pharmacies involved, and each had every incentive to provide prompt services so that nursing homes would not walk away from the vaccination transactions. Local pharmacies also often have existing relationships with nursing homes – relationships they want to maintain.
AP Photo / Stephen Dunn
Lessons for the rest of the country
What can other states learn from West Virginia’s success story?
First, to accelerate the explosion of the vaccine, the US needs to address the bottlenecks – the shortage of resources, especially staff and distribution points, needed for vaccination.
Second, incentives are important. When designing vaccination programs, it is important to ensure that providers are motivated to use resources to expedite vaccination. Market competition is a powerful mechanism to achieve this.
Third, state and local leadership can make a difference. Although a lack of federal leadership is cited as the reason for the slow vaccination of vaccines, West Virginia has succeeded in vaccinating nursing homes because it may be more agile outside the federal program. State and local leaders can succeed when they are held accountable and when they proactively manage the process.
The US is only at the beginning of the COVID-19 vaccination process. Just over 3% of the country’s population has been vaccinated since January 13, and there are still many challenges on the way. The complex cold storage requirements of mRNA vaccines can make it difficult to reach rural areas without careful planning and logistical support. More health care staff and residents also refused to get the vaccine than health professionals would like to see. In West Virginia, about half of the nursing home staff members have declined. It all has consequences as the vaccinations continue.