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The deployment of the U.S. coronavirus vaccine is starting slowly as states struggle with logistical challenges.
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Public health experts are worried that the next round of vaccinations for older people and essential workers will still be chaotic.
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Several state health departments have told Business Insider that they are still in the process of determining the logistics of who will be vaccinated next and how the process will take place.
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It is unclear whether individuals need appointments. But spreading vaccines on a first-come, first-served basis can lead to long queues and health hazards.
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The news came in a press release last weekend: Elderly residents of Lee County, Florida, can get coronavirus vaccines on a first-come-first-served basis.
In the hours and days that followed, hundreds of people aged 65 and older lined up outside the vaccination sites. Some endured temperatures up to 47 degrees Fahrenheit when they camped overnight. Most sites reach every day before 7am – two hours before they open.
It was a preview of what a broader effect of vaccines might look like without adequate preparation and communication.
In most states, vaccines are currently being distributed among health workers and residents of long-term care facilities. This is one of the easiest groups to vaccinate: healthcare workers get the shots at their workplace, so it’s not difficult to determine if they are eligible. Meanwhile, CVS and Walgreens travel to individual facilities to vaccinate residents of nursing homes.
But the next vaccination round is likely to be harder to manage.
“It’s going to get a lot uglier,” said Dr. Ashish Jha, dean of Brown University’s School of Public Health, told Business Insider.
The Centers for Disease Control & Prevention has recommended that states prioritize essential workers and people 75 years and older in the next phase of vaccinations. This category is much larger than the previous one, with an estimated 49 million people. The initial groups amounted to only 24 million people. What’s more, it can be difficult to define the status of ‘essential worker’ and may differ according to the state.
Many state health departments, including those in Colorado, Connecticut, Indiana, Maryland, New Jersey, Pennsylvania, Vermont and Virginia, have told Business Insider that they are still looking at the logistics of who will be vaccinated next, how individuals will be prioritized and which sites will help with the vaccinations. Some departments have said they hope to finalize the parameters in the coming days or weeks.
The timeline is too slow, Jha said.
“It’s not like we’re months away from vaccinating people who’s 80,” he said. “We’ve hopefully been weeks away from vaccinating people who’s 80. I do not understand how we are going to do that, and neither does anyone else.”
Vaccination of essential workers presents new challenges
State health departments mostly say that vaccines will be available at some combination of local hospitals, health departments, pharmacies, medical offices and Federally Qualified Health Centers. The federal government has partnered with major chain pharmacies such as CVS, Walgreens and Walmart.
Vermont said it is entering into its own partnerships with pharmacies and that it already has relationships with local hospitals, but has not expanded further. Illinois has said it will work with pharmacies and also deploy mobile vaccination teams in vulnerable communities. Texas said the decisions and procedures are left to each of its 50 individual local health departments.
It is still unclear whether people will have to make appointments to be vaccinated in these or other states, and whether we will see longer queues. The Colorado Department of Health said Business Insider appointments may be available “in some cases.”
“I do not see a uniform, concise and clear communication on how to get vaccine, as it is being rolled out in a more public forum outside, for example, hospital staff,” said Marissa Levine, a professor of public health at the University of the South. -Florida, told Business Insider. “People need to know how to get the vaccine, when to get the vaccine, and who should get the vaccine, and how these decisions are made.”
When people stood in line, she added: “seems to me a very dangerous way to do it.” Coronavirus hospitalizations have reached the highest levels – more than 120,000 a day – in the US, and the country reported its highest number of daily deaths on Wednesday: more than 3,700. Encouraging vulnerable groups to come together could fuel the transmission.
It is also unclear what type of identification statements are needed to verify that people are in the vaccine priority groups. Lee County health officials, for example, have asked health workers to provide a copy of their ID number or a current paycheck.
“If you’re a nurse or pharmacist at CVS, how can you make sure someone is a mass transit worker?” Said Jha. “Do you need a letter from their HR department? Can anyone forge a letter?”
He added that states are “too stretched out” to resolve these issues on their own.
Vaccination sites remain in the dark
According to the CDC, states must have enough shots to start vaccinating essential workers and people over the age of 75 in January, and then they must complete vaccinations in February.
But even large health systems are not sure how it will turn out. In a statement to Business Insider, Kaiser Permanente, one of the largest healthcare systems in the country, said he was working with government officials but acknowledged that “we do not yet know how each state will approach this process.”
Three major primary care chains recently told Business Insider that they do not know when to vaccinate their own healthcare workers, let alone patients. They also do not know how many doses are coming, or what to say to patients who call to ask when they can get the shots.
“At this stage we do not yet receive much information from the state health departments or pharmacies or hospitals about when we will be engaged,” said Dr. Jason Lane, an infectious disease doctor at ChenMed, a Miami-based doctor. primary care chain, said.
Dr Emily Maxson, chief medical officer at Aledade, a network of independent practices, said the vaccination of vaccines so far ‘is entirely a mystery to front-line providers’.
‘A complete mess of a national implementation’
The U.S. has so far sent about 12.4 million doses of vaccine, but according to the CDC, less than 2.8 million people have received injections since Wednesday morning. Data backlogs mean the actual figure could be higher: Bloomberg’s tracker suggests nearly 3.5 million Americans were vaccinated as of Friday.
Either way, it is not nearly the Trump administration’s goal to vaccinate 20 million people by 2020.
Dr Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases, attributed the slow pace of vaccinations to the Christmas holidays and confusion over how many doses were available.
“We knew vaccines would come in December,” Jha said. “It’s not a surprise – and you would have thought that all the infrastructure, all the planning, all the data infrastructure, would have been all set up months ago so that the day the vaccine was approved, it could be shipped and could have started in people’s arms. ‘
However, the burden of the deployment has placed the burden on already overwhelming state health departments.
Local officials have the task of coordinating the vaccination schedules while also confronting a tsunami of sick patients. Many health departments do not have the funding to appoint enough staff to administer doses in large groups. Others do not have the expertise to transfer thousands of doses from local warehouses to the arms of individuals – which experts call the challenge “last mile”.
“Vaccines that sit on the shelves do nothing while thousands of Americans die,” Jha said. “It’s a travesty. It’s the most ridiculous example of our country’s incredible ability to be innovative in producing the vaccine and yet the inability of our government to help it get people.”
The recently passed coronavirus relief package gives states about $ 8 billion to help spread vaccines. Elected President Joe Biden said he needed more money from Congress to achieve his goal of vaccinating 100 million people in his first 100 days in office.
“The Trump team is handing over a complete mess of a national implementation,” Jha said. “The Biden team is going to put in a lot of hard work.”
Shelby Livingston reported.
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