Here are four important words in the next phase of America’s Covid-19 vaccination campaign: “Talk to your doctor.”
The US is reaching a tipping point in its vaccination drive. There will soon be more shots available than people coming to get them, if there aren’t already. “Most states appear to be at or near ... the point at which their supply is outstripping demand,” the Kaiser Family Foundation’s Jennifer Kates, Anna Rouw, and Josh Michaud wrote in a new analysis.
The easy part is winding down. Americans who were able and eager to get the vaccines have had weeks to get their shot. Now comes the hard work: persuading people who can be persuaded to get vaccinated, and reaching the disadvantaged patients who have still lacked easy access to a vaccine.
Primary care doctors say they can play an important role in meeting both goals. Surveys show people who are taking a “wait and see” approach to the vaccine can be convinced by their doctor that it’s safe and effective. Even doctors who are unable to give a vaccine themselves are more likely to know which patients may need extra assistance.
“We need to be part of the plan,” said Ada Stewart, a doctor in South Carolina and president of the American Academy of Family Physicians, adding that she was grateful the Biden administration had been engaging more with physicians. “I wish it had happened sooner.”
How to distribute and administer vaccines is a state-by-state decision, but so far states have largely focused their vaccine campaigns on mass sites, mobile clinics, and commercial pharmacies. The New York Times reported in early February that primary care doctors were already frustrated they were not being utilized more in the vaccination drive.
That may finally be changing, but it can still be a slow process. “There is not that steady stream or supply of vaccine that has trickled down to make it available at multiple sites,” says George Abraham, a Massachusetts doctor and president of the American College of Physicians.
In Boston, Abraham said, thousands of doses are still being targeted to mass sites such as those set up in Fenway Park and Gillette Stadium. But the state is shifting its strategy, setting a goal to close mass vaccination sites and move doses to physician offices and community clinics by the end of June.
The Biden White House recently announced its plans to push more vaccines into the community, trying to reach Americans where they are. The goal, experts say, should be for every contact with the health system to come with the offer of a vaccine. Achieving the necessary level of immunizations may still require more, but it’s a start as we shift into this more difficult stage of the campaign.
“New strategies are likely needed,” Kates told me. “The more touch points, the better, and since we know ... people would be most comfortable going to their doctor’s office to get vaccinated, these will be important touch points.”
Primary care doctors are already a valuable vanguard in getting Americans their routine vaccinations. They traditionally provide about half of all adult immunizations in the US, per the New York Times. But physicians have arguably been underutilized in the Covid-19 effort.
The logic of massive vaccination sites was sound early in the campaign, Abraham says. Capable of administering thousands of doses per day, such sites are more efficient, and when there was more constricted supply, it made sense to focus those doses on the locations that would deliver the most bang for the buck.
But those temporary sites were not for everybody. We were asking some people to drive 75 miles or more one way to get a vaccine. Abraham gave the example of one of his patients, an 86-year-old Latino man with lung disease who relies on a constant supply of oxygen. He can drive, but he wouldn’t be able to drive to the mass site, wait in line, and then drive back without running out of air. The patient also doesn’t have internet access, making it harder to sign up for an appointment unless he was willing to wait on hold over the phone.
Physicians can play a critical role now, Abraham says, in “identifying people who are economically disadvantaged [or] have more difficulty getting to appointments, and how they could best be served.”
They can also persuade. Among people who hadn’t yet gotten a Covid-19 vaccine, their doctor’s office was the place where they said they were most likely to get a shot, according to a February survey from the Kaiser Family Foundation. Black and Hispanic Americans were both substantially more likely to say they would get the vaccine from their doctor than at a community health clinic or mass vaccination site.
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Physicians are highly trusted by the American public: In a January 2019 poll from the Pew Research Center, 74 percent of people said they had a mostly favorable view of medical doctors.
“Patients trust their physician,” Abraham said. “They look to their physician for that endorsement that it’s safe to take the vaccine. That trust is crucial to overcoming the little vaccine hesitancy folks might have.”
With the harder-to-reach populations, it makes sense to make the vaccine available wherever they may come into contact with the health system. Already, as Politico reported in March, the Biden administration has concluded people are more likely to get the vaccine at their local pharmacy than a temporary site.
Now the White House is trying to expand the vaccine campaign even farther into communities. Biden is urging pharmacies to offer walk-up appointments and has announced $500 million in new funding to support community health clinics and other local organizations in expanding their vaccine drives.
The FDA is also considering an application from Pfizer to relax the stringent storage standards for its vaccine. If approved, that would make it easier for doctors to handle Pfizer doses, which currently require ultra-cold refrigeration that many offices don’t have.
Finishing the vaccine drive is not as simple as distributing doses to doctors all over the country. Storage is currently a challenge, especially for the Pfizer vaccine. Some clinics do not have the space to do patient monitoring (15 minutes post-vaccine for most people, or 30 minutes for those with a history of allergic reactions).
And some of the same disadvantaged people who couldn’t sign up for or get to a mass vaccination site might not make regular contact with a doctor. Black and Hispanic people are much less likely than white people to say they have a primary care physician in the first place; there are also economic disparities to consider, as cost is one factor that keeps people from the doctor.
That’s why some public health experts are already thinking beyond primary care physicians, though they agree they could be useful in the next phase of vaccinations.
“The challenges moving forward are about how to reach those who don’t routinely engage with any health care system and those who are hesitant to vaccinate for any reason,” Kumi Smith, who studies epidemiology and community health at the University of Minnesota, told me. “Increasing vaccine points at every corner of the health care system may help, but may not get us all the way.”
The community health investments proposed by the Biden administration could be valuable, putting more resources into trusted messengers who meet people where they are. Employers could also play a vital role.
Kates, who recently spoke at the US Chamber of Commerce, told me she heard from business leaders who were interested in receiving vaccine allocations directly from the federal government.
“That of course raises challenges,” she said, “but it does seem that employers are an untapped resource and will become more important over time.”
The final stage of the US vaccination drive should be an all-of-the-above approach. Make it as easy as possible for somebody to get a vaccine. That could start with putting the vaccine in the hands of doctors whom patients trust.
source https://www.vox.com/coronavirus-covid19/22419743/covid-19-vaccine-appointment-primary-care-doctors-office
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