From USA Today:
“COVID-19
vaccine doses have been delivered but are sitting on pharmacy shelves. Longer
delays could prolong the pandemic”
If the pace of
COVID-19 vaccine delivery into people's arms stays the way it has been for the
past few weeks, it could take years rather than months to vaccinate Americans,
and the outbreak will continue to dominate lives. Federal officials overestimated the speed at
which vaccines could be given, making delivery a disappointment in an otherwise
successful vaccine development effort. Doses have been distributed behind the
government's initial schedule – 15 million, instead of the 20 million doses
promised to be delivered by the end of 2020. About 70% of those doses are
sitting on pharmacy shelves, according to government data, and only about 14%
of doses destined for nursing home residents and caregivers have been injected.
Although
vaccination is off to a rough start, it's not too late to turn the situation
around, according to experts such as Kelly Moore, deputy director of the
Immunization Action Coalition, an education and advocacy group. To do so will
require a host of improvements, including more money, additional staffing and
greater experience with vaccines that have been shown to be safe and effective
but not so easy to use. About 200,000 doses are being given a day. Anthony
Fauci, director of the National Institute of Allergy and Infectious Diseases,
said vaccinators should soon be able to deliver 1 million a day. "There were a lot of aspirational goals
set by federal officials about how many vaccines could be delivered how
quickly," Moore said. "The delivery of a box of vaccine to a clinic door
is the easiest part of the process." Chicago has delivered 95% of the
vaccine it's received, but at the current rate of delivery, it would take a
year to a year-and-a-half to vaccinate the city's residents, Mayor Lori
Lightfoot said Tuesday. "That is unacceptable,” she said. “The federal
government must absolutely, 100% step up.” Chicago has built infrastructure to
deliver the vaccine, Lightfoot said, but needs more doses. “The federal
government has to step up, finally, and do a better job at protecting American
lives from this terrible virus.”
Operation Warp
Speed, the federal program tasked with developing and delivering COVID-19
vaccines, promised to vaccinate 20 million Americans in December. Three weeks
after shipping began, the program has distributed 15 million doses to hospitals
and nursing home providers, but only 4.5 million people have gotten the first
of the two-shot regimen. That means 30% of available doses have been used. Among nursing home residents and caregivers,
365,000 shots have been delivered out of more than 2.5 million distributed – a
14% usage rate. The numbers may be somewhat better than they appear because of
a lag in reporting, but there's no question that fewer shots are being given
than was planned or expected. Federal officials have focused on getting the
vaccine onto hospital shelves, but to get them off the shelves requires
"an enormous human element," Moore said. There are always bugs when
you "translate from paper to practice," she said, and federal plans
didn't give enough consideration to the need for scheduling and organizing
clinics, educating patients and caregivers and resolving the small problems
that crop up. Hospital workers and public health officials are exhausted after
11 months of fighting the virus. "And now they're being asked to ramp up
the most ambitious vaccine program the country has ever seen," said Dr.
Howard Koh, a former assistant secretary for health at the U.S. Department of
Health and Human Services and now a professor at the Harvard T.H. Chan School
of Public Health. The protocols for this vaccine are different from those for
the seasonal flu vaccine, for which a nurse can wheel a cart through hospital
hallways, delivering shot after shot. People who receive a COVID-19 vaccine
have to be watched for 15 minutes to ensure they don't have an allergic
reaction. This requires hospitals to set aside space and personnel – both of
which are at a premium. The process is further slowed as caregivers have to
think about who should or shouldn't be vaccinated. "All of those things
are just part of the not-unexpected challenges we face in implementing such a
complex program with a new vaccine based on a new platform in the midst of the
height of the pandemic with exhausted health care workers who are at the end of
their rope after all the work they've been doing for the past year," Moore
said. By the time there is enough vaccine to distribute outside hospitals and
other care facilities to the broader community, vaccinators will have worked
out some of the kinks in the system, she said. It may get easier to vaccinate large numbers
of people when shots can be delivered at neighborhood pharmacies and health
care facilities. CVS is ready to deliver
vaccine at all 10,000 of its pharmacies nationwide and expects to be able to
give 20 million to 25 million doses a month once enough vaccine is available. "We're
ready to go once the government authorizes wider distribution," said Mike
DeAngelis, a CVS spokesperson.
Frustrating
front-line experience Dr. Steven Wolf said his experience last weekend
illustrates many of the challenges facing vaccinators. Wolf, who co-runs
neurology services for YAI, a New York-based support organization for people
with autism, Down syndrome and other conditions, came in over his vacation to
vaccinate patients and the staff members who care for them. "I
was envisioning that we were going to get them in and out fast," Wolf
said, but the process was "horribly terrible." It took 52
clicks on each person's digital medical record before the patient was ready to
receive a shot. That was after YAI had managed to get consent forms signed by
family members and guardians for those who couldn't sign for themselves. "It
was just freaking endless," Wolf said of the paperwork. He and two
others were able to vaccinate 40 people
in three hours, far fewer than he anticipated. Ten caregivers refused to
receive the vaccine. Some wanted to talk it over with family members. Others
wanted more people to go first, while some repeated conspiracy theories about
the vaccine. Wolf said he considers himself a pretty persuasive person,
and he was armed with lots of facts about the minor side effects and major
benefits of the vaccine, but he said he and his colleagues couldn't persuade
those 10 to get vaccinated. "We talk people into medication and
surgery and all these other things, and we could not convince these 10 that
this is what you've got to do to take care of yourself," he said. "I
came home so frustrated."
Lack of
money, focus and leadership Although Congress allocated $8 billion for
vaccine distribution, Koh, the former federal health official, said it's not
enough and should have arrived months ago. "This is a field that
has been under-resourced and overlooked for far too long," Koh said. Koh,
who was commissioner of public health for the Commonwealth of Massachusetts
during 9/11 and the anthrax scare in 2001, said officials promised then never
to be caught off guard again by a public health emergency, but that resolve
didn't last. He criticized the lack of federal leadership and
politicization of public health, saying state and local governments should
collaborate, not go it alone. "A crisis like this should be
bipartisan, nonpartisan, one government response," he said, but that's not
what's happened. Moore lives in Tennessee, which has eight neighboring
states each with different policies. In Bristol, Tennessee, police officers have
to wait until health care workers are vaccinated, while officers across the
border in Bristol, Virginia, are allowed to line up. Different standards
could mean vaccinators will hesitate to make sure they're not making a mistake,
and recipients will be more likely to pass on the vaccine, thinking they're not
a priority. There's no right way to prioritize who should get the
vaccine first, second and third, Moore said, but having each state choose its
own path is too confusing. "The right way to do this is to pick one
way," she said. These
problems are all solvable, Moore said, and it's realistic to think they will be
fixed within the next month, and the number of vaccinations will reach 1
million a day nationwide, as Fauci suggested.Surgeon General Dr. Jerome Adams,
speaking on NBC News’ 3rd Hour of TODAY agreed that the state delivery systems
have been uneven, with some distributing 75% or more of available doses, and
other not even 25%. He said there
would be more money coming to help out, more locations will soon be added to
provide vaccinations and more people eligible to get the vaccine. “Your
headline today really should be 'Surgeon General tells states and governors to
move quickly to other priority groups,'” he said. The bottom line is
that everyone wants vaccinations to move faster, said Nancy Foster, vice
president for quality and patient safety policy at the American Hospital
Association. Vaccines provide the chance to get beyond COVID-19 as a force in
our lives. "It is the great
opportunity and the great hope," Foster said. "No one wants to see it
moving slowly."
^ Every day
that the Local, State and Federal Governments and those tasked with delivering
the vaccine delay means many more Americans infected, hospitalized and dead. To
say that this is life or death is exactly correct. ^
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