Saturday, January 23, 2021
Health

Hospitals: Stop Playing Vaccine Games and Show Leadership

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America’s hospitals are supposed to be the center of scientific genius, but in stewarding the COVID-19 vaccine, many hospitals have been the center of poor management and cronyism. Wealthy health systems with thousands of employees have been making excuses why they don’t have the funds, staff, or state guidance to immunize vulnerable seniors in their community while at the same time these hospitals are vaccinating their own administrators and young, work-from-home communications staff, human resources staff, and accounting personnel.

This is a manufactured problem. The CDC, states, and hospitals should have distinguished frontline COVID-19 workers from everyone who has a job connected to healthcare. As University of Iowa immunologist and CDC committee member Stanley Perlman, MD, PhD, told the New York Times, the CDC never intended to include workers who don’t interact with patients, like administrators and graduate students, in the first tier of priority vaccinations. Yet weeks after the FDA authorized the life-saving vaccine, hospitals like Brigham & Women’s Hospitals, Massachusetts General Hospital, Columbia, and Vanderbilt raced to give the vaccine to young non-patient-facing students and staff. Many of those staff now realize the injustice in their allocation and admit they feel terrible displacing a vulnerable American in the vaccine line. Hospital leaders: this is a disgrace to our great profession. You should have known better.

This allocation crisis is not unexpected given the growing divide between hospital administrators and frontline physicians. Instead of convening the great medical minds on their staff, many hospitals took the lazy path of relying on the government to tell them what to do, even though the government guidance was purely advisory and not legally binding. It turned out to be late guidance and bad guidance. A simple strategy of allocating the vaccine by age, as the U.K. is doing, would have resulted in far less decision paralysis and misallocation. It would also have saved more American lives.

Over the last few weeks, many hospitals found themselves unexpectedly sitting on a COVID-19 vaccine surplus. That’s because some were shipped more vaccine than they have staff, and less staff took it than anticipated. I spoke to many hospital CEOs over the last few weeks about how to best handle their vaccine surpluses. Many were sincerely interested in trying to do what’s best. But it was clear to me that they didn’t want to do anything outside of their state’s advice.

But why are hospitals, loaded with smart doctors, allowing state governments to tell them what’s best for public health? When I would suggest to hospitals that they send their surplus to a local pharmacy or grocery store with a lot of experience with community vaccinations, I was told that the state would frown on a transfer. I was also told that they needed to use their vaccine supply on young healthy staff so that the state would give them more. When I suggested to hospitals that they should start community vaccinations, I was told they didn’t have a process set up and that it would not be profitable. But can’t hospitals pull together all their brainpower to figure out how to allow community members to use the same vaccination station?

Regarding the expense, the total administrative cost to vaccinate seniors from the community in clinic is less than one-quarter of their CEO’s pay in a single year. Given the health emergency this year, we physicians need to urge our hospitals to live up to their community mission.

Hospitals should stop giving excuses and start showing some leadership. At minimum, hospitals should use the seasonal flu shot protocols we already have in place to immunize clinic and hospitalized patients as we have for years. Every year since flu immunization of clinic and hospitalized patients became a quality metric, nearly every patient coming to see me in clinic and every patient I discharge from the hospital is offered the flu shot. Why can’t hospitals include the COVID-19 vaccine in that offer? The reality is that some hospitals are already taking a stand for what’s right. They have made a decision not to wait for their state guidance, and to go ahead and offer the vaccine to older Americans, both patients they identify as high-risk from their medical records and members of their community at large.

In fairness to hospitals, they should not have been in this predicament where they are a primary site for community vaccinations. Local pharmacies, grocery stores, and dialysis centers have extensive experience administering vaccines each year and should have received more vaccine supply. The underutilization of dialysis centers to vaccinate dialysis patients is the most troubling to me. Kidney disease is the #1 most common risk factor for COVID-19 death. Every year, U.S. dialysis centers give kidney patients the flu vaccine early and efficiently. They have a great system in place. Yet the nation’s vaccine plan did not ship the vaccine to any of the nation’s 7,500 dialysis centers or even include them in the distribution planning discussions. If they were, they would have been a key partner to swiftly protect those most vulnerable. To save the greatest number of American lives, states should send more vaccines to pharmacies, grocery stores, and dialysis centers after nursing homes have been fully supplied. They know how to vaccinate communities quickly.

Tragically, most of the vaccine supply has not been shipped yet. That’s because the old guard medical establishment convinced the government to hold back 55% of the nation’s vaccine supply to reserve second doses, even though there is much more vaccine coming online to meet that demand. President-elect Biden announced he plans to release the entire supply to speed up vaccination efforts, and the department of HHS now says they will no longer recommend reserving the second dose. In my opinion, it can’t be done soon enough.

Confusion about vaccine priority groups and logistics has put hospitals in a decision paralysis at a time when they should be showing leadership. Hospitals should bypass the complicated CDC, state and local guidance, and immediately offer their vaccine surplus to the oldest and most vulnerable patients and members of their community. Some states are living in an ivory tower making the arguments within complicated bureaucracies that community immunizations are best performed at pharmacies and grocery stores rather than hospitals. They are right, that is true. But there are vaccine surpluses sitting on the shelf at U.S. hospitals right now as thousands of Americans die each day. Let’s stop arguing and be pragmatic. Hospitals should show leadership and give the vaccine surplus to local seniors — a simple strategy that maximizes the number of lives saved.

Marty Makary MD, MPH, is editor-in-chief of MedPage Today as well as professor of surgery and health policy at the Johns Hopkins University School of Medicine and author of The Price We Pay: What Broke American Health Care — and How to Fix It.



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