For a small-town physician, being given a supply of the Covid-19 vaccine can make a world of difference.
In Cut Off, La., 30 of primary care physician Gary Birdsall’s patients have died from Covid-19. In his small rural community, they were neighbors and friends. So when a shipment of the Moderna vaccine arrived at his practice, it changed everything. As he described it to a reporter, the vaccine “put some degree of power back in my hands to prevent some of the illness I’m seeing.”
The Biden administration’s American Rescue Plan corrects a critical oversight in the previous administration’s vaccine planning: the exclusion of primary care offices in the Covid-19 vaccination effort.
Our country’s independent primary care providers are experiencing the painful déjà vu of once again being marginalized — they were also last in line to get protective equipment during the pandemic’s worst supply shortages and last in line for relief payments. And today, most primary care offices have no access to vaccines for their patients despite the fact that they hold the trusted relationships necessary to vaccinate a hesitant populace.
Most of these practices have struggled to receive vaccines under the Centers for Disease Control and Prevention’s current rules, which delegate decision-making to individual states and allow only large retail pharmacies to get vaccine shipments directly from the federal government.
Given the initial distribution channels, no one should be surprised by the underwhelming national vaccination rates. Local health departments are besieged and lack the logistical support and staffing for vaccine outreach based on tiers the CDC established. Pharmacies seldom enjoy long-term relationships with patients and rely upon those already interested in getting vaccinated to proactively seek them out. Many rural areas don’t have a single pharmacy. Mass vaccination efforts disadvantage frail older individuals who need to avoid crowds to stay safe, and many older patients lack the technical skills to obtain vaccination appointments online. All of these channels have failed to engage patients of color, widening health disparities.
Just two days after Biden’s inauguration, his team offered some hope. The American Rescue Plan explicitly mentions the intent to fully leverage the nation’s primary care workforce and decrease health disparities. And in early February, the administration took a much-needed step toward closing the gap for patients from underrepresented groups, promising 1 million doses for the nation’s health centers.
Primary care practices can play essential roles in the country’s vaccination effort. Not all patients who need the vaccine will successfully navigate through a local government portal or website, and show up to be vaccinated where and when requested. It’s important to meet patients where they are, take advantage of when they are present in the office to vaccinate them, and deploy time-tested workflows to prioritize patients in need of vaccination and convince hesitant patients of the benefits. Patients will need reassurance and surveillance, support for side effects and lingering questions. These are all fundamental tenets of primary care.
Consider the role primary care doctors play in flu vaccination. In the 2019-2020 flu season, 18,487 primary care practices in the U.S. vaccinated more than 150,000 older adults covered by Medicare in a single day. These primary care practices are poised to critically extend Covid-19 vaccination capacity nationwide, particularly for vulnerable, rural, and underrepresented populations.
Under the American Rescue Plan, our nation’s distribution strategy can leverage primary care providers rather than systematically excluding them. The logistical challenges of small-batch distribution have already been solved. What’s needed now is to expand existing channels.
The CDC’s Vaccine Tracking System (VTrckS) has already enabled centralized access for large pharmacies, and the Biden administration successfully began leveraging this system to ship vaccines directly to local pharmacies on Feb. 11.
The most efficient way to deputize the U.S.’s primary care workforce is to expand VTrckS access directly to those primary care offices willing to receive vaccine shipments and vaccinate patients. With their less-prohibitive cold storage requirements, the Moderna and Johnson & Johnson vaccines are sensible alternatives to the Pfizer/BioNTech vaccine for primary care offices.
Every primary care practice in the country could put 100 doses to work right now. For efficiency, let’s start with the 10,000 U.S. practices that have more than 500 Medicare beneficiaries.
Partnering with Medicare has additional benefits. Medicare directly insures most high-priority individuals: those age 65 and older and individuals on disability. The federal government could use its own data to monitor doses delivered through claims and target priority practices for distribution based on underserved populations and geographies.
In primary care practices across the country, we have a national, committed and eager workforce accustomed to calling patients who know and trust them. We just need to put the power back in their hands. We must arm them and enable them to serve. Lives depend on it.
Farzad Mostashari is an internal medicine physician, the founder and chief executive officer of Aledade, Inc., which supports independent primary care practices, and the former National Coordinator for Information Technology at the U.S. Department of Health and Human Services. Emily Maxson is an internist and primary care physician, and chief medical officer at Aledade.