One year after Covid-19 was declared a national emergency in the United States, and with more than 525,000 Americans having lost their lives to it so far, the country is finally beginning to make progress toward getting a handle on this terrible pandemic, thanks to the distribution of several highly effective vaccines.
The vaccine distribution system seems to be working, despite considerable obstacles. We see it in the way that long-term care residents and staff, who were particularly hard hit over the past year, are experiencing falling infection and mortality rates that dovetail with extensive vaccination efforts. The success within the nation’s long-term care community after a challenging start is largely due to a partnership among stakeholders and the federal government that ensured appropriate allocation of vaccines — and end-to-end support — to protect vulnerable Americans in these facilities.
It’s now time to do the same for another of the nation’s most at-risk groups: Americans living with kidney failure who rely upon life-sustaining dialysis treatments. Policymakers need to work with the nation’s dialysis providers to get this done.
More than half a million Americans have kidney failure, also known as end-stage renal disease, and rely on dialysis to survive. They are disproportionately affected by Covid-19. A recent study found that 20% of people on dialysis who developed Covid-19 died from the infection, a significantly higher percentage than in the general population. Data from the Centers for Medicare and Medicaid Services show that people with kidney failure who get Covid-19 have the highest rate of hospitalization among all Medicare beneficiaries — a rate nearly seven times higher than the hospitalization rate for Medicare beneficiaries overall.
Communities of color are experiencing higher rates of Covid-19 infection, hospitalization, and death than white communities, with death rates twice as high among Black people as among white people. This mirrors the existing disproportionate impact people of color have long experienced with kidney failure. Black people make up just 13% of the U.S. population but account for 35% of Americans with kidney failure; they are nearly four times more likely than white people to develop it. Ninety percent of people needing dialysis also have comorbidities like heart disease, diabetes, and hypertension that also put them at risk of developing severe Covid-19 or dying from it.
Most people who need dialysis have been unable to socially distance since the pandemic began. They need to go to dialysis clinics three times per week for four hours at a time, where they are exposed to other patients and staff during their life-sustaining treatments. Many have limited mobility and challenges with transportation, limiting their ability to go to a vaccination center at a large stadium or a distant clinic difficult, if not impossible.
But there is a solution. If policymakers act now to allocate Covid-19 vaccines directly to the nation’s dialysis providers, they can administer them to patients. The qualified, experienced medical staff at dialysis centers and their established storage and safety protocols make it possible for the vaccine process to occur without delay to both patients and caregiving staff.
These clinics already vaccinate patients for influenza, pneumonia, and hepatitis B, and stand ready to vaccinate for Covid-19, with existing cold-storage capability, nursing personnel for vaccine administration, and supplies to manage any side effects. Dialysis facilities already function as patient-centered medical homes in which patients receive much of their overall medical care. This ensures that the clinics would be able to thoroughly follow up and provide patients with their second doses. Furthermore, experience shows that in-clinic vaccination significantly reduces refusal rates (to exceptionally low levels of 10% to 20%) which is key, since we need to ensure that as many people as possible receive the Covid-19 vaccine.
Federal vaccine allocation to community dialysis clinics cannot happen quickly enough. Lives depend on it.
There is a light at the end of this very long, very dark tunnel. Emerging on the other side of this health emergency means moving quickly and wisely to reach the groups most at risk for succumbing to Covid-19. On behalf of dialysis patients, we urge the federal government to act now to establish a federal vaccine allocation for dialysis clinics.
Donna Christensen is a member of the American Kidney Fund Board of Trustees, an emergency and family practice physician, former member of Congress from the U.S. Virgin Islands, and former chair of the Congressional Black Caucus Health Braintrust. LaVarne A. Burton is president and chief executive officer of the American Kidney Fund. Gary A. Puckrein is president and chief executive officer of the National Minority Quality Forum.