Since COVID-19 vaccine distribution began at Fairfax, Virginia-based Inova Health System, staff members spent the latter portion of their days racing around the hospital looking for healthcare workers who hadn't gotten the shot yet.
It's been a similar story at distribution sites around the country: The health system in the Washington, D.C., metropolitan area must thaw a certain number of vaccines each day for appointments booked by healthcare workers who are among the highest priority for the vaccine. But any leftover doses must be used within six hours and can't be refrozen.
In some places that have allowed vaccine distribution through retail pharmacy locations, including nearby D.C., a lucky few individuals who are not part of the priority groups who've happened to be at pharmacies at the right time have become the recipients of these leftover doses.
But up until Monday—when Virginia officials announced expanded prioritization in some of that states' counties—Inova couldn't move on to the next priority groups even though appointments were no longer filling up.
So a daily hunt for available arms to administer shots ensued.
"Vaccines look like scarce resources, but they're only scarce if we're not giving them out, which is why I feel so strongly we've got to stop over-prioritizing, increase our ability to deliver them quickly, make sure the folks who are eligible have the opportunity to get in. But if they don't come in, we can't wait months hoping those folks will show up," Inova CEO J. Stephen Jones told Fierce Healthcare.
Coordination from a federal agency such as the Centers for Disease Control and Prevention could help states and health systems overcome the early stumbling blocks of a fragmented system and speed the process, he said.
"We've got to keep getting these vaccines into people as quickly as possible to not only start developing herd immunity but, importantly, each person we prevent from getting COVID-19 is someone we might've kept out of an overcrowded intensive care unit," Jones said.
It's an idea that's been gaining louder support in recent days. Last week, the American Hospital Association sent a letter to the Department of Health and Human Services (HHS) calling for the agency to take a larger role in supporting the distribution of COVID-19 vaccines. The letter comes as frustrations are boiling over in hospitals that are shouldering both the rollout and massive surges of the virus. On Tuesday, American Medical Association President Susan Bailey, M.D., also issued a call for immediate action necessary for a coordinated, comprehensive federal response to the COVID-19 pandemic.
In an op-ed for The Washington Post, Kaiser Family Foundation President Drew Altman called for more federal direction and a simpler priority system for the distribution of COVID-19 vaccines. “Hundreds of different distribution programs are being organized across the states and counties for front-line health workers, residents of long-term care facilities, essential workers, the elderly and the general public, all in different sequences," he wrote."The system we have makes sense on paper, but it’s too complex to be effectively implemented by our fragmented, multi-layered health system.”
On Tuesday, federal officials announced they'd release all second COVID-19 vaccine doses immediately and expand eligibility for people 65 years old and older to help speed up the rollout of doses that have been delayed. Officials with Operation Warp Speed, the joint HHS and Department of Defense initiative, laid out the major changes Tuesday and adopted a plan that has been reportedly floated by President-elect Joe Biden.
“We are telling states they should open vaccinations to all of their most vulnerable people. That is the most effective way to save lives now,” said HHS Secretary Alex Azar during a briefing with reporters.
But hospitals would benefit from a system that's coordinated at the top to overcome shared problems, industry experts say.
"There's been a lot of concern with the temperature storage, and 'Is that is going to be a big problem?' As it turns out, no. I think that's one of the least complicated aspects of this vaccine rollout," Jones said. "It becomes a matter of you don't want to waste it so you don't want to thaw out 1,000 doses and if only 200 people show up, you've wasted doses. And we've seen some headlines of some places that have had doses thawed out and no one showed up and they went in the garbage. That's a tragedy."
Inova moved from 500 doses a day to more than 2,000 appointments a day.
"What we've seen is that once we got our team vaccinated, we opened up to other healthcare workers. Anyone who can prove they are a healthcare worker we're bringing them in and getting them their vaccine. Even with that, we've got the availability to expand it more—if we're allowed to expand it more—because we're not allowed to give it to people who are ineligible."
"At some point, access to the vaccines themselves could become a limiting factor," Jones said. "But so far that's not been the case."