Even as the supply of COVID-19 vaccines continues to increase, many doctors clamoring to distribute the vaccine directly to their patients are finding their requests go unheeded, experts say.
"Leaving physician practices out makes no sense at all because patients trust physicians on vaccines more than they trust anybody else," said Bob Doherty, senior vice president of governmental affairs and public policy at the American College of Physicians and a MedPage Today editorial board member. "Patients need to be able to get vaccines from their personal physician, who can reassure them about the safety of the vaccine, and also monitor the potential side effects. But right now, many primary care physicians have not been included in the distribution plans at all."
"I think it's a great idea," said Yalda Jabbarpour, MD, medical director of the Robert Graham Center at the American Academy of Family Physicians, and a family physician herself. "That's where people usually get their vaccines -- the primary care office."
Additionally, studies have found that "most Americans, their trusted source of information about vaccines, and particularly the COVID vaccine, is their primary care provider. Anecdotally, I've been seeing that like crazy. The second the Pfizer vaccine got emergency use authorization, patients were calling off the hook: When would they be eligible? How do they get the vaccine? Patients who have vaccine hesitancy wanted to talk to me about my experience getting the vaccine," she said.
Maryland's Distribution Program
There is at least one state government that's getting on board with distributing to physician offices. Under the Maryland Primary Care Program -- which provides funding for delivery of advanced primary care to 562 practices statewide -- COVID-19 vaccines have been distributed to 236 practices, said Howard Haft, MD, the program's director, who spoke during a phone interview at which a public relations person was present. "Primary care doctors have been clamoring to do COVID vaccinations since the beginning of the pandemic," he said. "As we developed vaccines, they were front and center, saying, 'we're here and ready to do that.'"
Haft said the rollout in Maryland is "going very, very well; we look at how quickly the primary care physicians are able to use the vaccine, and essentially they use it all within the week they get it, and they actually could use more." Unfortunately, however, the state "is limited by the amount the federal government gives us each week," he added.
The program "is really addressing the issue of health equity," he continued. "They're able to use the data the state provides to them to understand which of their patients are already vaccinated and which have not been, and they can also tell by race, ethnicity, age, and underlying medical condition, so they can reach out to the older [patients], those who have other barriers ... and may not have been as equally immunized as others, and they're able to bring that back into perspective and deliver vaccines in an equitable fashion."
The state is distributing only the Moderna and Johnson & Johnson vaccines because the Pfizer vaccine only comes in lots of about 1,000 vials, "which is a lot for a primary care practice to store and use in a relatively short period of time," Haft said. (A Pfizer spokesman said that although the vaccine lots are large, there are multiple options for vaccine storage, including commercially available ultra-low-temperature freezers that can extend storage for up to 6 months, as well as the shippers in which the vaccines arrive, which can be refilled with dry ice to allow storage for up to 30 days.)
Vaccines are shipped directly to the practice from the distributor or the manufacturer, and arrive Monday morning each week via Federal Express or UPS, Haft said. "Every Monday or Tuesday they fill out a survey and say how many doses they'd like for the next week ... Everybody gets at least 100 doses and it could go up to -- the sky's the limit."
Interest From the White House
Haft said he has heard from other states interested in Maryland's program, and also from the Biden administration. "The White House chief of vaccines has been interested, and will be visiting some practices here in the near future," he said. The state plans to continue expanding the program, with a short-term goal in the next few weeks of hitting 400 practices.
The Biden administration has publicly said it is interested in the idea of distributing vaccines through doctors' offices. "We're relying on local voices and local doctors to provide the best information, which every set of data we've seen, and even from some news organizations, show that those are the most trusted messengers," said White House Press Secretary Jen Psaki at an April 21 press briefing. "Along with the CDC, we're working to help states expand vaccine distribution to primary care physicians."
California is also including providers in its distribution efforts. Any provider can sign up through its myCAvax website to become a vaccine provider, although the process can be a little cumbersome, noted Anthony York, spokesman for the California Medical Association. "We're helping identify local providers, physicians, and also helping individual physicians navigate the process," York said in a phone interview. "We've been engaged for several weeks in terms of trying to identify where the need was going to be" to get vaccines into arms.
Some Doctors Taking the Reins Themselves
In some states, doctors -- particularly oncologists -- are acting on their own. Kashyap Patel, MD, an oncologist in Rock Hill, South Carolina, petitioned his local government for weeks to be able to distribute COVID-19 vaccines to his patients. "We got approved this week," Patel said in an interview last week. "We will get our supply this Friday and will do it next week. We are in the process of figuring out who we are going to vaccinate first." He noted that half of the patients in the state are not yet vaccinated, and many still have reservations about the vaccines and their side effects.
Cancer patients are good targets for office-based vaccination because their chances of getting the coronavirus are higher than the normal population, "and if they get it, they have a three to five times higher chance of being hospitalized or dying," said Patel, who is also president of the Community Oncology Alliance, an association of community-based oncology practices.
To identify patients who should get the vaccine, "we're going to create an algorithm from our electronic health records, pull out the patients we deem at highest risk, and start calling them on the phone, explaining that this is an option we recommend strongly that they do it," he continued, adding that the first shipment will contain 50 doses of vaccine.
Maen Hussein, MD, an oncologist in The Villages, Florida, has been mounting a similar effort. In Florida early on, vaccines were difficult to come by, with many available only through the Publix chain of supermarkets and pharmacies. "It was very hard to get an appointment because patients had to go online ... and lots of patients were complaining that they didn't know how to use a computer," he said. Even those who were computer-savvy had difficulties: "It took my wife 2 hours to get an appointment for her mother."
Oncology practices are good places to distribute vaccines because cancer patients who receive chemotherapy may be immunosuppressed for a week or 10 days, and therefore shouldn't be vaccinated during that time. "This way we can control when we give patients their vaccines, because I know their treatment schedule," he said. "That's why a cancer practice is different than primary care, whose patients are mostly healthy or have issues that won't interfere with the vaccine."
Initially, the county was only willing to give Hussein's practice 300 doses, and those had to be given to county residents even though patients also came from other counties, he said. Eventually, that restriction was relaxed, and within a few weeks, the practice was receiving 5,000 doses. "We started to give it to other offices and opened on Saturdays and Sundays" for vaccinations, he added. "We really try hard not to waste any doses."
https://www.medpagetoday.com/infectiousdisease/covid19vaccine/92285
