Daniel Duncanson, the chief executive of a physician practice in Florida, finally got some COVID-19 vaccines for his front-line workers after haggling with a major hospital. But it’s not clear when more are coming amid a shift in strategy from health care providers to massive vaccination sites.
“We need 200 doses for our employees’ second doses, and I’ve got none in right now,” said Duncanson, CEO of SIMEDHealth.
Duncanson said many doses in his county were recently committed to a vaccination effort at the University of Florida football stadium last week.
Across the country, COVID-19 vaccines are increasingly being distributed in mass clinics built from scratch in stadiums rather than doctors’ offices.
Distributing a large amount of the perishable vaccines through these “megasites” is more speedy than scattering small amounts among a jumble of decentralized health care providers. But rather than primary care physicians reaching out to their patients with vaccines according to priority groups, individual consumers have had to scavenge for appointments in a cutthroat competition that disadvantages some of the most needy.
Stadiums and arenas that have become key hubs in the American vaccine rollout include State Farm Stadium in Arizona, Gillette Stadium in Massachusetts, Minute Maid Park in Texas and Bank of America Stadium in North Carolina. The massive clinics have become emblematic of the unprecedented effort to end the pandemic.
The role of these huge sites will likely grow over the next few weeks as the Biden administration deploys the aid of the National Guard, the Federal Emergency Management Agency and even the Department of Defense.
Experts say one advantage of stadiums is that using them is efficient, key in a pandemic that kills thousands of people per day and could continue to devastate the country as new mutations spread.
“Pandemic vaccination is quite different from your routine immunizations. We’re in this race against time,” said Jen Kates, an expert with the nonpartisan Kaiser Family Foundation.
But the approach has rankled family doctors and primary care physicians, who insist they already have the resources to get hundreds of COVID-19 vaccines to hard-to-reach patients through their trusted staff.
About 85 percent of independent practices are seeking a supply of vaccines to give to patients but have not received any, according to a trade association survey released in late January. Even 45 percent of practices affiliated with major hospitals, which served as the key vaccination hubs in the rollout’s first weeks, have not gotten a supply.
The survey of 400 medical practices was conducted by the Medical Group Management Association, a lobby group.
“Current distribution efforts take patients away from trusted ties with their physicians and force them into haphazard vaccine chasing,” said Halee Fischer-Wright, CEO of MGMA.
The U.S. approach contrasts with the main strategy in the United Kingdom, where National Health Service general practitioners and nurses have been the primary vaccinators and where vaccines have been distributed smoothly and rapidly, although the country is also beginning to stand up some of its own NHS-led mass vaccination sites.
U.S. state officials insist the lack of vaccines for physicians’ offices is due to a supply shortage.
The Mississippi State Department of Health is being inundated with calls from doctors who say they have capacity to give out more vaccines than they can get their hands on, according to State Health Officer Thomas Dobbs.
“Seriously, we get dozens of calls every day, if not hundreds. People are saying, ‘We need more vaccine. We want vaccine,’” Dobbs said.
Dobbs said some providers are administering vaccines, but a majority of doses are devoted to “high throughput” drive-thru sites.
Paul Pritchard, chief quality officer of a medical group in Wisconsin, helped develop a high-volume vaccination site capable of inoculating a couple thousand shots each week, with the capacity of scaling up to 16,000 doses per week. But far from ramping up, he has seen his supply of vaccines decline.
“This week’s supply was half of what we requested and 10 percent of the week prior. Our allotment has been diluted,” said Pritchard. “We’re working at a fraction of our capacity.”
Equity and infrastructure needs
There are pros and cons to the mass vaccination sites, state public officials and experts say.
They acknowledge that by administering vaccines more quickly at large sites, they may be sacrificing vaccinations for at-risk populations, including people who are homebound or who cannot drive in poor weather.
“I do think mass vaccination clinics can help with speed and efficiency. You’ve got your system in place. They can reliably get a lot of people vaccinated in a single day,” said North Carolina State University supply chain expert Julie Swann. “But you have to be sure you’re not driving certain inequities. Are people able to get there if they are less mobile? Are they able to sign up if they don’t have a lot of experience with technology?”
Nirav Shah, director of the Maine Center for Disease Control and Prevention, said the state made deliberate attempts to distribute vaccines to places that won’t have the same volume as a large-scale vaccination clinic but may help hard-to-reach people.
“Those sites serve rural or disadvantaged populations,” Shah said. “Maybe they can’t do 500 shots a day. Maybe they can only do 20 shots a day.”
Shah said he had to balance equity concerns with other challenges in distributing the vaccine through primary care doctors: whether they could guarantee that no doses would be wasted, had large enough waiting rooms to allow people to socially distance, had deep freezers capable of storing the delicate vaccine by Pfizer/BioNTech and could vaccinate people without interfering with day-to-day care.
Providers concede that mass vaccinations would be a departure from daily care but insist they want to chip in.
“We anticipate that it would be disruptive to our usual operations, but we outlined a plan for investing in tents and other supplies. We did this for testing, and we could do the same thing as far as vaccination goes,” said Scott Hines, chief quality officer of Crystal Run Healthcare in New York. “We could do a lot of this on the weekend or in early evening hours. We feel like we owe this to our patients and our community.”
Duncanson said that while he does not have his own deep freezers, he is located just miles away from an academic medical center that has them and it would be relatively easy to store unused doses.
Mass vaccination sites pose their own logistical problems, including staffing. In Missouri, the National Guard recruited medical students to administer the vaccine, requiring weeks of planning. Some stadiums have also had spoiled doses, according to some reports.
Health care providers also say vaccinating in doctors’ offices builds trust in the vaccine.
Some states insist they can balance the speed of stadiums with distributing the vaccine in an equitable and sensitive way.
In New York, a new push to vaccinate Bronx residents at Yankee Stadium was done in partnership with SOMOS Community Care, a practice that serves many Black and Latino patients.
California Democratic Gov. Gavin Newsom said the opening of a mass vaccination site at Oakland Coliseum, with help from FEMA and other federal agencies, was being done with an “equity lens.”
Experts say the choice of sites does not have to be binary, and that doctors’ offices are likely to have a larger role as more supply is manufactured.
Glen Nowak, a former Centers for Disease Control and Prevention spokesman during the H1N1 pandemic and University of Georgia expert in health communication, said mass vaccination sites can also ensure trust in the process, as long as things run smoothly and people are trained to provide competent information to skittish patients.
But underinvestment in public health infrastructure over decades has also shaped the spontaneous approach to vaccine distribution.
Mississippi’s Dobbs said in many states it’s difficult to gauge whether white or wealthy people received most of the vaccines because of this lack of preparedness.
“We do this over and over again. We have a crisis and we say, ‘How do we fix it?’ But we don’t prepare for the next one,” he said.