Hospitals begin to receive first doses of COVID-19 vaccines

• The initial round of 2.9 million COVID-19 vaccine doses is shipping this week — out of 20 million expected for the month.
• Hospitals and health systems have been among the first to receive and administer the vaccine to staff.
• Remaining provider concerns include vaccine avoidance by staff, storage logistics and whether availability will be widespread.

On Dec. 14, hospitals nationwide began to receive and administer to frontline staff the first U.S.-approved COVID-19 vaccine.

The administration of the vaccines followed the Dec. 11 approval of emergency use authorization by the Food and Drug Administration (FDA) for the two-dose vaccine developed by Pfizer and its partner BioNTech.

The 2.9 million doses shipping this week will be allocated to states based on population and then distributed according to plans developed by each state.

The states are following the Dec. 1 recommendations by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), which were then adopted by the CDC director. Those recommendations prioritized vaccine administration for healthcare personnel and residents of long-term care facilities.

Pfizer has allotted 100 million doses for U.S. residents — enough to fully immunize 50 million people, since the vaccine is designed to be provided in two doses given several weeks apart. An FDA advisory panel will meet later this week to consider approval of a seperate, single-dose vaccine, from Moderna. If that is approved, officials from the U.S. Department of Health and Human Services (HHS) said they anticipate 20 million will receive at least the first dose of a vaccine in December, as will 30 million more in January and a cumulative 100 million by the end of March.

The federal government is paying for the cost of the vaccines, ancillary supplies (like needles and syringes) and distribution. Insurers, both private and public, will pay for the cost of administration. For instance, Medicare will pay $28.39 to administer single-dose vaccines, and for multidose vaccines it will pay $16.94 for initial doses and $28.39 for the final dose in the series.

The size of the distribution challenge — even just to priority recipients — was illustrated by recent estimates by the Kaiser Family Foundation, which concluded 19.7 million work in healthcare settings, and roughly 15.5 million of those have direct patient contact. In addition, there are 1.2 million nursing facility residents and about 800,000 assisted-living facility residents, according to the estimate.

Provider deployment of vaccines

The University of Iowa Health Care announced Dec. 14 that it was the first health system in that state to start vaccinating employees.

“This is an historic moment to change the course of the pandemic and we are proud of our role as leaders in this process,” Suresh Gunasekaran, MBA, CEO of UI Hospitals & Clinics and associate vice president of UI Health Care, said in a release.

Due to limited supplies, the health system prioritized primarily frontline providers and staff working in the units that directly care for patients with COVID-19. Several leaders who are essential to the COVID-19 pandemic response will also be among the first vaccinated, the health system said.

The health system polled more than 12,000 staff last week and found 85% were willing to receive the vaccine when it’s offered.

Reluctance to accept the vaccine could eventually affect efforts to achieve widespread immunity, as only about half of Americans plan to get the vaccine when it becomes available, according to recent survey results.

Other concerns identified

Healthcare providers also worry that the Pfizer vaccine requires ultra-low temperature storage, which many smaller and rural facilities lack.

HHS Secretary Alex Azar sought to ease those concerns during a Dec. 14 briefing by noting that the vaccine ships with 10 days of secure dry-ice storage capability.

“There is nothing in the nature of the Pfizer vaccine or distribution that prevents use in rural [locations]. You just want to make sure you use all of those doses within the relevant time frame,” Azar said.

The Pfizer vaccine is shipping in packages of 975 doses, while the Moderna vaccine will ship in lower-volume dose packages and can be stored in standard freezers, Azar said.

Andy Brailo, chief customer officer for Premier, said in a written statement that many of his organization’s hospital members have been designated a vaccine distribution hub and tasked with distribution to other vaccination facilities within their states.

“Enormous hurdles and questions remain on security, cold-chain capability and supplies, and equitable access and distribution in rural and diverse communities,” Brailo said.

 Several governors have indicated that their state’s long-term care residents and staff will be first in line, including Governors Andrew Cuomo (New York), Ron DeSantis (Florida), Kim Reynolds (Iowa), Andy Beshear (Kentucky) and Brian Kemp (Georgia).

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) said more than 100,000 who have died from COVID-19 were in long-term care. The group is urging all states to follow recommendations from the CDC and prioritize long-term care facilities during the first phase of distribution.

“A one-month delay in distributing the vaccine to all long-term care residents and caregivers could result in more than 20,000 of our residents losing their life when a vaccine could protect them,” Mark Parkinson, president and CEO of AHCA/NCAL, said in a written statement. “We’re in a life-or-death race against the clock.”

Gen. Gustave Perna, chief operating officer of Operation Warp Speed — the federal vaccine distribution program — said four states have contracted with national pharmacy chains to begin vaccine distribution this week in long-term care facilities, and more than 1,100 such facilities will begin vaccinations Dec. 21.

“We have to ensure that the persons, not only the elderly but the staff, can be inoculated at the same time so we close the bubble on each facility,” Perna said at a Dec. 14 briefing.