Amid some resistance by healthcare workers, COVID-19 vaccine delivery continues to roll out

With early delivery of the first COVID-19 vaccine going smoothly, healthcare leaders are campaigning for clinicians to take and promote the vaccine.

As the first 2.9 million doses of the vaccine began to be delivered this week, three major provider-advocacy groups publicly urged clinicians to take the vaccine.

“Our hope is simple; we urge you to get the COVID-19 vaccine and share your experience with others,” states an open letter from the American Hospital Association (AHA), the American Nurses Association and the American Medical Association. 

An AHA spokesman said that letter stemmed from “public polling we have seen, along with what we are hearing from members when they talk to their workforce.”

Assorted surveys in recent weeks have found that varying shares of healthcare workers would be reluctant to take the vaccine, which was approved Dec. 11.

For instance, a Dec. 15 national survey by the Kaiser Family Foundation found 29% of self-identified healthcare workers said they probably or definitely would not get the vaccine.

An October survey by the American Nurses Foundation, which polled 12,939 nurses, found 36% would not take the vaccine if their employer did not require it. Of the respondents, 44% said they worked in an acute care hospital.

Internal polls by health systems also have identified some reluctance.

The University of Iowa Health Care polled more than 12,000 staff last week and found 85% were willing to receive the vaccine when it’s offered. Similarly, nearly 15% of employees polled by Jackson Health System in Miami said they were not interested in taking a COVID-19 vaccine either now or later, according to published reports.

Such healthcare worker reluctance to take the vaccine is “significant; I’m not sure how significant,” said Chuck Alsdurf, CPA, director of healthcare finance policy, operational initiatives, for HFMA. “The reluctance, I hope, will subside once the senior leaders and potentially former presidents receive the vaccine.”

Hospitals and health systems may benefit from using approaches, such as requirements to get inoculated, that they undertook amid employee resistance to flu vaccines in recent years, Alsdurf said. They also should emphasize communication with employees about the vaccine’s importance and safety.

“We’ve been here before, and I think we’ll get through it,” Alsdurf said.

Hospital executives have told AHA that they will likely decide whether to require COVID-19 vaccination of their employees when safety and efficacy data are released in the spring, at the earliest, according to Colin Milligan, an AHA spokesman.

“That said, hospitals and health systems are urging their staff to take the vaccine as an important step to provide additional protection from the serious consequences of COVID-19,” Milligan said.

Hospitals’ logistical approaches

Health systems have undertaken a range of measures to ensure willing employees are quickly vaccinated as the doses arrive.

Snehal Gandhi, MD, medical director in the Division of Hospital Medicine for Cooper University Hospital in New Jersey, said his organization has staggered employee vaccinations within units and specialties to minimize the effect of any staff absences from vaccine side effects.

 “You could potentially have people after the first dose or the second dose develop symptoms that may be severe enough that they may not be able to work,” Gandhi said during a media briefing by the Alliance for Health Policy.

Side effects reported from vaccine trials have included low-grade fevers and muscle aches, which are similar to early COVID-19 symptoms.

“One of the discussions that we had frequently was about, ‘How do we schedule our people in such a way that, even if they do have side effects, they are not all calling out simultaneously,” Gandhi said.

The hospital also is providing vaccinated employees with a fact sheet about the emergency use authorization by the Food and Drug Administration for the Pfizer vaccine “so they are aware of what’s going on” regarding potential side effects, he said.

Additionally, the hospital had employees download a reporting app for COVID-19 tracking and provided a hotline for them to receive guidance and help.

“We have a lot of communication, even when the pandemic started and now during the vaccination phase of it,” Gandhi said. “There are a lot of different channels where we can support them and communicate with them.”

Communications include regular emailed updates and a podcast to address issues affecting employees.

Pharmacy delivery

This week’s first deliveries of the vaccine have gone smoothly, said Claire Hannan, executive director for the Association of Immunization Managers.

Although some states continue to tweak their distribution plans, “As far as I’ve heard, things are running smoothly at this point,” Hannan said during the briefing.

Two national pharmacy chains — Walgreens and CVS — have signed up about 80% of long-term care facilities to begin receiving direct vaccine distributions next week, said Ed Kaleta, group vice president for U.S. government relations with Walgreens.

After states receive their population-proportionate allocations of vaccines, the pharmacy chains will administer direct deliveries to the long-term care facilities that have signed up with them for delivery.

Those distributions will be based on recommendations from the Centers for Disease Control and Prevention:

• Targeting populations with the highest risk of death
• Targeting medically underserved areas and smaller facilities
• Ensuring as little waste as possible

“So all of our planning stacks those three different factors,” Kaleta said during the media briefing. “And then that is how we overlay which long-term care facilities will be scheduled and coordinated in that order.”