Nursing Home Vaccine Push Heads for Completion, a Month Behind Schedule
(Bloomberg) -- A U.S. program to vaccinate nursing home residents and staff is moving slowly toward completion in the coming weeks, with the goal of wrapping up the effort by late next month.
The federally run program contracted with major pharmacy chains around the U.S. Launched in December, it was meant to speed vaccines to the most vulnerable people in the U.S. But disruptions over the winter holidays and the challenge of going from facility to facility vaccinating older people have added at least a month to the timeline.
Perceptions of the program’s slower-than-expected rollout have also been shaped by complaints from state governors that doses allocated to the nursing homes have gone unused, even as they run short of vaccine for the general public. But unlike a mass-vaccination clinic that can handle thousands of people a day, the nursing homes are a far-less efficient setting, requiring trips to the homes and then going door-to-door.
“This is not mass vaccination, and there were some misconceptions going into it by the public that we would sweep through thousands of homes in a week,” said Ruth Link-Gelles, who leads the effort for the U.S. Centers for Disease Control and Prevention. “It’s plodding along from room to room; it just takes time.”
Because of their age and frailty, nursing home residents have been the most likely to die from Covid-19. Infections have run rampant among staff as well, leaving them among the harder-hit health-care workers. Many nursing homes have put up strict isolation rules, leaving residents lonely and isolated for months. Protecting them with a vaccine would change the face of the pandemic and provide much-needed relief.
An analysis of state and federal data by Bloomberg shows that in 20 states, there are 2.1 million doses that have been allocated to the nursing home program but have still not been counted as used. The unused doses represent 44% of about 4.92 million doses allocated or shipped to them through the U.S. program. It’s a greater share than the 30% of doses that haven’t been counted as used across the entire U.S., according to the Bloomberg Vaccine Tracker.
Vaccination events at the homes are done in waves, with a first clinic to vaccinate as many people as possible, a second one four weeks later to administer second doses and give shots to anyone missed in the first round, and a final visit four weeks after that to complete the vaccinations.
The pharmacies contracted by the federal government to run the nursing home program say they’re using most of what they have. A spokeswoman for Walgreens Boots Alliance Inc. said the company had used up 70% of the doses it had been sent.
Mike DeAngelis, a spokesman for CVS Health Inc., another major pharmacy chain operating the program, called the effort challenging, typically requiring “multiple phone calls with the facilities to arrange vaccination visits and getting an accurate count so we bring enough vaccine, vaccinations teams often having to go room to room to administer shots.”
DeAngelis said that as of Wednesday, CVS had completed 90% of vaccinations at the skilled-nursing facilities in its portfolio. At assisted-living facilities, which house older but less-care-intensive residents, it has completed 84% of first doses and 27% of second doses. In total, it has administered 3.2 million shots, he said.
In recent weeks, some doses allocated to states are being rerouted to programs for the general public.
In Michigan, 30,000 doses have been taken from the nursing home program and shifted into the state’s regular vaccination effort, said Lynn Sutfin, a spokeswoman for the Michigan Department of Health and Human Services. California has moved 180,000 doses from the long-term care program to its regular vaccinations, Illinois recently shifted over 97,000 doses, and North Carolina has reallocated 15,000 doses, according to representatives for those states.
It’s not clear how many, if any, of those reallocated doses are included in the unused 2 million found in Bloomberg’s analysis. Michigan’s 30,000 doses have already been removed from its tally, but a representative for California’s health department wasn’t immediately certain if the doses had been pulled from the state’s count or not.
In some cases, states have asked permission from the federal government to reallocate the doses before they’re delivered, said Link-Gelles. But for doses that have already been received by pharmacies in the states, they’ve been told they should just begin using them with the broader public. That's made knowing exactly where every dose is difficult or impossible, at least in real-time.
“We don’t have that line-level accounting of the doses,” Link-Gelles said.
More Than Needed
Another issue is that the CDC purposefully over-allocated doses to the nursing homes before the program’s start in December. Because there is no national registry of how many people are in nursing homes, the agency made the calculation of how many doses were needed by taking the number of licensed nursing home beds and assuming they were all full.
“In a perfect world, we would have had census numbers in the facility and then payroll data for staff,” said Link-Gelles. “Neither of those things are available for these facilities en mass.”
Given the vulnerability of the nursing home residents, the agency erred on the side of over-allocating doses to them, knowing it could redirect them later.
“If we used the bed counts, we were probably going to over-allocate. The flip-side of that was going to be under-allocating,” Link-Gelles said.
In reality, of course, many beds are empty. Slowing down the program further was the fact that it launched over the Christmas and New Year’s holidays, when many families pulled residents out of the facilities and staffing was thin.
“If I could do it all again, I would not launch the program the week of Christmas,” Link-Gelles said.
Some nursing home staff were also reluctant to get the shots during the first rounds of vaccinations clinics at the homes. A Feb. 1 CDC report found that nursing home staff were being vaccinated at about half the rate of residents, with many refusing the shots.
Link-Gelles said that many staff at first didn’t want to be “guinea pigs” getting the vaccines before anyone else, and that as vaccinators have returned to the homes for second rounds, more are accepting them.
“We’re seeing an uptick in staff getting their first doses at the second clinic,” she said.
While the CDC publishes data on how many doses have been administered in the long-term care facilities, it has yet to provide information on how many doses were sent to nursing homes under the program. That makes it impossible to comprehensively judge how quickly the effort is moving. And while 20 states publish data on allocations, that information can be out of date or incomplete.
It’s still unknown exactly how many doses have been wasted, an inevitable part of any vaccination campaign. And delays in record-keeping can mean that shots have been administered but not recorded, which may be the case with some of the 2.3 million unlogged doses tallied by Bloomberg.
Link-Gelles said the CDC plans to publish more data soon on distributions, and continues to work with states and pharmacies to redistribute or reallocate unneeded doses.
“We really don’t want the states or the pharmacies sitting on vaccines,” she said.
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