In the rush to immunize people against Covid, federal and state health officials have overlooked the role of doctors, physicians say.
Primary care doctors have grown increasingly frustrated with their exclusion from the nation’s vaccine rollout, unable to find reliable supplies for even their eldest patients and lacking basic information about distribution planning for the shots.
“The centerpiece should be primary care,” said Dr. Wayne Altman, the chairman of family medicine at Tufts University School of Medicine who also sees patients in Arlington, Mass. State officials there are using Fenway Park and Gillette Stadium as mass vaccination sites, rather than ensuring practices like his can inoculate patients who are at high risk from the coronavirus.
“If you distribute the vaccine to all these practices and let them go at their pace, it would accelerate this rollout dramatically,” Dr. Altman said.
There are roughly 500,000 primary care doctors in the United States, who have traditionally administered nearly half of all adult vaccinations, inoculating their patients against pneumonia, flu and other infectious diseases. While most physician offices can’t handle storage for the Pfizer-BioNTech vaccine because of its need for special freezers, doctors say they could easily administer the Moderna vaccine with adequate storage measures as well as some of the others likely to become available soon.
“We’re ready,” said Dr. Elizabeth Kozak, an internist in Grand Rapids, Mich. She was approved in early January to deliver the Moderna vaccine. “We haven’t seen a thing, but we’re ready.”
Federal and state officials have focused most of their efforts on large vaccination sites, and are still setting priorities for frontline workers, teachers and people 65 and over. They also are relying on the big drugstore chains, like CVS or Walgreens. As part of that strategy, the Biden administration announced last week that it planned to distribute an additional million doses of vaccine to 6,500 pharmacies this week.
The administration has promised to give states three weeks’ notice about how many doses they expect, which should help with distribution plans. While supplies are not expected to increase significantly until April, the administration has talked about being able to vaccinate 300 million Americans by the end of the summer.
With the current supply, Dr. Carlos Portu, an internist in Naples, Fla., likens his patients’ efforts to find the vaccine to “whack a mole”; availability pops up, on a website or on Facebook, only to disappear very quickly.
His elderly patients struggle to check the website of their local Publix supermarket at 6 a.m. every day to try to find an appointment. Some may not even be able to remember their email address, let alone know how to refresh their web browser frequently enough to land a spot.
“We vaccinate every single year millions of Americans for influenza,” Dr. Portu said, adding, “It’s a shame we haven’t been given a seat at the table.”
Dr. Farzad Mostashari, a former Obama administration official whose company, Aledade, works with primary care doctors like Dr. Portu, has witnessed the struggle to get his own parents vaccinated.
“We need to use the systems people use normally,” he said. “A big part of that is going to be primary care doctors’ offices. They know how to give vaccines and have the trust relationship.”
Federal officials say they understand the critical role physicians play, especially in persuading Black and Latino patients who may be hesitant to get the vaccine.
But the largely first-come first-serve system, which heavily relies on someone’s ability to sign up for the vaccine by navigating a complicated website or driving to where doses are available, is reinforcing many of the country’s inequities. In many cities, individuals from wealthier, largely white neighborhoods, are taking up more than their representative share of the limited supply of the vaccine.
“Primary care doctors have been a loud and frequent voice in the conversation we have had on a path to equity,” said Dr. Cameron Webb, an internist who is now a senior policy adviser for Covid equity to the White House. He pointed to the administration’s recent efforts to supply vaccines to federally qualified health centers, which serve individuals who are likely to be at the highest risk from the virus and those who live in the most vulnerable areas. “It’s a critical component to our strategy.”
Despite their eagerness to participate, only one of five primary care physicians said they were giving the vaccine to their patients, according to a survey conducted in mid-January by the Larry A. Green Center with the Primary Care Collaborative, a nonprofit. Given the widespread shortages of supply, many could not get the vaccine, and a third of them reported they had not been in contact with their local health department.
Dr. Katelin Haley, a family medicine doctor in Lewes, Del., is one of the lucky few who just received 240 doses of the vaccine and will be immunizing patients this week. Her staff had been checking every day with the state to see when they could expect a shipment. “Chasing the vaccine has been almost a full-time job,” she said.
While Dr. Haley, who also works with Aledade, is sympathetic to the state’s struggle to get adequate supplies of the vaccine, she thinks practices like hers need some of the doses. “It’s a delicate balance to address the state’s needs and the individual practice’s needs,” she said.
Some physicians, like Dr. Altman, have received small amounts of the vaccine but they do not know when they may have enough to immunize all of the patients who qualify. In late January, Dr. Altman and his staff vaccinated 200 patients in the practice’s parking lot, in spite of the frigid weather. “Patients were literally in tears, they were so grateful for our efforts,” he said.
The Trump administration left it up to the states to determine how they distributed the vaccines, and the states, and even local communities, are taking different approaches. “So much of whether primary care is leveraged depends on the state,” said Ann Greiner, the chief executive of the Primary Care Collaborative.
Although the demand for vaccines is currently outstripping supply, relying on primary care doctors to vaccinate the public when supply begins to outpace demand later in the year is essential, said Dr. Asaf Bitton, a primary care doctor who is the executive director of Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. Their involvement will be critical to overcoming vaccine hesitancy and reaching herd immunity.
While some conversations are beginning to take place, “they should have been starting to happen six months ago,” he said.
In other countries, like England and Israel, where primary care is more central to the overall delivery of health care, doctors are playing an important role in getting the public vaccinated, said Dr. Ezekiel J. Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania and a member of the coronavirus task force set up by President Biden before he took office.
“We don’t exactly have that system in America,” he said, adding that he and his colleagues advised the incoming president of the need for a hybrid approach.
Doctors may also be in the best position to persuade patients who are hesitant to get the vaccine, by being able to talk with them one-on-one and even by making sure to offer the shot as part of a routine visit. A recent Kaiser Family Foundation survey found eight out of 10 people are likely to rely on the advice of a doctor, nurse or some other provider in deciding whether to get immunized.
“We can’t have one or two strategies for vaccine distribution,” said Dr. Evan Saulino, a family physician in Portland, Ore., who has talked to patients, including those who are Black or Spanish-speaking, who are not sure they want the vaccine. Some of his patients are distrustful of the government and may not want to get a shot from someone in uniform. One person he spoke with would not go to the drugstore but might consider being inoculated at his clinic.
Dr. Kozak, the internist from Michigan, agreed, saying doctors like her could focus their attention on people who can’t easily navigate the current set up. “We might not be able to do the numbers but we are able to do the more fragile and vulnerable populations,” she said.
