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Large hospital systems are grappling with how best to decide which health workers will be vaccinated first against COVID-19, a difficult task when you don’t know what vaccines they will receive, how many and when they will arrive.
The first COVID-19 vaccine could be cleared for use in the United States as early as next month, with Pfizer Inc. and the BioNTech SE candidate already under review and Moderna Inc. firing not far behind. Federal officials, meanwhile, have signaled that healthcare workers and high-risk elderly Americans should be vaccinated as a first step in what could trigger months of tough decisions involving other key priority groups.
But following those initial guidelines could prove difficult. With 21 million healthcare workers in the United States, there will almost certainly not be enough doses to reach them all at once. This forces hospitals to categorize their employees based on the most likely distribution estimates, a task made even more complex for some systems by a disparate state-by-state approach.
Minnesota’s Allina Health system, which employs 15,600 workers in direct contact with patients in Minnesota and Wisconsin, estimates it could receive 3,000 to 4,000 doses initially. The plan: prioritize those who interact directly with coronavirus patients by listing each worker by job type and the units in which they work.
“We are looking at all employees, where they work, what their roles are and what their risk of exposure is,” said Ryan Else, a doctor who oversees the coronavirus response at Allina Health hospitals.
Health systems that operate across state borders face an even greater challenge. As states draw inspiration from federal guidelines, they develop their own priority lists, creating a situation where some employees in one state might get vaccinated before their peers in another.
“How fair does that seem to people in the same system?” said Amy Compton-Phillips, physician and head of the clinic at Providence, which operates 51 hospitals, as well as clinics and doctor’s offices in seven states.
Like Allina, Providence also plans to vaccinate workers based on their roles in an attempt at fairness. The health system will notify workers when it is their turn to get the vaccine. It also creates an appeal process if people think the groups have been misclassified. “When things are scarce, you make very difficult decisions. They don’t feel good, ”Compton-Phillips said.
Federal officials plan to initially ship 6.4 million doses nationwide, according to Gus Perna, COO of Operation Warp Speed. More doses will then be dispatched on a weekly basis with the aim of distributing 40 million doses by the end of the year, Perna said during a call to reporters on Tuesday.
Shipments will be split among states based on the size of their adult population, not in response to virus outbreaks, US Department of Health and Human Services Secretary Alex Azar said on the call. .
“We wanted to keep it simple, first of all because we are seeing the spread and vulnerability to the disease across the country,” Azar said. “But also, once we get through those initial slices where we’re in a much more scarcity situation, we’ll eventually get to the point where it would have to be per capita. So instead of having multiple methodologies, we thought it was better to keep it simple. “
Some health systems are taking a more granular approach to preparing for vaccine use.
Advocate Aurora Health Inc., with 26 hospitals and even more clinics and physicians in Illinois and Wisconsin, identifies workers most at risk of serious illness, predicting he will not receive enough doses to cover employees uniformly. This means taking into account details such as the prevalence of the coronavirus in a particular community, as well as employee risk factors, said Robert Citronberg, physician and executive medical director of infectious diseases and prevention.
“We want to target as best as possible the people most at risk of becoming seriously ill from COVID, and we know these are the elderly, people with underlying medical conditions,” Citronberg said.
Northwell Health, in New York City, with 23 hospitals, has already compiled a spreadsheet of its 74,000 workers that ranks them based on their risk of catching the novel coronavirus at work, according to Mark Jarrett, who is a doctor and responsible for the system quality.
Northwell’s calculation assesses the degree of employee interaction with infected patients and, like Advocate Aurora, the prevalence of the virus in the community. This second data point can sometimes change, so people working in more widespread areas are vaccinated first.
And Jarrett brings another problem to the table. He’s less worried about people clamoring for a vaccine and more worried that workers don’t want it, a fear other hospital executives across the country echo.
Health systems have already had to grapple with anti-vaccination movements when concerns over the speed of the COVID-19 vaccine development frightened workers again, Providence’s Compton-Phillips said.
Allison Suttle, physician and chief medical officer of Sanford Health, based in Sioux Falls, South Dakota, hopes the clinical trial data will reassure workers in the system. Internal investigations have revealed that more people have said they will take a COVID-19 vaccine after Pfizer and Moderna released initial results showing their candidates were each around 95% effective.
Cautious optimism
“I am optimistic, cautiously optimistic and proud of our healthcare workers who are ready to jump, stretch their shoulders and get the shot,” Suttle said.
If and when the Food and Drug Administration approves candidate vaccines, the Centers for Disease Control and Prevention will make its final recommendations for who to vaccinate. Members of the CDC’s immunization committee will review the data to see if the formulas work better in some groups than others.
In the meantime, health systems will continue to prepare as best they can. When asked if Northwell knows how many doses he will receive, Jarrett laughed.
“No,” he replied. All estimates are subject to change, Jarrett said, and even the smallest of fluctuations could make a big difference.
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