The Simple Reason West Virginia Leads The Country In Vaccination Of Nursing Home Residents

The urgency to vaccinate nursing home residents is evident in the numbers. The COVID-19 pandemic has claimed the lives of more than 136,000 residents and employees of long-term care facilities in the United States alone, accounting for nearly 40% of all deaths in the United States linked to the disease .

Echoing this emergency, Secretary of Health and Human Services Alex Azar said in mid-December: “We can get all nursing home patients in the United States vaccinated before Christmas.” Yet by Christmas most states had barely started.

Other states were still far behind when West Virginia became the first state to complete the first round of the two-dose vaccine series in nursing homes on December 30.

What did West Virginia do differently?

The numbers tell a story. As a professor specializing in the management of healthcare operations, I believe they hold important lessons for other states and for the rest of the vaccine deployment.

The mathematical problem of pharmacy

The first important point is that West Virginia has chosen not to participate in a federal partnership program that relies on giant drugstore chains CVS and Walgreens to deliver vaccines to nursing homes. Instead, the state relies on a network made up mostly of local pharmacies.

West Virginia was also praised for how it used the time between when authorization for the first vaccines became evident and when the first doses arrived to plan for deployment.

The big difference is in the numbers. As part of the federal partnership program, CVS planned to have around 1,000 of its pharmacies as vaccination centers to serve some 25,000 nursing facilities across the country, a CVS official told The Wall Street Journal in early December. . Likewise, a Walgreens official said his company would have between 800 and 1,000 Walgreens pharmacies to serve as hubs for around 23,000 nursing homes.

This meant that each CVS and Walgreens pharmacy on average planned to serve about 25 retirement homes.

West Virginia has chosen to mobilize independent pharmacies and drugstore chains, rather than relying solely on CVS and Walgreens. More than 250 pharmacies have offered their assistance in vaccinating people in 214 nursing homes. In other words, each nursing home is served on average by more than one pharmacy.

Vaccination of nursing homes is a labor-intensive operation. Obtaining consent from residents and staff is time consuming and confusing. Some people also refuse the vaccine. As of Jan. 14, only about a quarter of the vaccines distributed to nursing homes through the federal program had reached people’s arms, while West Virginia had started vaccinating new groups and giving second doses.

Incentives are another issue

In addition to unbalanced mathematics, there is a history of incentives.

Under contracts signed with the US Department of Health and Human Services, CVS and Walgreens have essentially secured the right to vaccinate about 99% of the nursing homes in the US that have signed up for the program. There was little incentive to engage large numbers of pharmacies and workers in the arduous task of vaccinating people in nursing homes.

In West Virginia, however, hundreds of local pharmacies and other drugstore chains were involved, and each had a vested interest in providing prompt services so that nursing homes did not back out of vaccination deals. Local pharmacies also often have relationships with nursing homes – relationships they wish to maintain.

Courses for the rest of the country

What can other states learn from West Virginia’s success?

First, to accelerate vaccine deployment, the United States must address the bottlenecks – the lack of resources, especially staff and distribution points, needed for immunization.

Second, incentives matter. When designing immunization programs, it is important to ensure that providers are motivated to commit resources to accelerate immunization. Competition in the marketplace is a powerful mechanism to achieve this.

Third, local and state leaders can make a difference. While the lack of federal leadership was cited as a reason for the slow rollout of the vaccine, West Virginia was successful in vaccinating nursing homes because it might be more agile outside of the federal program. Heads of state and local leaders can be successful when they are held accountable and when they manage the process proactively.

The United States is only at the beginning of the COVID-19 vaccination process. Just over 3% of the country’s population had been vaccinated as of January 13, and there are many challenges ahead. The complex cold storage requirements for mRNA vaccines can make it difficult to access rural areas without careful planning and logistical support. More healthcare workers and residents have also rejected the vaccine that public health professionals would like to see. In West Virginia, about half of nursing home staff refused. All of this has implications as vaccinations continue.