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Want to Save Lives? Let Us Give COVID Vaccines in Our Offices, Docs Say

What if there was an easy way to shorten the window to full COVID-19 vaccination and herd immunity by as many as 100 days, and potentially save 150,000-to-200,000 lives?

There is: just let people get their COVID vaccines at their primary care doctors’ offices, suggests Jack Westfall, MD, MPH, director of the Robert Graham Center at the American Academy of Family Physicians (AAFP). “You don’t sit out your best player in the big game, yet that’s where primary care sits in terms of vaccine distribution,” Westfall said last week at an online event on the state of primary care.

Right now, those getting a COVID-19 vaccine typically head to their local pharmacy, hospital, community health center, or mass vaccination site. But “if you look at who does vaccines in the United States, about half of vaccines are given in primary care practices, whether that’s Medicare or for the whole population,” said Westfall. “Interestingly, Medicare knows exactly how many patients have received vaccines in primary care practices and could ship that number to the primary care practice to deliver for those Medicare beneficiaries, and vaccine companies know who has ordered them before.” According to the Medical Expenditure Panel Survey, primary care physicians account for 54% of vaccine visits, he added.

AAFP president Ada Stewart, MD, noted in a statement that “Despite many patients contacting their family physicians for information on how they can receive the COVID-19 vaccine, 85% of independent practices are unable to obtain COVID-19 vaccines for their patients … The AAFP is advocating that federal, state and local governments take immediate steps to supply community-based primary care physicians with COVID-19 vaccines, and that vaccination strategies should leverage trusted primary care physicians to reduce vaccine hesitancy.”

Primary care physicians are not the only ones hoping to administer the vaccines in their offices, however. “Oncologists are in the right seat to administer the vaccine,” said Ted Okon, executive director of the Community Oncology Alliance (COA), which represents office-based oncologists, at a COA media roundtable last week. Cancer specialists “have numerous immunocompromised patients that can get the vaccine, but it’s been very frustrating for patients — especially cancer patients, who tend to be older — to find out how to get the vaccine, where to get the vaccine.”

“We’ve been trying our best to be at the front line to help vaccinate our patients,” said Kashyap Patel, MD, COA president and an oncologist in Rock Hill, South Carolina. “COVID-19 has brought out the huge amount of social disparities that makes certain ethnic groups more vulnerable to the virus as compared to other populations. And you combine that with patients with cancer — so when I look at my minority cancer patient who already has social determinants of health putting them at a disadvantage, and when they have two-to-three times higher risk because they have cancer, we are compounding the risk of adverse outcome by a factor of seven or eight.”

At Patel’s own practice, “We pushed our case hard, we worked with the state government, we got confirmation that we would be approved for COVID vaccine distribution, but there’s no supply chain established where we could know when we’ll be getting it,” Patel said. “So our biggest concern right now is how do we continue to maintain our patients in a safe environment to ensure they’re not exposed to unexpected mortality.”

Others would welcome seeing patients get vaccinated in any physician office — whether a specialist or a primary care physician. “I’d like to point out a lot of people don’t see primary care doctors because a significant part of our population has chronic disease and they’re seeing their specialist,” Halee Fischer-Wright, MD, president and CEO of the Medical Group Management Association, which represents physician practices, said in a phone interview. “So we’re advocating for vaccine to go to those places where they take care of patients, which may be the oncologist, the renal doctor, or the cardiologist, in addition to primary care.”

As to the question of whether it’s more efficient to get the vaccine at mass vaccination sites that can serve large numbers of people, “I think those concerns are well-founded because the supply was so profoundly limited at the front end, so you wanted to get the biggest bang with the really limited supply that you had,” she said. However, “as we start getting into the spring months — late March, April, May — we’re going to see a dramatic increase in vaccines … We will have more supply of vaccines then we have people who can potentially get it. That gives us the redundancy to allow for those vaccines to hit medical practices.”

What about physicians having the supplies to administer the vaccine, and can they meet the cold storage requirements needed for Pfizer’s shot? “The first wave of ‘We have to do this and it can’t be done in physician offices’ was with the Pfizer vaccine that had to be frozen at such low temperatures, you could only do it in a hospital or large research center that had storage for it,” said Fischer-Wright. “Now with the Moderna vaccine, the J&J vaccine, and hopefully the Novavax and AstraZeneca vaccine,” which don’t have such requirements, “there really is no barrier to doing it in a physician’s office.” And the FDA on Thursday relaxed the cold-storage requirements for the Pfizer shot as well.

The element of trust will be a major factor in overcoming vaccine hesitancy among that last group of people needed to reach herd immunity, said Fischer-Wright. “The barrier to the United States getting to a number of people vaccinated that we can go back to ‘normal’ — with 85% of people vaccinated — is going to be dependent on that last 10, 15, 20% of people having trust in people giving the vaccine … and that can only occur in the medical practice. It’s not going to occur in the car line.”

But despite the clamor among physician organizations, many localities don’t seem to be taking the bait. “In general, we are not hearing about many locations that have moved to support physician-based immunization,” Adriane Casalotti, chief of government and public affairs at the National Association of County and City Health Officials, said in an email. “At this point, supply is still incredibly limited, so vaccination is mostly happening through centralized locations. Where we are hearing that physicians may have the vaccine tend to be those who are connected to a large hospital system … There is certainly interest in having more access points via physician offices, but at this point the real focus is on getting enough supply into the existing distribution locations.”

Last Updated February 26, 2021

  • Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow

Source: MedicalNewsToday.com