A few weeks ago, a small rural hospital in Susquehanna, Pennsylvania, received its first shipment of Moderna COVID-19 vaccine and quickly began vaccinating the hospital’s health care workers and skilled nursing facility staff and residents. After the Barnes-Kasson County Hospital immunized all the Advisory Committee on Immunization Practices (ACIP) Class 1A workers and residents who requested the vaccine, it moved to the next level of eligibility and started immunizing Class 1B first responders and teachers who worked at two of the county’s school districts. On January 6, 2021, the Pennsylvania Department of Health ordered the hospital to stop immunizing all but Class 1A health care workers and nursing home personnel and residents. According to published reports, the state health department notified the hospital: At this time, our top priority is vaccinating phase 1A individuals. However, our main goal remains ensuring all Pennsylvanians interested in receiving the vaccine will do so … The vaccine plan is designed to give the department and stakeholders a roadmap for distributing the vaccine to phases; the main issue remains that we are simultaneously building a road as we build the map. While health departments continue trying to build a road and a map simultaneously, people will continue to acquire and die from COVID-19. Although the current Pfizer vaccine requires storage temperatures well below the capability of most medical offices and many hospitals, the Moderna vaccine can be easily refrigerated and stored as most other vaccines. Rather than have the vaccine sitting on ice and possibly reaching its expiration date before being used, state health departments should be taking a lesson from a small rural hospital and start expanding their immunization guidelines and networks. The most logical and effective way to do this would be to start shipping the Moderna vaccine to primary care medical practices and allow the individual practices to start immunizing their patients according to the existing schedule. After ACIP Class 1A patients who were health care workers or nursing home staff or residents were vaccinated, the medical practices would be allowed to vaccinate their Class 1B patients who were 75 years of age and older, and critical workers, such as police officers, firefighters, teachers, grocery store workers, and postal employees. After all of their 1B patients were immunized, the medical practices would be allowed to vaccinate Class 1C patients who were 64 to 75 years old, 16 to 64 years old with high-risk medical conditions and additional critical workers. What health departments are not allowing for is the age disparity in various locations. Many communities are made up of predominantly elderly patients, while other communities have a preponderance of middle-aged residents. To vaccinate one community and force another to wait months for its turn is short-sighted. To vaccinate an entire nation in lockstep is even more so. Many medical practices serve large Medicare populations, and acquiring the COVID-19 vaccine from their primary care physician would be a quick, convenient, and comfortable way for elderly and disabled patients to become immunized against COVID-19 and for the United States to achieve vaccine acceptance, compliance, and herd immunity much quicker than will be achieved by current methods. Although many practices would not be willing or able to vaccinate their patients, those practices that did agree to follow guidelines and immunize patients would be performing a critical service. The sooner Americans are vaccinated against COVID-19, the sooner our nation will be able to lose the masks and get back to life as we once knew it. Instead of watching the COVID-19 vaccine aging on ice, the time has come to put our vaccination program into a higher gear and start using our ample resources to the best possible advantage of every American. To date, only 27 percent of distributed vaccines have been administered. We can and must do better than this. Bernard Leo Remakus is an internal medicine physician. Source
