Vaccinating millions of Americans against the COVID-19 virus is proving to be a complicated process already plagued with many setbacks.
But there's already a ready-made vaccine distribution system that can be tapped into to accelerate the rollout, some experts say: primary care doctors.
Primary care doctors provide nearly half of all vaccines in the U.S. and their role may help assure successful delivery of the COVID-19 vaccines to communities across the nation, including rural and remote communities, according to a preprint study published in the Annals of Family Medicine
Doctors, county officials and a member of the Western New York Vaccination Planning Team say primary care physicians need to begin to distribute the COVID-19 vaccine.
"Bottom line, if we engage and activate the ready-made primary care practices, we can accelerate COVID-19 vaccine distribution and reach herd immunity through immunization sooner," said John Westfall, M.D., a co-author of the study and director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.
"Vaccine manufacturers already know who orders vaccines and could deliver vaccines to those same primary care offices. Medicare knows who provides COVID-19 to Medicare beneficiaries and actually know how many beneficiaries get their vaccines from these practices. They could ship out that number of vaccines to each primary care practice for their seniors. Or do so in waves," Westfall said.
There’s growing frustration among medical groups about being shut out of the vaccine distribution process with primary care docs even missing out on getting the vaccines themselves.
The Medical Group Management Association (MGMA) is urging the Biden administration to include medical group practices in COVID-19 vaccine distribution strategies moving forward. A survey reflecting responses from 403 medical group practices showed 85% of independent practices actively seeking the COVID-19 vaccine for their patients received some as of Jan. 21-24. Nearly half (45%) of hospital- or health system-owned practices seeking vaccines still hadn't gotten any. Meanwhile, the majority of practices that have gotten the vaccine (54%) say they only received enough to vaccinate 1% or less of their patients.
The COVID-19 pandemic recovery will require a broad and coordinated effort for infection testing, immunity determination, and vaccination, the study authors said.
The study evaluated the delivery of vaccinations, using 2017 Medicare Part B Fee-For-Service data and the 2013-2017 Medical Expenditure Panel Survey at the service, physician, and visit level. The data shows that primary care physicians have played a crucial role in delivery of vaccinations to the U.S. population, including the elderly, between 2012-2017.
Overall, PCPs provided the most vaccinations (46%), followed closely by mass immunizers (45%), then nurse practitioners/physician assistants (5%). There were clusters of counties that had over 50% of vaccinations provided by PCPs throughout states such as Louisiana, Pennsylvania and Massachusetts, the study found.
Locally, Dr. Nancy Nielsen indicated, "The big problem is no primary care physicians have gotten the vaccine. If the state can send 100 doses to a pharmacy, they can send 100 doses to a doc who knows which patients need it. I'm very disappointed that that whole distribution channel to physicians has not opened up," Dr. Nancy Nielsen, the lead for the Western New York Vaccination Planning Team, said.
Dr. Raul Vazquez, a physician at Urban Family Practice, said he's been in practice for 25 years and has 15,000 patients, but no vaccine.
"We have been submitting for COVID since December. Every week you have to put in your order, and we have not gotten a single vaccine," Dr. Vazquez said.
County health directors said having doctors start vaccinating their patients can help.
"Doctors know their patients better than we would. Doctors can prioritize their patients easily. I think to us it just makes sense. They want it. They're asking for it. It just needs to get to them," Dan Stapleton, the Public Health Director in Niagara County, said.
"I can't tell you what the state's reasoning is for only right now giving vaccine doses to state sites, county sites, hospitals, federally qualified health centers and pharmacies. That's their decision. If we can have more doses that are available to the state, they'll be able to provide more doses to community providers," Dr. Gale Burstein, the Health Commissioner for Erie County, said.
Dr. Vazquez said there are a great deal of advantages when it comes to doctors distributing doses.
"You know the population. You know exactly the demographic. It's an easier process because all they have to do is sign a form. They're already in our database," Dr. Vazquez said, "It's not just we'll get the national guard to set up a vaccine site. That's going to help in the beginning, but once you drill down you're going to have a lot of appointments that are not going to get filled because people don't feel comfortable. They need that extra step that a primary care doctor can provide."
Dr. Vazquez said if the state does not start distributing doses to primary care physicians, there will be a cap in how many people are willing to be vaccinated at the current available sites.
"I see that as a problem that will develop. Because again, if you don't want the vaccine, I don't care what you put there, it's not going to happen. I think that's where we can have a bigger impact," Dr. Vaquez said.
Dr. Vazquez said the black and brown community is particularly hesitant to take the vaccine, and that's where doctors like him can help.