Updated on: January 25, 2021

COVID-19 Vaccination: Not fast enough

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Original story posted on: January 18, 2021

The vaccination effort has been suboptimal.

It is mind-boggling how rapidly they were able to develop effective vaccines against COVID-19. It really was at warp speed. However, vaccines don’t protect people, vaccinations do. The vaccination effort has been suboptimal.

In response to an overwhelming feeling of helplessness and depression, I contacted the Ohio Board of Health which referred me to my local Board of Health. I couldn’t find the way to volunteer on the website, so I did the old-fashioned thing and called. The person I spoke with relayed my information on, and I was contacted promptly.

I followed instructions, registered, and was accepted to the Cuyahoga County Board of Health Medical Reserve Corps to be a vaccinator. Further directions have not been forthcoming. I am going certifiably insane waiting to be deployed. Patience is not one of my virtues!

From the moment we learned about COVID-19 from China, we anticipated the day we would have a vaccine. Why was there no nationally-orchestrated strategy to get vaccines in arms?

On Sunday, I caught up with my old boss. He had messaged me a picture of his vaccination card, noting, “Volunteering has its perks!” When I called him to see how he had managed it, he explained that since he was an established volunteer for his local hospital, when they had leftover vaccine during a vaccination clinic, they had contacted him and offered him a shot.

This is in contradistinction to an article I read from Cincinnati.com where they detailed vaccine going to waste after a nursing home overestimated the number of doses they needed. With the strict temperature requirements of these vaccines, if you don’t use doses, they expire, and you lose them. Apparently, this is going on a lot more than the general public is aware.

There has been a lot of press about how and why the vaccination effort is failing. I wish I had all the information and was empowered to help solve the problem. Patience may not be one of my virtues, but efficiency and process improvement are in my wheelhouse. From what I can glean, there are multiple opportunities for improvement in the process.

  • There isn’t enough vaccine to go around yet. We should have activated the Defense Production Act (DPA) and ramped up the manufacture of the vaccine and should have commissioned enough stock for our population. Biden is supposedly planning to invoke the DPA. Increasing supply will be helpful.
  • The vaccines currently under emergency use authorization (EUA) require two doses. In theory, the second dose was supposed to be withheld to ensure availability so people could reach fully vaccinated stage. In practice, there has been talk about rolling out the first dose more liberally and administering the second shot in a delayed fashion. This approach has not been widely accepted by the medical establishment. If you want to change protocols midstream, you should do the studies to support the updated procedure. Also, there are reports that the second shot had not been held back as planned, and that supply is, again, in question.

Johnson & Johnson’s adenovirus-vector-based vaccine which is awaiting approval is a single dose regimen. That will be very welcome, but apparently, they are having difficulties meeting production quotas as well.

  • Vaccine is not being evenly distributed and administered. States and local municipalities are variably controlling the process. Some states are holding huge vaccination events in stadiums, some states are barely getting their nursing home residents vaccinated, and some (e.g., Ohio) are expecting 85-year-olds to sign-up on the computer or to call 800 different providers to find one with vaccine and availability. Some states are vaccinating individuals who are 80 and over; some are accepting patients 65 and above. Should states with higher positivity rates get vaccine preferentially? Even if those states are the ones refusing to take mitigation precautions?
  • Is the hold-up not having enough vaccinators? Get volunteers processed more efficiently. There are retired doctors, nurses, paramedics, pharmacists all over who would be willing to help. My town’s firefighters are willing to vaccinate our population, but Ohio is purportedly only allowing medical institutions or the public health system to procure and administer vaccine.
  • There is significant vaccine hesitance in the general population, especially among people of color. Get the word out. Get vaccinated now so you can have Easter together soon!

I sure hope the posts on social media are encouraging folks to get vaccinated. To those of us chomping at the bit, it just feels a little mean and discouraging.

  • Vaccine shouldn’t be wasted. If a vaccination event is being held, and they run out of people in the priority group but have vaccine in vials, family members should be called, non-medical employees recruited, random ladies on the street should be accosted. Put the vaccine in someone’s arm, rather than in the garbage!

We must up our game. I know all of you out there join me in not wanting to wait 5 or 10 years to achieve herd immunity. We don’t know whether we will need boosters. Will this be a yearly vaccine like the flu shot? Will this be a yearly battle? There is already a mutated version of the virus which is more contagious. I saw speculation that SARS-CoV-2 may remain in circulation forever but may temper to be more like the common cold. Personally, I’d rather we eradicate it like polio.

As an article in my Sunday paper said, “Vaccines don’t save lives. Vaccinations do.” Please get yours as soon as you can!

P.S. After I put the finishing touches on this article, I received an email requesting my assistance as a vaccinator for the City of Cleveland. Hooray! I’ll let you all know how it goes.

Programming Note: Listen to Dr. Erica Remer every Tuesday when she co-hosts Talk Ten Tuesdays with Chuck Buck at 10 a.m. Eastern.

Erica E. Remer, MD, CCDS

Erica Remer, MD, CCDS has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. She was a physician advisor of a large multi-hospital system for four years before transitioning to independent consulting in July 2016. Her passion is educating CDI specialists, coders, and healthcare providers with engaging, case-based presentations on documentation, CDI, and denials management topics. She has written numerous articles and serves as the co-host of Talk Ten Tuesdays, a weekly national podcast. Dr. Remer is a member of the ICD10monitor editorial board, a former member of the ACDIS Advisory Board, and the board of directors of the American College of Physician Advisors.

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