It’s been an astounding week of highs and lows regarding the vaccination process in Mississippi. Seniors over age 75 rejoiced at the ability to finally sign up for a COVID-19 vaccine. Access opened up further with the announcement that those over 65 were also eligible as well as those under 65 with underlying medical conditions.
In all of the headlines and frenzy of activity, though, something almost went unnoticed. There was a significant population of people nearly completely overlooked—our most vulnerable patient population who reside in nursing homes and other long-term care facilities.
It’s hard to fathom how this happened unless you’ve been watching the players from the beginning. Most may not realize that Dr. Thomas Dobbs and his team at the Mississippi Department of Health have limited influence over the vaccine supply that is tied up with federal contracts awarded to CVS and Walgreens to administer vaccine to patients in the nursing homes and long-term care facilities. This is a separate vaccine allotment from the federal government. MSDH has worked very closely with Mississippi’s physicians and hospitals on plans to administer vaccine. Planning has been ongoing for quite some time, but this was a different supply of vaccine that was reserved for long-term care facilities.
Early in the pandemic, CVS and Walgreens appeared to have the federal administration’s and White House’s ear, participating in press events in the Rose Garden regarding their ability to test and diagnose our patients with COVID-19. In Mississippi that never materialized.
For one reason, production of testing was never at a level to maintain such a process, and also because this is what physicians do. We take care of our patients by assessing them, testing them and diagnosing them. It is common sense for clinics and hospitals to test patients, handle and process swab specimens as we always do. Physicians statewide stepped up and directly provided care for the patients. Many times they utilized the infrastructure of the area hospitals, but it would never be a physician’s thought to send their patients through a drive-through at a retail pharmacy to be tested and diagnosed. That’s not how medicine works.
Pharmacies Lobbied to Give Vaccinations
It was no surprise to most physician leaders when the federal government essentially bypassed MSDH and awarded a contract to CVS and Walgreens to vaccinate the nursing home and long-term care facility residents. It was upsetting, but not surprising.
Of course it makes no sense to have to create a new type of workforce that must actually drive to a facility and vaccinate the residents there when there are nurses working in all of these facilities who are already physically onsite and who give patients injections daily. Our physicians are at these facilities providing care for their patients, and these are people with real relationships who know their patients. These relationships matter, especially in a health crisis.
While vaccine reactions are very rare, they can occur, and not everyone knows how to draw up and administer injections correctly. It takes professionals trained to monitor people after vaccination for any possible side effects and to recognize the subtle signs that may not be “normal.” These are skillsets long held by physicians and nurses.
Several years back pharmacies, lobbied to be able to give vaccines in their places of business. This quietly pulled vaccines out of the clinics and into the hands of pharmacies. Retail pharmacies grew larger, especially with the recent CVS/Aetna merger. In-house pharmacy primary-care clinics are on the rise (some staffed by physicians and some not), and there is much more emphasis on the BIG corporate nature of medicine and much less on the sacred doctor-patient relationship. Our physicians literally grieve this. For most of them, the human compassion part of medicine is what drew them to it in the first place.
Patients: Sitting Like Ducks Waiting for Vaccine
So awarding the pharmacies the contracts to grow a new healthcare workforce to come and vaccinate the patients who already have caregivers was no surprise. The sad part is that we physicians nearly helplessly watch as our most vulnerable patients sit and wait for the federal government plan to spring into place.
It’s been a crawl. These patients sit like ducks waiting for their chance at a vaccine, while CVS and Walgreens figure out how they will build and implement a workforce to do the things physicians and nurses already have been doing and want to do. Give us the vaccines. Let us vaccinate our patients. This is what we do.
It does not appear to be much of a priority to CVS and Walgreens to vaccinate these residents, who are our patients and someone else’s mother or father. These large retail pharmacies have had vaccine since last month, and while improving a little on the volume they have been able to vaccinate, they have been far outpaced by MSDH and physicians statewide. The nursing home and long-term care facility vaccination plan has been a major disappointment, and physicians are pleading to be able to take care of our patients. We want to be there for them.
In a time when we are racing to vaccinate the population most at risk of succumbing to COVID-19, removing the physician from the picture and assuming we’d be too busy to do the basics like vaccinating our patients was a grossly misinformed plan. If the vaccine supply is released from CVS and Walgreens, we have an army of physicians signed up and ready to go.
We will do the thing we always do. We take care of our patients. As physicians, we swore to an oath to first do no harm. By virtue of the way our seniors have been neglected over the past month by the retail pharmacy chains, it appears they may well be motivated differently.
Although many patients are at risk, those in our long-term care facilities and nursing homes live in a communal setting. They don’t have the option available to them to shelter in place as so many others in the over-65 age group are able to do in their own homes. It is a tragedy inside a tragedy that we relied on chain pharmacies to vaccinate the greatest generation.
Our patients deserve better, and our physicians, if given access to the vaccines, could have vaccinated these individuals much sooner. There is hope that the retail pharmacies are coming online, and our long-term care facility and nursing home residents will soon receive their first vaccinations. What that new workforce does next is anyone’s guess.
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