White House, state officials scramble to get docs’ help with lagging vaccination effort

But sending Covid vaccines to doctors’ offices, which typically administer a large share of routine adult vaccinations, isn’t as easy as it sounds. Five months after Covid-19 vaccinations began, many states are still going through the process of signing up physicians and addressing their concerns over requirements for handling the shots. The situation underscores the difficulty the Biden administration faces in the next leg of the largest and most complex vaccination campaign in U.S. history.

A particular challenge for many doctors: The vaccines are shipped in huge quantities. Two of the authorized shots — those from Pfizer and Moderna — have cold storage requirements that could be difficult for some physician practices, especially in rural areas where vaccine hesitancy tends to be higher. And depending on the shot, vials can contain between 5 to 15 doses that must be used in the same day once they’re opened, increasing the likelihood that doses could get wasted in small settings like doctors’ offices.

White House officials said they’re working to resolve these issues, promising that physicians will play a major role in President Joe Biden’s new push to vaccinate at least 70 percent of adults by July Fourth. Biden last week said that pediatricians will be key to vaccinating children, as millions of younger teens are expected to soon become eligible for the shot from Pfizer and its German partner BioNTech.

Surveys have often shown physicians are seen as trusted messengers on vaccines, and their relationships with patients could be essential to overcoming hesitancy or skepticism.

“As we’re entering this next phase of our vaccination programs, we are clear that engaging primary care providers is going to be a critical part of this effort,” a senior administration official said.

While the federal government has shipped tens of millions of doses directly to community health centers and retail drug stores, the official said the administration isn’t planning a similar effort for doctors’ offices.

Instead, the administration has been working with states, who control distribution for about half of Covid shots produced, to prioritize doses for primary care practices in areas ranking high on the Centers for Disease Control and Prevention’s social vulnerability index, which measures communities most in need of assistance based on factors like transportation access, housing conditions and poverty level.

White House officials on a private call with governors on Tuesday urged them to get more vaccines to pediatricians and family physicians, according to two sources. The White House has also considered encouraging emergency room physicians to administer the vaccine when a patient is discharged, according to three sources with knowledge of the talks.

Several states in recent weeks have begun shipping vaccines to doctors, casting a wide net for willing vaccinators. With one of the nation’s lowest vaccination rates, Louisiana is now allowing any physician, regardless of specialty, to provide Covid shots. New Mexico, which for months led the nation’s fastest vaccine rollout, is now allocating 11 percent of its doses to pediatricians and OB-GYNs in addition to primary care providers.

But elsewhere, state officials said they’re still facing other challenges enlisting doctors. One of those is simply understanding which primary care practices in their states want to administer shots — and how many.

“With states, they vary dramatically in terms of their ability to connect to primary care practices,” said Ann Greiner, the president and CEO of the nonprofit Primary Care Collaborative. “I know states that don’t have the data about the primary care practices in their state. Some have very tight relationships.”

While getting shots to doctors is expected to help boost vaccination rates, that on its own won’t be enough to win over a sizable portion of the country that’s still unvaccinated. For starters, an estimated quarter of Americans report not having a primary care provider.

About 57 percent have received at least one dose, and a Kaiser Family Foundation poll on Thursday found just 9 percent of unvaccinated adults planned to get a shot. About 20 percent of adults have consistently said they are adamantly opposed to the vaccine.

State officials, who now have more vaccine than they can administer, are anxious to try new strategies. Virginia until recently had been telling doctors to only order what they were sure they could distribute that week, which kept many doctors, especially smaller practices, from participating. Now that supply is so far ahead of demand, the state is working to sign up more doctors.

“The most important thing is to have vaccine on hand so when your patients come in … you have the ability to give that shot right then and there,” said Danny Avula, the state’s vaccine coordinator.

Still, some doctors have concerns about the potential for wasted doses in small settings, where the number of people seeking vaccines could fluctuate unpredictably. While some people will make an appointment for vaccination ahead of time, health experts expect that doctors can convince patients they see for other health concerns to get vaccinated on the spot.

Physician groups have pushed the administration to make vaccines available in one-dose vials to cut down on waste. The Biden administration official said the government is “looking into this,” but the three companies with Covid-19 vaccines in use in the United States have not indicated plans to do so.

State officials are telling physicians not to worry about wasting doses, a sentiment that would have been unthinkable just a few months ago when vaccines were scarce.

“Given that supply has outstripped demand, we’re telling providers to do the best they can … but to not stress about it,” said Tracie Collins, New Mexico’s health secretary. “We certainly don’t want to waste vaccine, but we want to get as many people vaccinated as possible.”

Medical trade groups are working with the Biden administration to get the word out that vaccines are now becoming more widely available to doctors. Some doctors have felt discouraged about their ability to get vaccines, so they haven’t yet signed up to administer Covid shots, said American Medical Association President Susan Bailey. She said some doctors in her community in Fort Worth, Texas, signed up as early as December to receive doses but have not yet gotten any.

Since mid-March, Maryland has been running one of the nation’s largest tests for sending Covid shots to doctors. A pilot program distributed vaccines to 37 primary care practices, mostly serving Black and Hispanic communities. Data showed Black and Hispanic patients at the practices were being vaccinated at rates higher than their representation in the state, according to Howard Haft, the state official leading the program.

The program has since expanded to nearly 240 practices and is expected to grow to about 400 in the coming weeks. Participating doctors can check the state’s health information exchange to see if their patients have been vaccinated — and are encouraged to contact those who haven’t gotten a shot.

“Patients prefer to get information from their trusted providers,” Haft said, “and if they have a choice, they prefer to get the vaccinations in their offices.”