Health officials and advisory groups have warned that initial supplies of an approved COVID-19 vaccine will be scarce.
How are health care providers deciding which of their employees will get vaccinated in the initial rollout? “Marketplace Morning Report” host David Brancacccio put that question to Dr. Jonathan Lewin, CEO of Emory Healthcare, the largest health care provider for the state of Georgia.
Below is an edited transcript of their conversation.
David Brancaccio: So there you are, Georgia’s largest health care provider, you’re ready to start giving out some vaccines?
Jonathan Lewin: We are just excited to do it and we are completely ready to move forward as soon as we get it.
Brancaccio: There’s not going to be enough for everyone. So what are the thoughts about first of all your staff, who will get it first?
Lewin: Yeah, so we’ve spent a lot of time thinking about how to prioritize what is a scarce resource. And we really based it on sort of the guiding bioethical principles of maximizing benefits, minimizing harm, making sure we mitigate health inequities, promoting justice, promoting transparency.
And really, there are a couple of overall rationales in how we prioritize because it’s pretty clear the initial supply will be less than the number of health care workers who are interested in getting the vaccine. So we’re looking at prioritization based on the geography, we’re going to start with people in the emergency rooms, the intensive care units, obviously including our many COVID intensive care units.
We’re going to continue to look at risk factors, and importantly, the essential reality of preserving our ability to deliver care. And importantly, that’s not just the doctors and nurses but it’s many of the people, the respiratory therapists, the lab techs who run the lab, who come into contact with potentially infectious materials, as well as people you might not think about, our environmental services people, the people who clean the rooms are critical as well.
Vaccine distribution guidance at the national and state levels
Brancaccio: It’s so interesting, because I mean, someone on the outside might have thought you just needed to wait for your orders from, let’s say, the Centers for Disease Control, or let’s say, some office for the state of Georgia, but you seem to have quite a lot of latitude to make these decisions for your employees?
Lewin: Well, we’ve been in fairly constant contact with our Georgia Department of Public Health and as well as the [Centers for Disease Control], we’re fortunate the CDC is actually sitting about a stone’s throw from my office at Emory [University]. So we’re very close with both of them. And they’re providing overall guidance. But really, their guidance is more on the order of, you know, phase one A, which is health care workers, you know, on the front lines or health care workers with direct or indirect contact with patients or infectious materials and then the long-term care facilities and employees.
But within the individual health systems and health care workers, it’d be challenging for them to give really universal guidance, because you have organizations like ours with, you know, 26,000 people and you have small rural hospitals where there may be 100 employees or 200 employees. So to give that kind of detailed guidance, especially for a complex organization like ours, would be tough from CDC. So you’re right, we actually have spent time not only working on our own, but also helping through the Georgia Hospital Association, helping to inform other hospitals and health care systems, how we’re doing it to help them decide what might be good guidance as they develop their plans.
Prioritizing vaccine access for the public
Brancaccio: Now, this is for your people but what about prioritizing who gets the shots for the more general public? That’s got to be someone else.
Lewin: CDC has really come up with the major guidance and it’s similar — the National Academy of Medicine, had a committee that also looked at prioritization across the whole population. And they’ve really come to consensus between those two organizations on how we do it. And they’ve given us a list of phases, different phases that we’ll go through, as we get to prioritizing the entire group. And again, it starts off with health care personnel and long-term care facility residents, it goes to essential workers, then it goes to adults with high risk medical conditions, people over 65. And that guidance, again, has come out strong and we’re ready to start vaccinating the broader public as soon as we get to those individual phases.
Brancaccio: Now, this may sound like a little too much of a practical question, but I am curious. How’s it going to work on your staff? I mean, your employees won’t be able to see the whole list in ranked order. Will they get like a set of emails saying today’s your day? How will it work as a practical matter?
Lewin: Yeah, we have work groups who have worked on the operating models to get this done. And this is a tremendous logistic as well as information technology challenge. So we’ve set up the digital processes in our employee management systems, so that we will be able to send out email invitations to those people who are next on the list. And it’s going to say something along the lines of, “you are next for vaccination, here is our scheduling system, please schedule your appointment.” And we are going to do it purely on appointments for our health care workers. And if you’re not interested in getting the vaccine right now and want to wait, let us know. So we can go farther down the list. It’s all going to be done digitally through our scheduling system we’ve set up for this. And importantly, it will also then trigger the second dose scheduling.
Public information campaigns around the virus and vaccine
Brancaccio: You raise an interesting issue, there are some people who for maybe immediate health reasons may not want to get the shot right away. Others may just have reluctance. That’s an issue for the wider society. Is Emory Healthcare thinking about ways to do outreach to the more general public, with so many people with questions about the safety of this whole thing?
Lewin: We are and we’re spending a fair amount of time and effort on getting the messages around COVID in general out. We actually created a community outreach program that specifically reaches out to the African American and Latinx communities in metro Atlanta to try to make sure people are getting the right information about COVID, about testing and now about vaccination as well.
So that’s a big part of our mission, again, as the major academic health care system in the state to make sure we’re doing our job of helping people understand the true information and allowing them to make an informed decision about when they get the vaccine. There’s a big segment of the population who are hesitant about getting the vaccine, mostly because it appears to have been rushed. Well, we are convinced with the [Food and Drug Administration’s] work with the vaccine and related Biologic Advisory Committee, that’s going to be meeting this week about the Pfizer vaccine and next week about the Maderna vaccine, we know the people on that committee, they are strong scientists.
We actually took part in the Moderna phase one and phase three trials. So our scientists also have had a chance to really dig in. And we’re convinced it’s not going to be released under emergency use authorization, until a lot of really good and smart people have decided it’s both safe and effective. So we’re going to try to get that message out. And again, we’re hopeful that within the health care workforce, once it’s available, there will be a whole lot more people who want to get it as soon as possible, then there are the people who are hesitant and want to wait and see how it goes in the first set.
Brancaccio: Pretty amazing, though. I mean, if you think back to March of this year, when we were getting a much stronger sense of just how bad this pandemic would be, the idea that you and I will be having this conversation in early December about how to get an actual vaccine into people’s arms, it’s been a dramatic road to be able to have that option so quickly.
Lewin: Well, we’re battling a virus that shows no signs of slowing down anytime soon. And really ensuring that health care personnel are healthy and able to heal the sick is essential. Making sure that we take care of vulnerable populations is essential. There are so many ethical, operational, and health care challenges that we as a country really have never had to face before. So this is an historic battle. It’s going to require continued working together in order to really conquer this foe.
What happens if the federal government does not provide more money to state and local governments in the next round of coronavirus relief?
Unlike the federal government, most state and local governments are bound by balanced budget requirements, meaning that when revenues decline, they’re forced to either reduce spending or increase taxes. Without federal assistance, the revenue drop would likely result in more job losses, said Tracy Gordon, a senior fellow with the Urban-Brookings Tax Policy Center. State and local governments employ more workers than any other sector, Gordon said.
What will it take to persuade people to get a COVID-19 vaccine?
There’s a saying in public health that vaccines don’t save lives, vaccinations save lives. A recent Pew Research poll shows 60% of Americans would definitely or probably get a COVID-19 vaccine if one were available today. That’s an improvement, but 21% still said they do not intend to get vaccinated and are “pretty certain” more information won’t change their minds. So what’ll it take? Building trust, said James Colgrove, a professor of public health at Columbia University. Having famous people get vaccinated on camera is one tactic for that. Former Presidents Barack Obama, George W. Bush and Bill Clinton have already volunteered.
Are states ready to roll out COVID-19 vaccines?
Claire Hannan, executive director of the nonprofit Association of Immunization Managers, which represents state health officials, said states have been making good progress in their preparations. And we could have several vaccines pretty soon. But states still need more funding, she said. Hannan doesn’t think a lack of additional funding would hold up distribution initially, but it could cause problems down the road. “It’s really worrisome that Congress may not pass funding or that there’s information circulating saying that states don’t need additional funding,” she said.
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