New Covid 19 cases are low in San Antonio, but they are still out there. I was reminded of that this weekend when a patient emailed me that he and other family members had tested positive. His symptoms were mild and he has now recovered completely. He received the Johnson and Johnson vaccine a month ago. Disappointing? Yes, but while we think the vaccines are about preventing disease they are also about mitigating illness. They are designed to keep patients “out of the hospital and out of the morgue”. They aren’t 100% effective in preventing illness. That’s while I still wear a mask when I am in close proximity to others who vaccine status is unknown.
Will we reach herd immunity?
Herd immunity is a form of indirect protection from infectious disease that can occur with some diseases when a sufficient percentage of a population has become immune to an infection, whether through vaccination or previous infections, thereby reducing the likelihood of infection for individuals who lack immunity.
It looks doubtful because the virus has mutated becoming more infectious and many people are resistant to being immunized. Because of the mutations the percentage of the population that have to have antibodies against the virus for the virus to “die out” is unknown, but the higher the percentage the less likely the virus is to spread.
If you haven’t been vaccinated, you should. You can walk into HEB from 3-5 PM Monday through Friday without and appointment and get immunized. Walgreens and CVS also have the vaccine.
Now the focus should be to get the vaccine in physician’s offices.
White House, state officials scramble to get docs’ help with lagging vaccination effort
Doctors could be especially helpful vaccinating hesitant Americans, but health officials are still figuring out how to get them involved.
The Biden administration and state health officials are rushing to overcome logistical hurdles to get more Covid-19 shots into doctors’ offices, believing that physicians who have largely been excluded from the inoculation effort so far could be key to boosting vaccination rates.
For months, doctors have lobbied the White House and states to ship them doses, but officials instead focused their efforts on mass vaccination sites and other places that could quickly immunize hundreds or even thousands of people daily. With demand for shots now slipping faster than health experts expected, officials are now trying to steer doses to smaller, local sites like doctor offices that can make targeted efforts to reach people who are hesitant to get vaccinated or have faced other obstacles like lack of transportation.
“There’s absolutely no reason that primary care clinicians and other community-based physicians and providers shouldn’t have access to the vaccines to distribute to their own patients,” said Bob Doherty, a senior vice president of the American College of Physicians, who says his organization and other doctor groups have repeatedly pressed that message with top administration officials.
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.”
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Now, when most of our patients have been immunized, they want to give us vaccine. The only vaccine that is practical for physicians’ offices is the Janssen Covid-19 Vaccine (Johnson and Johnson). That one has been associated with rare side effects as mentioned in a previous blogpost, but is appropriate for most patients.
The vaccine comes in boxes of 10 vials which each contain 5 doses. We will probably ask for 50 doses, but you have to use the vial within 6 hours of opening it.
The exciting news is that the Pfizer vaccine has been approved for adolescents 12-15 years of age. Why is important that they get immunized when they usually only get mild disease? The disease isn’t always mild and there are rare severe side effects. If fewer people get sick there is less virus circulating to mutate. There is less virus that may be transmitted to vulnerable people.
On May 10, 2021, the FDA expanded its Emergency Use Authorization (EUA) for the Pfizer/BioNTech mRNA-based COVID-19 vaccine to include adolescents 12-15 years old.1 The vaccine has been authorized for use in persons ≥16 years old since December 2020.2
Expansion of the EUA was based on the results of an observer-blind trial (summarized in the FDA Fact Sheet) in 2260 adolescents 12-15 years old who were randomized 1:1 to receive the Pfizer/BioNTech vaccine or placebo at 0 and 3 weeks. There were 0 cases of COVID-19 with onset ≥7 days after the second dose among SARS-CoV-2-naive subjects who received the vaccine and 16 cases among those who received placebo. Compared to persons 16-25 years old who received the Pfizer/BioNTech vaccine, vaccinated adolescents 12-15 years old had numerically higher geometric mean titer levels of SARS-CoV-2 neutralizing antibodies (1239.5 vs 705.1) and similar adverse effects.3
With the expansion of the EUA, the FDA has added a warning to the vaccine Fact Sheet describing a risk of syncope following injection; the risk is higher in adolescents than in adults.3 Clinical trials evaluating use of the vaccine in children 6 months to 11 years old are ongoing.4
- FDA News Release. Coronavirus (COVID-19) update: FDA authorizes Pfizer-BioNTech COVID-19 vaccine for emergency use in adolescents in another important action in fight against pandemic. May 10, 2021. Available at: https://bit.ly/3y4KYhO. Accessed May 11, 2021.
- FDA authorizes Pfizer-BioNTech COVID-19 vaccine. Med Lett Drugs Ther 2021; 63:1.
- FDA. Fact sheet for health care providers administering vaccine (vaccination providers). Emergency Use Authorization (EUA) of the Pfizer-BioNTech COVID-19 vaccine to prevent coronavirus disease 2019 (COVID-19). Available at: https://bit.ly/37fX1NG. Accessed May 11, 2021.
- Pfizer Press Release. Pfizer-BioNTech announce positive top-line results of pivotal COVID-19 vaccine study in adolescents. March 31, 2021. Available at: https://bit.ly/3h3i1MT. Accessed May 11, 2021.