As COVID-19 Vaccinations Slow, FPs Begin Delivering More Doses
May 21, 2021, 5:21 p.m. Scott Wilson — At the start of the year, herd immunity against COVID-19 was a blank canvas, and family physicians were eager to pick up the paintbrush.
A remarkable area of that space has been covered: As of May 20, some 160 million Americans had received at least one dose of a COVID-19 vaccine, and nearly 129 million were fully vaccinated.
But the pace has slackened, and more than half of the country’s population remains unvaccinated as summer approaches and many retailers and communities have halted mask requirements.
Now, family physicians — largely left out of the initial vaccine rollout — are busy painting in the corners. They’re also visible, vocal advocates working against the vaccine hesitancy that’s contributing to the slowed immunization rate.
One example: Amar Duggirala, D.O., M.P.H., of Poolesville, Md. His Poolesville Family Practice was one of 17 primary care clinics selected for a pilot program in that state to test family medicine’s vaccine reach.
From its March launch, it was an instant hit, he told AAFP News.
“They basically said, ‘Here are 100 doses to see if you guys can do this,’” said Duggirala, who, with the Maryland AFP, had advocated for such a program. “Every practice I know of finished the 100 doses easily.
“The first week, we individually called our high-risk patients we knew hadn’t been vaccinated. Maryland has a great database that updates daily, so we knew who didn’t have it already. An immunocompromised patient cried after the first dose, out of sheer relief.”
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Using as a dedicated vaccination clinic a former retail clothing store in the same mall where the practice operates, Duggirala had no difficulty running through every available dose. As the program increased its allotments, the practice was soon administering 50 shots a day — a strong number relative to the local population.
“My practice is in the rural third of Montgomery County,” Duggirala said. “We’re two physicians in a town of 6,500, in a rural part of a very populous county — the only doctors for 15 miles. Our priority was to get our town and part of the county vaccinated. The other practices in the pilot also had populations with lower vaccination rates, especially among Hispanic and Black patients.
“One patient we vaccinated the first day was a 95-year-old veteran, a Marine who fought in three wars and, because of his age and he doesn’t drive, couldn’t get a vaccine. His neighbor, who helps him with the internet and complicated things, brought him. She’s a sister-in-law of one of my patients and found out we were giving vaccines. In small communities like this, word of mouth is how it works.”
By the time the pilot program reached its planned end point, it had shifted to become a dedicated part of the state’s vaccine infrastructure. As of mid-April, Maryland primary care practices had administered nearly 35,000 vaccine doses.
Other states are making similar moves, and family physicians are pleased.
Reno, Nev., member Andy Pasternak, M.D., M.S., said this month that he had reached a milestone: administering his 3,000th COVID-19 vaccine dose.
Pasternak, who is active in a Nevada nonprofit focused on immunizations and campaigned early against COVID vaccine hesitancy, gave most of those injections at mass-vaccination events. But he also has spent the past six weeks delivering doses at his office — a number that’s already above 300.
Wisconsin recently shifted focus from high-volume events to accelerating vaccine access by public and private clinicians, including primary care practices.
And officials in Michigan, where state AFP President Mark Hamed, M.D., M.P.H., M.B.A., has steadily called for strong primary care vaccination involvement, are finally taking the advice.
“We have made great progress but have a long way to go, and that is why we believe it is time to bring Michigan’s primary care physicians into vaccination administration efforts, he said in March. In recent weeks, Hamed — a Sandusky, Mich., physician who is medical director for health departments in eight counties in that state — also has further boosted his already forceful pro-vaccination outreach.
The Biden administration signaled months ago that it hoped to leverage patients’ trust of their primary care physicians against vaccine hesitancy — a valid strategy, research suggests.
Related to that approach, the White House recently said that federally funded community health centers, nearly 1,000 of which joined the vaccine rollout in March, have so far administered more than 10 million COVID-19 vaccine doses, with more than 60% delivered to minority populations.
That news put paid to March congressional testimony by AAFP member Jerry Abraham, M.D., M.P.H., C.M.Q., of Los Angeles. Federally qualified health centers are a vital target of the Academy’s workforce advocacy, and Abraham, who runs one, advised lawmakers to ensure that such centers were central to the vaccination drive rather than relying on mass sites.
“Although our FQHC accounts for only a small fraction of the hundreds of vaccinating organizations in greater Los Angeles, we routinely account for nearly 10% of the COVID-19 vaccinations given within the county,” he said.
As early as the first week of March, in fact, his clinic was vaccinating 12,000 people a week.
An April Kaiser Family Foundation report further validates the importance of community health centers in vaccinating Black and Hispanic patients.
“People of color made up the majority of people who received vaccinations at community health centers, including 59% of people receiving the first dose and 54% of people receiving the second/final dose of the vaccine,” the report says. And it includes a positive note amid stagnant or declining national data points: “The shares of health center vaccinations received by people of color has increased in recent weeks compared to vaccinations in early 2021.”
“I’m optimistic,” Duggirala said of the progress. “We’d been working on the runup to the vaccines since October. Now we’re planning on six months doing vaccinations like this. When you get everyone up and running, the effect we’ll have will be much larger than mass-vax sites, when you count it all up.”