President Biden released the National Strategy for the COVID-19 Response and Pandemic Preparedness on January 21, 2020. It is an ambitious attempt to decrease the spread of the novel coronavirus and get hundreds of millions of Americans immunized. This COVID-19 vaccine plan, however, is missing a key element. Namely, primary care.
An incomplete national strategy for COVID-19 response
The goal of 70-80% herd immunity through immunization will add to the estimated 10% current immunity due to the COVID-19 infection. We need 150 million vaccinated adults to reach this level of community immunity. Immunizing 1-1.5 million people per day will get the U.S. to a reasonable herd immunity by Fall. But it won’t happen if we don’t take full advantage of all the potential vaccine distribution resources available to us.
Primary care clinicians can greatly expand the vaccination effort
Primary care practices provide over half of the current adult and childhood vaccines in the U.S. Vaccine manufacturers know which primary care practices provide vaccines because they already ship vaccines to these practices. Also, Medicare has vaccine billing data for primary care physicians who offer immunization to their elderly patients. This provides an immediate opportunity to disseminate COVID-19 vaccines to practices that care for elderly Medicare beneficiaries.
This established vaccine infrastructure is only one of many reasons primary care is the ideal healthcare setting for vaccine distribution. Vaccine hesitancy has been a growing problem in the U.S. over the past several decades leading to numerous vaccine preventable outbreaks of measles. And because COVID-19 has become a political issue, the vaccine has garnered even more hesitancy than usual.
Primary care can help. In fact, the vast majority of Americans surveyed (85%) reported that their own doctor or personal health provider is their most trusted source for information on the COVID-19 vaccine. Primary care clinicians are often a usual source of care, a trusted source of information, and geographically accessible in nearly every county in the U.S.
Positioned to address issues of health equity in COVID-19
Most importantly, in order to effectively fight the COVID-19 pandemic, we need to ensure equitable access to the vaccine. Primary care is prepared to meet this charge.
The gap in vaccination rates by race and ethnicity has once again highlighted the racial/ethnic healthcare disparities in our nation. People of color are less likely to be vaccinated despite higher rates of COVID-19 related morbidity and mortality in Black and Hispanic populations. Vaccine hesitancy, the digital divide and language barriers are all contributing to this gap.
Distributing vaccines through primary care offices can eliminate many of these barriers. This is where patients, regardless of the language they speak or their tech savviness, already receive care and have established trust. And it is well established that a strong primary care infrastructure reduces healthcare disparities and ensures more equitable access to care. It has particular benefits for underserved communities. Relying on primary care for vaccine distribution can help ensure a more equitable process and greater access for communities hit hardest by the COVID-19 pandemic.
Ship 1,000 COVID-19 vaccines to every primary care practice
The typical primary care clinician provides over 3000 office visits per year for an average panel of 1500-2500 patients. Primary care clinicians can provide their patients and communities with reliable scientific information about the COVID-19 vaccines, counsel the risks and benefits of the vaccine, and provide the vaccines in their offices. Some primary care clinicians might only counsel their patients and refer to other mass immunization clinics, pharmacies, or public health agencies. Regardless, primary care offers the necessary trusted relationship to increase local, state, and national COVID-19 vaccination rates.
It is time for the Biden administration to engage primary care organizations in its COVID-19 vaccine plan. Primary care is, in fact, willing and ready. General Internists, Family Physicians, Geriatricians, and Pediatricians see millions of patients daily. They can provide vaccines to eligible patients every day. To reach the goal of 1.5 million immunizations per day will require all the health care workforce available.
Ship out 1,000 vaccines doses to every primary care practice in the U.S. By doing so, we will see needles in arms and decreased spread of COVID-19. There are over 200,000 practicing primary care physicians and another 100,000 nurse practitioners and physician assistants. With 1,000 doses, each provider could vaccinate up 500 people.
There are logistic hurdles for sure. This includes a limited vaccine supply. But a quick back-of-the-envelope calculation gives some insight into just how quickly primary care could speed up the vaccination process. For example, we could ask each primary care provider to deliver just 20 vaccinations per week (less than a quarter of an average provider’s weekly visits). This could add 3 million fully vaccinated individuals per week to the national tally. As a result, it could help us reach national herd immunity months sooner.
A prominent part of the national vaccine strategy
Primary care is available for COVID-19 response and recovery. And, of course, primary care will continue to be here for the myriad other issues facing America. A vaccine dissemination system already exists in the many thousands of primary care offices nationwide. Let’s add primary care as a prominent part of Biden’s COVID-19 vaccine plan.
Jack Westfall
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