I have to admit that I’m apoplectic about the current rate of COVID-19 vaccination in the U.S. While limiting the vaccine to nursing home residents and medical care workers made sense in order to immunize the most at-risk individuals first, the lack of infrastructure to get these immunization campaigns done has seriously delayed accomplishing that goal.
More importantly, I am disheartened by the reports that many health care workers are refusing to be vaccinated. While I can understand that people without science or medical backgrounds can be swayed by the poisonous misinformation circulating social media that suggests you can become sterile or hypersensitive to COVID-19 infection from the vaccine (none of which is true of course), I don’t want to believe that people with a background in health care believe this garbage.
Therefore, I have been talking with numerous health care providers to get some idea of what the issues are that have delayed immunization. Not surprisingly, their reasons for delaying vaccination are varied, but are not related to fear of the vaccine. Most have been overlooked in the rollout of the COVID-19 vaccine campaign.
As I have stated before, the number one and two problems in the rollout have been related to the holiday timing and logistics. The amount of vaccine and the timing of distribution was not clearly defined to most states, and there appears to have been little planning for the vaccination campaign. This may be due to cynicism that the vaccines either would not be effective or would not be available when the government predicted. This was a disastrous miscalculation.
Initially there were reports that states might receive less vaccine than they thought, but this also was mostly incorrect. The infrastructure therefore was not prepared when the vaccine arrived, and there was no direction given for efficient means to run these immunization campaigns. This failure also revealed the tattered public health infrastructure in most states, which is now scrambling to try to figure out how best to dispense these vaccines.
Many health care workers have been away from their jobs during the holiday and often had no childcare during this time. For many this was the first opportunity they had to spend time with their families, and they are unwilling to give a half a day of it to go through a cumbersome vaccination process. Holiday medical staffing also tends to be limited and often requires longer shifts. This makes it difficult for individuals to leave their jobs to be vaccinated, especially since they are not being given time off for this effort.
Many health care workers are dealing with surges in COVID-19 infections and hospitalizations that have increased their numbers of patients. While this is overwhelming hospitals only in certain locations, such as California, many hospitals are afraid to give time off to employees because of the concerns about increases in post-Christmas infection. Employees are very committed and, when faced with the acute need to care for people, or the more remote need for vaccination, health care workers have focused on their jobs. Many are afraid to get the vaccine and possibly to have to take a day off for side effects, leaving their units short staffed.
Remarkably, some health care providers have postponed being vaccinated to allow their older and more at-risk colleagues to get the vaccine first. While this was well intentioned, it has delayed the overall vaccination program and, paradoxically, put colleagues at greater risk.
Another interesting concept is that most health care workers have been dealing with this virus for nine months. In some ways they have become comfortable with it and with the protection that their PPE provides. This makes vaccination seem less like an acute personal need.
Finally, many health care workers either are known to have been, or suspect they have been, infected with COVID-19. They are delaying vaccination because it is now clear the infection itself provides immunity. Since they are not being offered routine testing for antibody to the virus that would document a productive COVID-19 infection that has induced immunity, they don’t know if they really need immunization. Routine antibody screening could be done rapidly on all these individuals and facilitate protecting all non immune healthcare workers with the vaccine.
While many of these issues are unique to health care workers, they also impact the general population. We need to immediately do everything we can to get these vaccines out to everyone. Coupling vaccine campaigns with screening for prior infections with antibody, and using more efficient public spaces with Internet based sign-up campaigns, (in place of “call in” numbers!) would truly facilitate this process.
The most frustrating thing for me is that no one seems to be in charge of this process in most states. There needs to be some intervention to take over these programs from overwhelmed public health authorities and run them more efficiently. We have the means to do complex logistics with incredible efficiency — just look at the number of Amazon, FedEx, and UPS trucks on your street every day! They are delivering vaccine to states, why not just-in-time deliveries to vaccine centers? We can call nationwide pharmacies and get our prescriptions in 24-48 hours; we could do this with vaccines.
People should not die simply because of a delay in getting them vaccines.