COVID-19 vaccinations continue to dribble out …

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. 

Personal Protective Equipment has become the accepted norm!

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.

Lines for vaccine in Florida

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.   

Despite knowing we needed freezers, neither states nor the federal government was able to get them off backorder!

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.     

Published by jbakerjrblog

Immunologist, former Army MD, former head of allergy and clinical immunology at University of Michigan, vaccine developer and opinionated guy.

17 thoughts on “COVID-19 vaccinations continue to dribble out …

  1. Why are there long lines in Florida? Is the state not following CDC guidelines for vaccinating health care, front line, essential personal, and those in elderly care homes first?

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    Liked by 1 person

  2. St Joe’s makes it very smooth and easy to be vaccinated. Our department reached out to us, facilitated making an appointment. The process of receiving the vaccine was also simple. Show up at the appointed time, fill out a questionnaire, talk to a cordial nurse who administered the vaccine. Sit in a comfortable chair for 15 minutes with a timer they set. When it rings, answer a couple questions and go home.
    As you have pointed out, social distancing limited the number of people at a given time. Quite different than the polio vaccine 60 or so years ago where there were long lines at a local public school.
    Other states could follow the lead of Trinity/SJMH to enhance the roll out.

    Liked by 1 person

  3. I enjoy your posts, and find them educational. As a recently retired executive of large scale technology and operations, it’s frustrating to be on the sidelines, knowing that I (and many others who I know) could be part of an operational & logistics leadership team that could orchestrate the distribution process at no cost to the state or federal government. Most state, federal and healthcare organizations don’t have in house expertise for complex operational challenges, and yet there seems to be little desire to tap Americans who would proudly serve their country by helping to lead this effort. This requires a depth of expertise and orchestrated teams. It also requires clear selection criteria for prioritizing the sequence of locations and people, with empowerment to make decisions closest to the action, guided by the sequencing principles. Anyone with experience in complex and large scale operational / logistics could see this debacle coming before it even started…..sadly! Thanks again for your public service!

    Liked by 1 person

  4. Very well stated Dr.Baker. It’s probably easier to get an Uber ride or a pizza delivered than get a COVID-19 vaccination now. If it wasn’t so tragic, it would be funny. Let’s hope and pray someone, like the new administration, gets this better organized.

    Liked by 1 person

  5. Excellent points. As I watched my son, a 31 yo student Pastoral Care intern, get his vaccine on Fri. New Year’s Day at the Big House, I wondered why I wasn’t seeing more people entering. As someone who had to deal with ICU hospital staffing over the holidays, I wondered if it was too difficult to get time off or coverage.

    As your blog noted, the vaccine roll out has been disorganized. My friends across the state and country have very different vaccination strategies or lack of strategy.

    By the way, 2 days later, my son has had no reaction to the vaccine. He usually has a reaction to his flu vaccine. He was also one of your severe asthmatics and had pretty significant food allergies.

    Liked by 2 people

  6. I agree with all of your points. I would add that there are many who have been locked in our homes for over 9 months waiting patiently for our turn. Wish there was a way to reward us with a vaccine. I would gladly take the vaccine that the healthcare workers are refusing. I hope they will run the phases in parallel instead of linear. I think I am in phase 1c- under 65 but with issues that make me at high risk. I think the online registry idea is awesome. I want to make my case for phase 1c not someone else! Thank you for your efforts.

    Liked by 1 person

  7. Dear Dr. Baker, I could not agree with more. I’m a 76-year-old retired healthcare employee who’d give anything to get vaccinated so I can travel out of state to visit my sister who is seriously ill. This is so frustrating and wasteful of all the effort that went in to develop vaccines in record time. Kathleen

    Sent from my iPhone

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  8. Surprisingly when I was a practicing physician I never got much done when I was playing golf. Claiming American exceptionalism doesn’t make it true. The vaccine roll out is a national embarrassment. I’ve volunteered to help give vaccinations and have had no follow up from anyone.

    Liked by 1 person

  9. Turns out you don’t get much done when playing golf. A national embarrassment. As a retired MD I’ve tried to volunteer to give vaccinations. No call back. Ignored. More so called American exceptionalism.

    Liked by 1 person

  10. Where is the leadership? I couldn’t agree more. Give group 1A 30 days and move to the next group. No excuses. My daughter has been working 7 days a week 10+ hours a day in healthcare during this pandemic and was able to get her vaccination on her own time after hours. Unfortunately leaving it to individuals to take responsibility is not working. Thank you for your insight and service to all!

    Liked by 1 person

  11. Thanks once again for your perspective on this. This is my go-to place for facts and sanity.

    Just heard about a South African strain that an NBC reporter (Richard Engel) indicated was more mutated than the variation SE England. Noted that UK authorities are concerned that the more mutated, the greater the risk it would be resistant to the vaccine. Would appreciate your perspective on this.

    Liked by 1 person

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