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December 9, 2020

How these 7 hospitals and health systems are preparing to vaccinate staff

Daily Briefing

    Millions of health care workers likely will be among the first Americans eligible for a coronavirus vaccine, which could be authorized for distribution within the coming days. Here's how seven hospitals and health systems are preparing for the difficult challenge of vaccinating their staff.

    Who's first in line for a coronavirus vaccine? Here's what a key CDC panel says.

    The challenges of vaccinating millions of health care workers

    Last week, the Advisory Committee on Immunization Practices (ACIP), which is a panel of outside experts that advises CDC on vaccines, voted 13-1 to approve a recommendation calling for health care workers and residents and staff of long-term care facilities to be the first Americans eligible to access an authorized vaccine against the novel coronavirus. And experts expect that FDA could authorize America's first coronavirus vaccine within the coming days.

    But vaccinating America's 21 million health care workers, as well as the country's three million long-term care facility residents, won't be an easy feat—and it may even be impossible at the outset. That's because federal officials estimate there will be up to 40 million coronavirus vaccine doses available by the end of this year—which will be enough to vaccinate only 20 million Americans, at most, because the leading vaccine candidates require individuals to receive two doses.

    As a result, Pat Schou—director of the Illinois Critical Access Hospital Network, which works with 57 critical access rural hospitals—said he doesn't expect hospitals will receive enough doses to immediately vaccinate their employees.

    "We're not going to get 300 doses [immediately] for a hospital that has 300 employees," Schou said. "I think it's going to take a couple months. By mid-February, I would hope that we would have almost all our health care workers and EMS and be moving into long-term care. I think that's the best we can hope for."

    According to STAT News, there also are logistical challenges that could slow down efforts to vaccinate America's health care workers. For instance, hospitals will have to determine how to maintain vaccine doses that require ultra-cold temperatures; how they can reduce waste of unused doses; how they can ensure they are properly staffed so that patients are cared for while staff are receiving their vaccinations; and how they can allow large shares of their workers to take sick days at the same time if they experience side effects from the vaccine, which reportedly can include headaches, fatigue, fever, and potentially other symptoms, STAT News reports.

    Another problem, according to STAT News, is that there still are many unknowns about how coronavirus vaccines will be distributed. Two of the biggest outstanding questions are when health systems will receive vaccine doses and how many doses they'll get, STAT News reports.

    "We don't know a lot yet," said Dave Dobosenski, St. Croix Regional Medical Center's CEO. "We're craving to get some information here to understand what we're doing."

    How hospitals and health systems are preparing to vaccinate their staff

    Despite the unknowns, many hospitals and health systems are beginning to develop plans for how they'll vaccinate their staff.

    Some hospitals and health systems are developing plans with a vaccine's potential side effects in mind. For example, some hospitals and health systems intend to stagger vaccinations across and within their departments to ensure they don't face any staffing shortages as a result of physicians or nurses experiencing side effects, Business Insider reports.

    Other hospitals and health systems are planning to allow their workers to decide whether they want to be vaccinated when the first doses become available or to wait for more doses to become available, according to Business Insider. And others still are creating systems to prioritize which staff receive initial supplies of the vaccine.

    For example, at least four health care systems—Intermountain Healthcare, Mass General Brigham, Northwell Health, and Yale New Haven Health—plan to prioritize vaccinating employees who work directly with Covid-19 patients and those who are at risk of potential exposure to the novel coronavirus, including housekeepers and ICU nurses, Business Insider reports. And Intermountain also is taking into consideration which employees are most likely to be exposed to the virus outside of work, Kristin Dascomb, medical director for infection prevention and employee health at Intermountain, said.

    "We are discussing it both from an epidemiological point of view from the community, as well as an exposure risk assessment from internal to the hospital," Dascomb said.

    Jonathan Lewin, CEO of Emory Healthcare, said Emory decided to take a similar approach after a review of coronavirus infections among employees revealed that most of those workers likely contracted the virus outside of the workplace. "If they get sick anywhere, they create a significant risk to the delivery of health care for the full community," Lewin said.

    At Nebraska Medicine, initial vaccine doses are likely to go to health-care workers in the health system's EDs and other critical care settings, where providers may rush to treat patients without putting on personal protective equipment, Nicole Skinner—Nebraska Medicine's director of quality, patient safety, and infection control—said. However, Skinner said the health system may resort to using a computerized lottery system to offer vaccines to staff if the health system doesn't receive enough vaccine doses for all of its high-priority workers.

    Meanwhile, Mayo Clinic is looking through data on occupational risks to decide who should be at the top of its list for vaccination. While the health system waits for a coronavirus vaccine becomes available, "we're developing guidance and staying flexible," Swift said.

    Swift said Mayo Clinic expects most health care workers who receive the vaccine will experience side effects, but few of them will need time off. She added that managers will have to prepare staff for what they should expect when they receive a vaccine, and managers also will have to coordinate vaccine schedules.

    Tom Balcezak, chief clinical officer at Yale New Haven Health, said Yale New Haven also recognizes the need for flexibility when creating and implementing its staff vaccination plan. "We will refine our effort and it may look different as we learn more," he said.

    And at Mass General Birgham, Paul Biddinger, medical director for emergency preparedness, said officials are looking into how they can vaccinate as many employees as quickly as possible—noting that speedy vaccinations will be key to easing America's coronavirus epidemic.

    "It is our clear goal to vaccine everyone who is medically eligible as quickly as possible," he said. "Ultimately, the way we will get on the other side of this pandemic is to have all of us to develop sufficient immunity. … We don't want to waste any time" (Livingston/Akhtar, Business Insider, 12/6; Evans, Wall Street Journal, 12/7; Goldhill, STAT News, 12/7; Owens, "Vitals," Axios, 12/8).

    Learn more: How Covid-19 will impact the supply chain

    supply chain

    Covid-19 has revealed critical shortcomings in the health care supply chain. Shortages of personal protective equipment (PPE), ventilators, and other vital supplies have hindered the U.S. health care system‘s response to this crisis, and additional waves of shortages are likely in coming months.

    Read our take to learn three requirements for a more resilient, transparent supply chain in light of Covid-19.

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