COVID-19 has required each of us to change our daily routines and abandon activities that are a part of who we are. It has challenged us personally and professionally, and we battle each day to stay safe wearing face masks, use hand sanitizer, and socially distance to protect ourselves and others. Still, we watch family, friends, and colleagues experience physical illness, anxiety, PTSD, and even death. Some of my nursing colleagues and I were personally afflicted by COVID-19 and knowing as much as possible about the disease offered no comfort.
In December 2020, we all breathed a sigh of relief as the FDA approved two vaccines for emergency use. Since then, 48 million vaccine doses have been distributed throughout the United States, and three more vaccines are in late-stage trials.
Unfortunately, distribution is only one step in a very complex procedure necessary to get the vaccine into the arms of our people. Access to vaccinations has been, and continues to be, one of the most difficult steps in the process. With no national guidance in place for a COVID-19 vaccination rollout strategy, each state has been left to develop its own plan for distribution. Confusion persists, compounded by the urgent need for communication of accurate and timely information.
The tremendous variability in workflows and locations has created unnecessary frustration and delay for three vaccine recipients in my hometown alone. To demonstrate the range of approaches and misinformation circulating, here are their tales.
Group 1a: The Nurse, the Frontline Worker
Group 1a of CDC’s vaccine priority list includes healthcare personnel and residents of long-term care facilities. Accordingly, enough vaccine to administer both doses to frontline workers was distributed to healthcare organizations by our state’s Department of Health. Frontline medical and nursing staff were first to be vaccinated by the Employee Heath staff at my local hospital, including my daughter, who is an ED Technician. The process was as easy as completing some paperwork, getting vaccinated, scheduling an appointment 21 days later, and receiving a “DOING MY PART TO #COMBATCOVID19” sticker.
There was no mention of CDC’s V-safe program for tracking signs and symptoms after the vaccine. My daughter was told to check in with Employee Health staff if she exhibited any symptoms. She didn’t. Now that’s she’s received her second vaccine (21 days later), except for some mild discomfort in the first 24 hours, she is all clear of side effects. Pretty simple process, right?
Group 1b: The Firefighter/EMT
Firefighters and EMT’s are part of Group 1b on CDC’s vaccine priority list. Unlike frontline medical workers, they have to go through our state’s Department of Health website to schedule and receive their appointment time and information. A team of nurses, physicians, military, and nonclinical staff are traversing the state, popping up vaccine tents based on location and demand.
National Guard (NG) troops are responsible for logistics management including crowd control, blocking streets within a six-block radius, setting up tents, and maintaining supply levels throughout the day. Ultimately, their primary role is to manage the “gate” – validating that people meet Phase 1 criteria upon arrival and have secured an appointment. Regardless of need, we saw many drive-up vaccine seekers being turned away since they did not have a scheduled appointment.
My husband is an EMT. He scheduled his appointment through the Department of Health website, completed some paperwork, got the vaccine, waited for any adverse reactions, and received a card with the date of his second dose. No second dose appointment was scheduled while on site; he had to take care of that on his own.
Now, here’s where it gets really frustrating — for those most in need of vaccination.
Group 1c: The Seniors
A broadcast message on local news channels announced that those 65 years or older are now eligible for vaccination at a large mall parking lot near our home. I immediately logged into the Department of Health website and secured appointments for my mother and mother-in-law.
On arrival at the mall 30 minutes in advance of our appointment, I witnessed firsthand what we’ve been seeing on television – cars after cars after cars. The “drive-through” waiting line curled multiple times around the parking lot like a snake. A National Guardsman (NG) came to my car window to inform us that “Appointments don’t matter today. It is chaos.”
And just like that our wait began. At the two-hour mark, we finally arrived at the blockaded vaccine booth. The National Guard validated names, appointment dates, and times. We were cleared to go through.
We were directed to a booth where a nurse distributed the vaccine cards, the V-safe material, and discussed what signs and symptoms might happen. After that, it took us another 1.5 hours to get through another line, receive their vaccines, and wait 15 minutes for observation.
Four hours all told, my mother and mother-in-law were vaccinated. I helped my mom log into the V-safe app, but could not do this for my mother-in-law, as she still uses a flip phone with basic service and no texting capabilities. V-safe sent daily check-ins to my mom for the first seven days. It is now two weeks later and we are trying to schedule their second dose through the same website with no success. The media and state Department of Health continue to tout that second doses are available. I continue trying multiple times a day to schedule, but there are no appointments available in our or any surrounding counties. We will continue trying until we get them registered.
Learning some valuable lessons
This ”Tale of 3 Vaccinations” is more than a family status update. It illustrates the need for standardization. We must develop a unified process, create momentum, and demonstrate efficiency and safe distribution. If we are to achieve herd immunity and reduce vaccine hesitancy, we need leadership and a cohesive set of processes that leverage multiple vaccination centers and approaches. Further, we need to provide these centers with adequate supplies and communication capabilities to allow for proper access and coordination.
Some states are finding success in a range of ways — from choosing to work through a national partnership with large pharmacy chains to working with local hospital systems, pharmacies, and partners. One success is the state of West Virginia, which has given out 83 percent of its doses, by far among the highest in the nation. The state acted early in creating a network of pharmacies and pairing them with about 200 long-term care facilities through a federal program to vaccinate those most in need swiftly.
Because of their smaller populations, North Dakota and South Dakota have been able to collaborate among their three major hospital systems and the state health department on an ongoing basis. The state of Florida is leading the nation in terms of vaccinating seniors, due in part to multiple expansions of their partnership with Publix Super Markets to administer vaccines.
Once we get distribution and access underway, the last step is communication to our populations to help them understand when, where, and how to safely get the vaccine. Automated patient outreach is key to making sure we have all of our bases covered in order to move to a successful rollout nationwide, both in terms of logistics as well as distribution.
The expedited development of a vaccine for COVID-19 is truly miraculous, but it will not achieve its goal without a coordinated plan and frequent, accurate, and timely communication to the American people and the providers who are working so hard to keep us all safe. We can do better. Precious lives depend on our ability to work together and communicate.