The vast majority of nursing homes in the United States won’t start vaccinating staff and residents against COVID-19 until Dec. 21, and some won’t start until Dec. 28, according to the Centers for Disease Control and Prevention.
Monday’s rollout of the Pfizer-BioNTech vaccine brought confusion nationwide as it became clear long-term care facilities and nursing homes were not taking part in the initial immunizations, despite the CDC’s decision last week to include residents in the first phase of distribution.
That’s because the majority of long-term care facilities opted to take part in a federal program that uses pharmacy chains, including CVS, Walgreens and others, to facilitate vaccination of both staff and residents.
The Federal Pharmacy Partnership for Long-term Care program will launch Dec. 21 for jurisdictions that opted to use the Pfizer-BioNtech vaccine. More than 1,100 vaccination clinics at long-term care facilities across the country are scheduled to occur on that day, CDC spokeswoman Kristen Nordlund said.
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Another round will come on Dec. 28 for jurisdictions that opted to use Moderna’s COVID-19 vaccine. That vaccine has not yet been authorized by the FDA but is expected to be within the next two weeks. It does not have the ultracold storage requirements of the Pfizer vaccine, making it easier to use in areas without access to the specialized equipment.
A handful of facilities will start later this week to test the system so it can be scaled up next week, Nordlund said.
“We know this has been an agonizing year for families with medically fragile loved ones in long-term care facilities and equally hard on the people who work and care for those residents,” she said. “We are hopeful widespread vaccination of residents and staff in nursing homes and assisted living facilities will pave the way for families to see their loved ones again soon.”
The later launch dates were chosen to account for the time needed to ensure adequate vaccine supply and for pharmacy partners to schedule and coordinate clinics at each facility, she said.
Some areas not taking part in the federal program will begin earlier.
“CVS Pharmacy teams will administer vaccines in a handful of facilities in Connecticut and Ohio on Dec. 18,” said T.J. Crawford, vice president for external affairs at CVS Health.
At a briefing Monday, Gen. Gustave Perna, chief operating officer for the federal government’s Operation Warp Speed, said planning to get vaccine to America’s more than 70,000 long-term health facilities and nursing homes was “incredibly difficult.”
The longer lead time for the facilities was necessary given the complexity, Department of Health and Human Service Secretary Alex Azar said during the briefing.
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“They asked us to be sure … to give them headroom to be able to just get the logistics and operations established,” he said. “But there’s no prohibition on distributing and vaccinating sooner.”
The extra time was required in part to allow facilities to prepare so vaccinations can be done efficiently and with as few visits as possible “so we’re not going back and forth,” Perna said.
One issue is getting the necessary permissions signed for residents who may not be able to sign for themselves, he said.
“You have to make sure that all the patients have a signed contract which means sometimes you have to reach out to several layers of family to get the final approval,” Perna said.
Many nursing homes are still struggling with that requirement, said Kathleen Heren, Rhode Island’s long-term care ombudsman.
The CDC allowed nursing homes to get verbal permission from residents, she said, but the pharmacies that will do the vaccinations have mailed out written permission forms for residents to sign.
“We’re still working on how we’re going to get people vaccinated who do not have someone to sign for them, or for those with dementia,” said Heren, adding homes were hoping to get clarification from the state Department of Health.
In CVS’s case, those were printed forms in triplicate, said Dr. Richard Feifer, chief medical officer at Genesis HealthCare, which runs more than 500 short- and long-term care facilities in 34 states.
He doesn’t feel the wait is unreasonable as the vaccine was only authorized on Friday and it will take time for his staff to get consent forms in order for everyone who is to be vaccinated.
They must complete before the visit “because the pharmacy needs to know exactly how many doses need to be administered,” he said.
Some states heard different reasons for the lack of vaccine.
Brent Willett, president of the Iowa Health Care Association, said he was told the delay was due to a federal rule requiring states have on hand 50% of the vaccine needed for their nursing home residents before starting vaccinations.
Sarah Ekstrand, a spokesperson for the Iowa Department of Public Health, confirmed the requirement.
The confusion was frustrating for those who work in the field.
“I’m hearing from some members that they’re not happy, but it has to do with this being a whole different process” of distribution, said James Nyberg, executive director of LeadingAge Rhode Island, a group of 15 not-for-profit nursing homes in Rhode Island
“Obviously we wish we can get it as soon as possible, because every day counts,” he said
Contributing: Karen Weintraub, Tony Leys, Des Moines Register