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Primary care doctors are about to get what many have wanted since they knew a coronavirus vaccine was in development: a chance to offer patients shots at their offices.
Virginia public health officials say they’ll be pushing more doses to doctors in the coming weeks.
As demand for COVID-19 vaccinations wanes, immunization programs are having to shift focus from large-scale operations in convention centers and sports arenas to more tailored, neighborhood-based clinics.
Up until this point, Virginia’s vaccine rollout has hinged on hospitals, health departments and pharmacies. Now that most of the eager residents have received their shots or booked appointments, public health officials are changing the strategy to convince those still on the fence.
Infectious disease experts say reaching herd immunity, the level of vaccinated people needed to reduce the chances of unvaccinated people coming in contact with the virus, requires about 75 to 80% participation.
In Virginia, that equates to about 6.5 million people. Currently, there are 2.7 million fully vaccinated Virginians, or 32% of the population.
Dr. Danny Avula, state vaccination coordinator, said he believes family doctors will be key in persuading the unsure.
“Survey after survey shows that it’s your primary care provider that you trust to make health decisions around,” he said. “We want to get as many people as possible the opportunity to have those discussions with their primary care providers, and then be able to get vaccinated if they choose to make that decision.”
One such survey, conducted by The KFF COVID-19 Vaccine Monitor, found nearly 80% of U.S. adults who hadn’t been vaccinated would likely turn to a doctor, nurse or other health care provider when deciding whether to get a vaccine, including about 46%, who said they would be “very likely.”
But early this winter, primary care physicians unaffiliated with large hospital systems were frustrated because they had no shots to give their elderly and high-risk patients.
Though primary care practices usually don’t have the ultra-cold freezers once needed for the Pfizer vaccines, most could have handled Moderna and Johnson & Johnson without issue. In late February, the U.S. Food and Drug Administration revised its requirements for Pfizer, allowing its vaccine also to be stored and transported at regular freezer temperatures.
Avula said the appearance of preferential treatment for hospitals was an “unfortunate evolution” of the rollout. In the first phase, large allocations were prioritized for hospital systems to distribute to health care workers.
But fewer doctors, nurses and staff rolled up their sleeves for the shots than expected. Leftover supplies were reallocated to doctors in their systems to give to seniors and patients with chronic health conditions.
Even after supplies were shifted from hospitals to health departments for distributing locally, public health officials still held off from giving many doses to private practices, worried a decentralized approach would make it harder to track the data.
Only about 15% of the vaccines administered in the state have been by medical practices, according to the Virginia Department of Health.
Dr. Sterling Ransone, at Fishing Bay Family Practice in Middlesex County, has been one of the few primary care doctors able to get steady vaccine supplies for patients. As part of the Riverside Health system, one of his staffers has driven to the hospital about 35 miles away each day to pick up Pfizer doses.
Depending on the schedule, his practice administers 20 to 30 shots daily.
Because of the small quantity, he’s learned to be frugal with the resources. Ransone says he can draw six or seven doses out of each vial. And if he has any remaining, he and his staff call down a list he’s curated of high-priority patients.
Ransone, president-elect of the American Academy of Family Physicians, said that strategy is what health experts in the pandemic era are calling “microtargeting.” The first time he did it, he reached out to a 104-year-old patient and was able to get him the shot that day.
“We know who to call, we know who to say, ‘You should get this. Come on down and do it,’” he said.
That’s one reason he and many of his peers at the Medical Society of Virginia believe they can be a helpful tool in getting shots into the most vulnerable people, especially the reluctant ones.
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“When I’ve been able to sit and spend the time answering the questions that people have and the concerns they have, I have yet to have someone tell me, no, they didn’t want it,” he said. “And I do that many times a day.”
Seeing a need to transition from mass vaccination venues to doctor offices, the federal government is helping by ensuring supplies come in smaller quantities. Previously, for example, Pfizer doses came in trays of 1,170 units. Starting this month, packages will be available in 450 and 150 units, Avula said.
Virginia is also finding local pharmacies willing to receive vaccine orders to be divided into smaller portions for doctors in the area.
“That will make it more and more possible for smaller group practices to be able to receive vaccine,” he said.
The state health department also will change its communication with health care providers. Virginia is entering a new phase in the rollout, Avula said. That means vaccines, no longer in short supply, will be treated differently.
“Up until a couple of weeks ago, our messaging has always been use whatever vaccine you get, you’re expected to use it the week that you get it,” he said. “Now that we’re on the other side of the supply-demand curve, we providers should know that it’s OK to have vaccine and to be able to carry it over to the next week.”
Elisha Sauers, 757-839-4754, elisha.sauers@pilotonline.com