Dr. Mike Wasserman, a geriatrician and past president of the California Association of Long Term Care Medicine, an association for long-term care healthcare workers, said industry experts predicted that vaccination in their facilities would be slow.
"All of the issues we were worried about with nursing homes have happened. The nursing home rollout has been delayed and has taken longer than initially planned," Wasserman said.
He attributes that to the Trump administration's exclusive partnership with CVS and Walgreens. Instead, the government should have used the network of long-term care pharmacies across the country that already had relationships with nursing homes and assisted-living facilities and had existing systems for medicine distribution in place, he said.
"We don't have to look any further to ask ourselves, 'Why do we have all of these vaccines distributed and not used?' Vaccines meant for long-term care have not been given in long-term care," Wasserman said. "We targeted a group of people, and we have literally failed to get the vaccine into the arms of that group."
Wasserman served on the National Academies' Committee on Equitable Allocation of Vaccine for the Novel Coronavirus, which made recommendations to the federal government on how to proceed with long-term care vaccination. That group said long-term care as a whole should be prioritized in the country's vaccination effort. However, clinics have largely focused on nursing homes, leaving many in assisted living facilities and group homes to wait.
"Somewhere along the way, the CDC and/or the states or both seemed separate out nursing homes from assisted living and from group homes," Wasserman said.
As of Monday, CVS had completed its first-dose clinics at all of the 7,822 nursing homes partnered with the pharmacy. Yet it had only completed first-dose clinics in assisted living facilities and other long-term care sites in 11 states.
Walgreens doesn't break down which types of doses — first or second — have been administered. As of Jan. 21, the pharmacy had given 667,133 doses of the vaccine in the 5,530 nursing homes with which it is working and 334,131 doses of the vaccine in the 8,224 partnered assisted living and other long-term care facilities.
Wasserman said the vaccination process needs to be staff and patient centric.
"How do we get vaccines into the arms of residents, into the arms of front-line staff? It needs to be about making it easy for them, not about making it easy for CVS and Walgreens," he said. "What that means is, in addition to CVS and Walgreens, every long-term care pharmacy, every other pharmacy that already has those relationships with nursing homes, assisted living and group homes, that all need to be engaged now. There should be no turf battles."
Some vaccination delays stem from the required waiting time between doses. The Pfizer-BioNTech vaccine requires a 21-day interval between the first and second dose, and the Moderna vaccine requires a 28-day interval.
But states have also contributed to the sluggish rollout. Each state is responsible for its own vaccine distribution, leading to different approaches across the country, Wasserman said.
"You need a clear federal approach," he said. "What I'm encouraged by is the Biden administration appears to be taking the responsibility back to where it needs to be, which is the federal level."