- Reimburse states: States will be reimbursed for the costs of operating their vaccination programs, which will provide states with greater flexibility to support all of their needs.
- Create vaccination centers: These centers will be federally funded and supported by the Federal Emergency Management Agency (FEMA) and the National Guard. State and local officials will also remain involved, to ensure each center reflects the needs of the local community.
- Target congregate settings: Social distancing is essentially impossible in homeless shelters and prisons; targeting both may eliminate an important reservoir for viral spread.
- Leverage novel access points: Not everyone has a primary care provider. Plans are afoot to use community pharmacies and health centers to reach those who may not see a physician on a regular basis. For others, mobile vaccination centers will travel to meet patients more than halfway.
In the storied television series The West Wing, fictional president Jed Bartlet says, “There are times when we’re 50 states, and there are times when we’re one country and have national needs.”7 It seems like we are in the process of rediscovering what Aaron Sorkin, the writer and creator of The West Wing, knew in 2002. The piecemeal approach to vaccination, which depends on state and local public health agencies, is not adequately robust to defeat the gargantuan problem that faces us.
There is already a national infrastructure to track vaccine distribution nationwide. With some tweaks, this could be turned into a national vaccine registry to track who has been vaccinated and who has not. Such a registry may allow us to proactively reach out to individuals who need to be vaccinated, rather than waiting for them to find us.8
Of course, that would require we have some way of identifying the vaccine hesitant, who aren’t eager to be identified. That said, I know the government knows who I am, because I have a Social Security number and a driver’s license, I have registered to vote, I pay taxes, and I have been called for jury duty. None of these databases are an ideal resource for a vaccination registry, but any one of them might be a start.
The U.S. Department of Veterans Affairs may provide a good model for the rest of us. It has been actively reaching out to veterans to ensure those who have served don’t get left behind. It is even actively pursuing vets who are homeless, live in rural areas or otherwise may be harder to reach.9
The absence of such outreach risks leaving many patients behind, particularly the elderly. Older patients describe frustration with busy phone lines, conflicting sources of information and user-unfriendly websites that turn the process of trying to get vaccinated into a competition. For example, my state’s website notes that my institution offers coronavirus vaccination and suggests that you call to schedule an appointment. When you call, you hear a prerecorded message:
We recognize that COVID-19 vaccines are at the top of everyone’s minds, and we are eager to be a resource for all our patients and the public. Unfortunately,
we are unable to accept phone calls to schedule COVID-19 vaccinations at this time. We must keep our phone lines clear for people with urgent medical needs. When we are able to schedule by phone, we will communicate this information to patients and the public.
In other words: Don’t call us. We’ll call you. If I were on the fence about getting vaccinated, that message might be enough to make me give up. That’s a real problem.
