By Jared S. Hopkins and Anna Wilde Mathews
CVS Health Corp. and Walgreens Boots Alliance Inc. are preparing
to bring Covid-19 shots to long-term care facilities, but the
effort will need to navigate rollout details that may vary by
state, vaccines that require more than one dose and potential
reluctance by staffers to get the novel shots.
An advisory panel to the U.S. government recommended on Tuesday
that residents of long-term care facilities be included with
doctors, nurses and health-care workers to be first in line for
vaccines. States, which will ultimately decide how to allocate
Covid-19 vaccine supplies, don't need to follow the guidelines,
though they usually do. But logistics and other aspects of the
effort may differ among states, even among those that broadly
accept the panel's conclusions.
Vaccines are on track for federal authorization this month and
could begin shipping within days of receiving clearance, U.S.
officials have said. CVS and Walgreens will deliver most vaccine
doses for the nation's approximately 15,600 nursing homes and
29,000 assisted-living communities.
Hospitals and other medical clinics are slated to serve as
vaccination sites for health-care workers in the initial rollout,
but pharmacy workers are expected to come to nursing homes and
other adult-care facilities to deliver and administer the vaccines
to residents and, likely, staff.
The long-term care rollout will be an early test of how quickly
and efficiently CVS, Walgreens and governments can distribute
Covid-19 vaccines, a campaign expected to last months. They are
working to address storage and transportation issues for vaccines
that need to be kept at colder temperatures than vaccines for other
diseases, as well as concerns that some residents and staffers may
decline the shots.
Many details of the government plans remain unclear, just weeks
before doses might start being shipped, said nursing-home industry
officials, and executives with CVS and Walgreens.
"There's a lot of uncertainty," said Richard Feifer, chief
medical officer of Genesis Healthcare Inc., the largest U.S.
nursing-home operator. Also, he said, "there is so much local
autonomy," meaning plans and timing will vary among states.
Still, elder-care facility owners around the country are laying
the groundwork for vaccines. Some are launching campaigns to inform
residents, families and staffers, with the hope of persuading them
to receive the shots. Nursing homes often have to get consent forms
signed by family members, if residents aren't able to do so
themselves.
Nursing home staff and residents have been especially hard hit
by the virus. Last week the number of Covid-19 deaths in the U.S.
linked to long-term care facilities surpassed 100,000, nearly 40%
of the country's total.
There are around three million beds in U.S. long-term care
facilities, according to the U.S. Centers for Disease Control and
Prevention.
Nursing-home groups had pushed for their residents and staffers
to be included among those first to get the vaccine, pointing to
the losses caused by the pandemic and the rising number of Covid-19
cases in the facilities in recent weeks.
Nursing-home companies said they want their staffers to be able
to get the vaccine at their facilities, at the same time as
residents, though some states may not choose to do this.
The U.S. government in October picked CVS and Walgreens, which
operate about 20,000 stores combined, to administer vaccinations at
elder-care facilities, though other pharmacies can participate as
well.
Public health experts like the plans, citing the chains'
experience administering influenza vaccines at nursing homes. CVS
runs its own long-term care pharmacy operation, Omnicare. Walgreens
has a stake in another long-term care pharmacy provider,
PharMerica.
Flu vaccines are easier to administer, coming in filled syringes
and stored at refrigerated temperatures. The initial Covid-19
vaccines from Moderna Inc. and Pfizer Inc. and partner BioNTech SE,
need to be shipped in subzero temperatures and require two doses,
which means at least two trips to facilities.
"The details of the logistics for delivering these vaccines to
long-term care facilities are far more complex than a simple
influenza vaccination program, but that experience of doing those
simple annual influenza programs will make it a little easier for
people to learn the nuances of the Covid vaccines," said Kelly
Moore, associate director of immunization education at the
Immunization Action Coalition.
About 1,000 CVS pharmacies will serve as hubs to receive
vaccines from the government or vaccine makers, with small teams of
pharmacists visiting 25,000 facilities, said Chris Cox, a CVS
executive who is overseeing the vaccination rollout for the
pharmacy chain. He said CVS wants to deliver the first of two doses
within a month once a state gives the go-ahead, but said that
process will be sensitive since it is unclear when states will make
those calls.
"The difficult parts of this are just working through the
unknowns," said Mr. Cox.
Rick Gates, a senior vice president at Walgreens, said it too
was planning to set up vaccine hubs around the country, likely
around 800 to 1,000, to distribute shots to approximately 23,000
long-term care facilities. States may decide differently on how the
vaccine should be distributed, he said, and they can also vary on
how they prioritize the doses. Because of that, facilities in some
states may get shots before those in others, he said.
Another challenge is keeping the vaccines cold until they are
ready for use. The pharmacies must handle and transport them after
receiving them from vaccine makers and the government.
To keep the vaccines cold en route and at the nursing homes, CVS
said it will transport them in a special reusable cooling container
about the size of a briefcase made by Rochester, N.Y.-based
AeroSafe Global, which provides cold-chain services for
pharmaceutical companies. AeroSafe is providing CVS with 4,000
containers, each capable of holding at least 250 doses, said Jay
McHarg, AeroSafe chief executive.
On site, pharmacies will administer the shots, though public
health experts say it will be key for them to limit visits, in part
to curb exposure to the virus.
Both CVS and Walgreens are aiming to typically conduct three
trips per facility to administer the vaccines.
Facility staff who are likely to bring the virus from the
community should be vaccinated, said Dr. Moore. "The most critical
people to protect in order to save the lives of the people in a
long-term care facility are in fact the people who work there," she
said.
Elder-care facilities also are preparing.
The Evangelical Lutheran Good Samaritan Society, which operates
147 nursing homes, has created a video for staffers and residents
featuring a public-health expert talking about the benefits of the
vaccines. Chief Medical Officer Gregory Johnson is planning a
Facebook Live session to take questions from residents and family
members. The nonprofit, part of Sanford Health, has also sent
materials to its individual facilities to use as they reach out to
families to discuss the vaccine and obtain consents.
"We're in an education phase," said Dr. Johnson. Still, Good
Samaritan and Genesis both say they won't mandate staffers get the
vaccine.
Legally, there may be little preventing most employers from
imposing vaccinations, legal experts have said. However, they may
have to contend with some concerns, including federal and state
laws prohibiting discrimination in the workplace.
The Well-Spring Group, a Greensboro, N.C., nonprofit with two
communities that include nursing homes, assisted-living facilities
and independent living, is planning messages to residents and
families, including from two retired doctors who live in one of its
communities. "That will be rah, rah, you need to take this," said
Steve Fleming, the nonprofit's CEO.
Well-Spring won't require all staffers to get the vaccine, but
those with direct-care responsibilities will have to get counseling
that includes data about the novel shot.
CVS and Walgreens are also gearing up for a broader role in
vaccine distribution next year with other retailers once supply
grows enough for the general population.
Write to Jared S. Hopkins at jared.hopkins@wsj.com and Anna
Wilde Mathews at anna.mathews@wsj.com
(END) Dow Jones Newswires
December 02, 2020 10:14 ET (15:14 GMT)
Copyright (c) 2020 Dow Jones & Company, Inc.
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