Small Clinics, Practices Key to COVID-19 Vaccine Success: State Officials

Alicia Ault

April 22, 2021

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Primary care physicians and providers in small offices and clinics are going to be key to ensuring that the remaining half of the nation receives a COVID-19 vaccination, state health officials said Wednesday, and the federal government will soon start shipping smaller packages of the Pfizer/BioNTech vaccine that can be more readily used by individual doctors.

According to the Centers for Disease Control and Prevention (CDC), as of April 21, more than 215 million doses have been administered. Forty percent — 134 million Americans — have had at least one dose of a vaccine.

Among those who still haven't received a shot are people who don't have the time, may be homebound, or who have questions about the vaccine, or might say they will never be vaccinated, said Nirav Shah, MD, JD, president of the Association of State and Territorial Health Officials (ASTHO) and director of the Maine Center for Disease Control and Prevention, on a call with reporters.

Especially for those who fall into the "not ever" category, state officials "are working to find trusted messengers like doctors" who can connect with these individuals and give them information, he said.

Primary care physicians' offices and other small practice settings are "where we are most likely to reach many of the remaining 50%," said Steven Stack, MD, MBA, FACEP, commissioner of the Kentucky Department for Public Health, on the briefing.

State officials also "need to support all people to consult their personal physicians in whom they have confidence and trust to be informed of the benefits of COVID vaccination and the safety of this vaccination," he said, adding that "this is the way we put this pandemic in the rearview mirror and move on with our lives."

Stack said the federal government is starting by working with Pfizer to slim down its packages from 1170 doses to 450 doses. That should happen before June, said Stack, adding that state health officials will be able to distribute the smaller packages "more widely and to smaller settings."

Ideally, packaging for all vaccines will get down to single-dose, pre-filled syringes, he said. But that is a "journey" that the federal government has just begun, said Stack.

The White House had not responded to a Medscape Medical News request for comment by press time.

Having vaccines onsite in a physician's office is important, Stack said, adding that doctors "need to reach people in their persuadable moment."

Bringing Pediatricians on Board

Illinois state health officials have begun a process that will let pediatricians have weekly vaccination clinics and also have vaccine on hand to meet patients in the moment, said Ngozi Ezike, MD, director of the Illinois Department of Public Health, on the briefing.

She said the distribution can start even before the Pfizer vaccine is shipped in smaller packages — and as soon as the US Food and Drug Administration authorizes the vaccine for adolescents. Pfizer applied for emergency use approval for children ages 12 to 15 on April 9.

Local health departments will store the vaccine in their ultra-cold freezers. Pediatricians will identify how many people they hope to vaccinate each week and receive the doses on Monday, with the understanding that they must use the vaccine within 5 days, said Ezike.

The aim is to support vaccination clinics but also to ensure doctors have "doses on hand," so that a parent or adolescent could opt for vaccination during a visit.

Although estimating the number of doses required will be difficult and likely involve some waste, Ezike said it's important to be able to offer a vaccine in the office instead of having to refer someone elsewhere.

Alicia Ault is a Lutherville, Maryland-based freelance journalist whose work has appeared in publications including Smithsonian.com, the New York Times, and the Washington Post. You can find her on Twitter @aliciaault.

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