Promises, Questions Abound As Azar Floats Christmas Vaccination Target For Nursing Home Residents

December 14, 2020, Maggie Flynn, Skilled Nursing News - The emergency use authorization (EUA) granted to Pfizer’s (NYSE: PFE) COVID-19 vaccine late on Friday launched a flurry of promises and commitments to get the vaccine out to vulnerable long-term care residents as quickly as possible. 

Alex Azar, the secretary of the Department of Health and Human Services (HHS) suggested on Sunday in an interview with CBS News’ “Face the Nation” that all nursing home residents could be vaccinated by Christmas.

“As soon as they receive [the] vaccine, this is according to the governors telling us to ship to them, we can have every nursing home patient vaccinated in the United States by Christmas,” he said Sunday. 

Azar also said that reports that the Trump administration was telling CVS Health (NYSE: CVS) to wait until December 21 to administer vaccines to nursing home residents were the result of a misunderstanding, and that the administration is not asking CVS to wait.

He told CBS he expects 20 million vaccinations in December, with potentially up to 50 million total vaccinations by the end of January 2021.

That said, on December 11, Chris Cox, senior vice president at CVS Health had told Reuters that it expects to administer the first Pfizer vaccines to long-term care facility residents on December 21.

Cox explained to Reuters that this was to give vaccine administrators time to review information documents and procure waivers from nursing home residents and families.

According to Cox, CVS is working with 8,000 SNFs across the U.S.; in a statement issued December 11 noting the Pfizer EUA, Walgreens noted it is working with almost 35,000 skilled nursing and assisted living facilities across the country.

But the day before the Food and Drug Administration (FDA) granted Pfizer the EUA for its vaccine, Los Angeles County — the most populous county in the U.S. — pulled its nursing homes out of the federal program that uses CVS and Walgreens Boots Alliance (Nasdaq: WBA) to distribute the vaccines, the Wall Street Journal reported on December 11.

Under the county’s change, SNFs will receive vaccine doses directly and will be expected to handle “the vaccination of your residents and staff on your own,” likely starting the week of December 21, according to a letter cited by the WSJ.

There are 385 nursing homes in Los Angeles County, the article noted, citing the California Association of Health Facilities (CAHF).

The county will use strike teams to administer the vaccine in facilities that require it, director of public health Barbara Ferrer said on Friday, according to the WSJ.

According to the letter from Los Angeles County, SNFs had reported a lack of flexibility in the federal program.  The new arrangements will allow for vaccination without waiting for a scheduled visit from the pharmacies in the federal program, but it will also allow the vaccine to be staggered to avoid any scheduling issues due to side effects, for example. 

Side effects are one of the many concerns for health care workers, particularly those in SNFs, whom the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) recommended be among the first in line for a COVID-19 vaccine.

A spokeswoman for the CAHF told the WSJ there are both pros and cons to the decision, with significant operational issues on the one hand and flexibility in delivery on the other.

A CVS spokesperson told the publication that while the company has seen the e-mail from Los Angeles County, it had not been officially informed that it was leaving the program.

Another state, West Virginia, was considering crafting its own vaccination rollout as of December 10, Business Insider reported on that day.

Maj. Gen. James Hoyer, adjutant general of the West Virginia National Guard and the head of a task force leading the state’s pandemic response, told the publication that this is because many of the pharmacies in West Virginia are not part of big chains.

The goal in that largely rural state is to vaccinate all SNF and assisted living residents and staff members within 30 days of receiving vaccines at five designated hospitals, Business Insider reported, noting that West Virginia placed an initial order with the CDC for 16,575 doses of the Pfizer vaccine.

Dr. Richard Feifer, chief medical officer of Genesis HealthCare (NYSE: GEN), told Business Insider this was concerning, given the Kennett Square, Pa.-based operator’s 34 facilities in West Virginia.

“We’re concerned that they’re trying to reinvent the wheel, and we don’t have time to waste,” he told Business Insider.

The exact timeline of vaccine distribution will have a direct impact on the still-growing death toll in nursing facilities nationwide, American Health Care Association (AHCA) president and CEO Mark Parkinson said in a Friday statement welcoming the Pfizer EUA.

“A one-month delay in distributing the vaccine to all long term care residents and caregivers, could result in more than 20,000 of our residents losing their life when a vaccine could protect them,” Parkinson said.  “We’re in a life or death race against the clock.”

It’s important to note that even full vaccination of nursing home residents may not bring an immediate relaxation of the COVID-19 precautions that have governed the space since March, with ProMedica Senior Care — formerly HCR ManorCare — cautioning that the shots will not be silver bullets for the beleaguered sector.

“Our day-to-day operations won’t change,” ProMedica Senior Care chief medical officer Dr. Mark Gloth told SNN earlier this month, prior to the EUA.  “The vaccine doesn’t fix the problem. It is just one more tool.”

LeadingAge, which represents non-profit senior care providers, echoed that sentiment in urging fast distribution to nursing facilities — while also calling for additional federal relief and other direct actions from the incoming Biden administration.

“While the vaccine is not a panacea, it is a ray of hope for many older adults who have been so cut off from their family and friends over these past many months,” LeadingAge CEO Katie Smith Sloan said in a Friday statement.