Pennsylvania’s Centrally Planned Vaccine Plan

By: Georg Grassmueck

Pennsylvania’s Acting Secretary of Health Alison Beam said in a press release on February 12 https://www.media.pa.gov/pages/health-details.aspx?newsid=1292 that only four groups are allowed to handle distribution of Covid-19 vaccines going forward: hospitals, federally qualified health centers, county health departments, and pharmacies in effect shutting out primary care doctors from Covid-19 vaccine distribution.  In response, the Pennsylvania Academy of Family Physicians, Pennsylvania Osteopathic Medical Society, and the Pennsylvania Chapter of the American College of Physicians (physician group) collectively expressed disappointment in the Acting Secretary of Health’s misguided allocation changes to the state’s COVID-19 vaccination distribution plan, removing primary care providers from the list of those permitted to administer the COVID-19 vaccine. 

Their press release states:

Without sound justification and demonstrating a lack of understanding in the way most Pennsylvanians receive their health care, the Administration is making a woeful mistake by cutting out primary care physicians as eligible providers.

Justifying her action acting Secretary Beam said.

“As there is very limited COVID-19 vaccine supply compared to demand, every possible effort must be made so that the vaccine received in the commonwealth is effectively administered. To achieve this goal, I am issuing an order outlining appropriate steps and recognized best practices to ensure vaccine providers are effectively meeting the goal of vaccinating Pennsylvanians and creating a healthy Pennsylvania for all.”

While acting health secretary Beam’s intention of making use of every dose of the Covid-19 vaccine is commendable, what is so puzzling about this decision is the inconvenient fact that one of the most successful vaccine rollout by percent of people vaccinated is in the neighboring state of West Virginia.  West Virginia, a small and mostly rural state with a large elderly population, quite similar to Pennsylvania in many aspects, showed how to roll out Covid-19 vaccinations successfully. West Virginia is now being hailed as a vaccination success story, with 85 percent of its delivered doses already used, according to data from the Centers for Disease Control and Prevention, putting it second in the country behind North Dakota.  A key part of the strategy in West Virginia was the decision not to activate a federal partnership with pharmacy chains and instead relying on independent drugstores. 

Dr. Clay Marsh, West Virginia’s coronavirus czar and vice president and executive dean of health services at West Virginia University may have read some articles from the Mises Institute when he states “But we absolutely rely on the creativity and the innovation of all of our people. Because we don’t want to rely on external resource requirements for us to be able to do what we need to do.” 

Primary care physicians have plenty of experience administrating immunizations across a wide range of age groups.  They are in the business of connecting and caring for people at the local level on a daily basis.  They are best equipped to pull up a list of patients who qualify for the Covid-19 vaccine at each phase of the rollout.  But with the new order by the acting health secretary Beam, primary care physicians are being sidelined.  West Virginia has shown that good personal contact is key to the whole effort.  Most people in rural areas would rather get vaccinated by their doctor that they know and trust than by large impersonal semi-governmental vaccination centers.  According to the Pennsylvania Department of Health the list of approved vaccination sites will shrink from about 780 providers statewide to only 200 to 300 that will continue receiving doses from the state. 

In their press release the physician groups conclude:

Many people will turn to their primary care physician for guidance as to whether they should get the vaccine. Physicians, nurses, and physician assistants who provide care in private practices are trusted by their patients. This is especially noteworthy when considering those patients who may otherwise be reluctant to get the vaccine. A pharmacist or other provider who is unknown to the patient will not be able to provide that same level of confidence. Additionally, many older Pennsylvanians may believe that they will receive the vaccine in their primary care physician’s office. The new order creates yet another hurdle for a demographic who is already struggling with navigating the vaccine distribution landscape.

A main reason and good reason for the change in policy is to ensure all vaccine doses provided are administered and not wasted.  However, on February 17th acting health secretary Beam had to address a major vaccine snafu when COVID-19 vaccinations for up to 115,000 Pennsylvanians have to be rescheduled. According to Beam, the Moderna vaccine was inadvertently administered as the first of the required two shots when the serum was earmarked for the second shot instead.  Pharmacies often don’t have more than a day’s notice about shipments, which complicates scheduling people for vaccinations.  Each vial of the Moderna vaccine has 10 doses, and once the vial is open, the vaccine lasts only five hours. After five hours the vaccine has to be discarded, only a minority of primary care physicians can manage the logistical challenges of such a strict timeline.

Another reason for the change by acting health secretary Beam and an order by Governor Wolf is to expedite the rollout.  Pennsylvania’s COVID-19 vaccine program has been marred by glitches from the start.  It has been criticized over how fast its allocated shipments are administered ranking Pennsylvania in the middle while West Virginia ranks third according to the New York Times tracker.  

The glitches in the vaccine rollout in Pennsylvania are even more troublesome by the fact that President-elect Joe Biden tapped Pennsylvania Health Secretary Dr. Rachel Levine to be his assistant secretary of health in the U.S. Department of Health and Human Services.  Dr. Levine was in charge of the Covid-19 response in Pennsylvania and Pennsylvania is now trying to untangle its botched vaccine rollout under her leadership.  What can the rest of the country expect once Dr. Levine is in charge of a larger rollout?  

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