One of the biggest challenges this spring will be to find enough trained medical staff and ambulatory sites to vaccinate hundreds of millions of people within a six- to seven-month time frame.

States will prioritize sites to receive the COVID-19 vaccine. They also will prioritize which populations will be vaccinated first, since there likely will not be enough vaccine available to cover the entire United States population until summer.

Family planning centers might be lower on the priority list for vaccination because they serve a younger population, says David F. Archer, MD, professor of OB/GYN at the Jones Institute for Reproductive Medicine at Eastern Virginia Medical School.

“Family planning clinics are providing family care for some people who do not seek out other primary care,” Archer says. “I would say it is a worthwhile thing for them to offer up the manpower to give the vaccine and to elevate them as a priority to get the vaccine for staff.”

Vaccine Programs Possible

It is possible some reproductive health clinics, such as health centers that serve low income populations, will set up public vaccination programs because they employ skilled medical staff in areas with little infrastructure needed to offer vaccination programs.

For instance, in December 2020, Planned Parenthood of Northern New England offered free flu vaccines at all 12 of its Vermont health centers. (More information is available at: https://vermontbiz.com/news/2020/december/08/planned-parenthood-offers-free-flu-vaccines-vermont.)

“One of the long-term challenges is finding spaces where people can go to get vaccinated and making sure people have access to those sites,” says Samantha Penta, PhD, assistant professor, in the College of Emergency Preparedness, Homeland Security and Cybersecurity at the University at Albany (NY).

As of early January, it was unclear how the federal government and states would distribute vaccine to rural areas and to marginalized populations. Vaccination sites need staff and personal protective equipment to handle the vaccination process.

“This is going to be hugely important,” Penta says. “Those kinds of support supplies or processes are really important to consider in the delivery of a vaccine, because it’s not just putting it in someone’s arm.”

Consider Logistical Challenges

Providers should consider their strategy for delivering vaccination to their patient population. “You need to think about those populations as you design it,” Penta says. “It’s possible that the approach you take for organizing how staff and personnel get the vaccine will not work for patients.”

Thinking about these logistical challenges in advance will improve the eventual vaccination process. “The more you anticipate these things now, the smoother the process will be down the road,” Penta says.

Pros and Cons

There are many pros and cons, from the family planning center’s or OB/GYN office’s perspective, to these sites becoming vaccination places for their patients and possibly other members of their communities:

• Pro 1: Family planning centers serve populations that need vaccination access. “We don’t have a vaccine for everyone until we have a vaccine for pregnant women,” said Kathleen M. Neuzil, MD, MPH, FIDSA, Infectious Diseases Society of America (IDSA) fellow, director of the Center for Vaccine Development and Global Health, and Myron M. Levine professor in vaccinology at the University of Maryland School of Medicine. Neuzil also is co-director of the COVID-19 Prevention Network. She spoke at IDSA’s virtual COVID-19 vaccine briefing on Dec. 3, 2020.

“We know our children are suffering, and we’re seeing more impact of the pandemic on minority children,” Neuzil noted.

Pfizer and Moderna began studying the vaccines in adolescents in late 2020, she added.

“Pregnant women could make a decision to receive the vaccine, even though it’s not approved for this category,” Neuzil said.

The Centers for Disease Control and Prevention (CDC) listed pregnant and breastfeeding healthcare professionals on its priority list for vaccination. The CDC cited evidence that pregnant women were potentially at increased risk for severe COVID-19 illness and death.1

Although reproductive-age women are at less risk of severe COVID-19 symptoms, the women seen at family planning centers often work high-risk jobs, and this makes their vaccination a priority. For example, women who work in schools, the service and entertainment industries, or in factories might be at higher risk of becoming infected.

Women from multigenerational households and who are Native American, Latina, or Black American also are at greater risk of infection and morbidity from the disease.

“I would recommend people who work in bars and restaurants to be inoculated,” Archer says.

• Con 1: There are potential costs to facilities. The federal government has paid for the initial COVID-19 doses through Operation Warp Speed, and providers can receive these at no cost. But they cannot charge out-of-pocket costs for administration of the vaccine. Private insurance, Medicare, and Medicaid must cover the vaccine in states that receive public health emergency federal funding. But centers that serve uninsured populations, which participate in the CDC COVID-19 Vaccination Program, will have to bill the Provider Relief Fund for reimbursement of vaccine administrative costs.2

Healthcare facilities likely will have to cover the costs of any equipment they purchase for their vaccination program. “Providers may have to buy an arctic freezer, and they have to invest in that,” says Tinglong Dai, PhD, associate professor of operations management and business analytics at Johns Hopkins University Carey Business School. Dai also is core faculty at Hopkins Business of Health Initiative.

Another option is for centers to use a Pfizer portable cooler, but the vaccines only last for about a week.

• Pro 2: Family planning providers employ nurses and providers capable of administering the vaccine.

One major obstacle to a fast and efficient vaccine rollout is the lack of trained staff in many rural and underserved regions. For example, rural areas have about one-third fewer RNs than metro areas. Nonmetro areas also have 12.7 physicians per 10,000 people, compared with 33.3 physicians per 10,000 people in metro areas.3

Since the vaccine is new, it is important for healthcare providers to monitor the patients who receive the vaccine. This is why it is helpful to set up vaccine sites in locations where people already seek medical care, such as reproductive health centers.

“Vaccination can be done where you would seek your care if you had a problem with that vaccine,” Neuzil says.

• Con 2: Reproductive health clinics already are stretched thin. The COVID-19 pandemic burdened all healthcare providers in 2020 as patients overcrowded hospital emergency departments and intensive care units.

The pandemic may cause overcrowing in family planning centers, as an estimated 7.7 million workers lost their jobs by mid-2020. They also lost their employer-sponsored health insurance. Including family members, more than 14 million people will have to shift to an Affordable Care Act plan — or grapple with being uninsured or underinsured. This could cause long waits for appointments at free medical clinics and federally funded reproductive health clinics.4

Any healthcare facility that signs up to provide vaccines to the public should be prepared for this to take up to half a year to complete. “It will take four to six months before we have vaccinated enough people to reduce the rate of transmission,” Archer says. “The pool of potential infected people is huge, and the number of vaccinations will take too long.”

Another consideration is that reproductive health centers serve a younger population that likely will be low on the vaccine priority list. “Hospitals are trying to protect people at greatest risk,” Archer says. “In the ambulatory care situation, these are not people at the highest risk. If you ask the right questions, and they have not traveled or are being exposed, I think they’re probably at low risk of infection.”

REFERENCES

  1. Centers for Disease Control and Prevention. Interim considerations for COVID-19 vaccination of healthcare personnel and long-term care facility residents. Updated Dec. 3, 2020. https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19/clinical-considerations.html
  2. Schwartz K, Pollitz K, Tolbert J, et al. Gaps in cost sharing protections for COVID-19 testing and treatment could spark public concerns about COVID-19 vaccine costs. Kaiser Family Foundation. Dec. 18, 2020. https://www.kff.org/health-costs/issue-brief/gaps-in-cost-sharing-protections-for-covid-19-testing-and-treatment-could-spark-public-concerns-about-covid-19-vaccine-costs/#:~:text=The%20federal%20government%20has%20purchased,the%20federally%20purchased%20vaccine%20itself.
  3. Rural Health Information Hub. Physicians per 10,000 people for metro and nonmetro counties, 2017. https://www.ruralhealthinfo.org/charts/109
  4. Fronstin P, Woodbury SA. How many Americans have lost jobs with employer health coverage during the pandemic? The Commonwealth Fund. Oct. 7, 2020. https://www.commonwealthfund.org/publications/issue-briefs/2020/oct/how-many-lost-jobs-employer-coverage-pandemic