Industry Voices—Why states need to prioritize vaccinating primary care physicians

As the historic effort to roll out the COVID-19 vaccine changes hands from one administration to another, the U.S. is making yet another costly COVID-19 mistake. Once again, community primary care physicians and their staff have been left forgotten and defenseless on the front lines.

The federal government has left each state on its own to distribute life saving vaccinations, according to the Centers for Disease Control and Prevention's (CDC’s) general guidelines. To balance the CDC’s dual goals of “Prevention of Morbidity and Mortality” with “Preservation of Societal Functioning,” all states were to start distributing the vaccine to residents of long-term care facilities and healthcare personnel.

Our company works with over 7,800 primary care doctors across 31 states, and the stories they tell us are heartbreaking and infuriating. In most states, hospitals and large health systems have received the deliveries and thus the responsibility and privilege of vaccination distribution. Inevitably, hospital and health system staff, regardless of proximity to patients and visitors, are vaccinated first. Lab research staff are being vaccinated. Clinical staff in administrative roles who never encounter patients are being vaccinated. And yet, community primary care doctors, who triage COVID-19 patients every day and are unaffiliated with the local healthcare system, are not prioritized.

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Physicians in Arkansas have reported significant anxiety thanks to the disorganized vaccine distribution process in their state, which failed to consider the needs and limitations of rural communities. The state’s focus on hospitals and pharmacies as the sole distribution sites for the vaccine (and lack of guidance to these entities) has resulted in significant frustration and disappointment from both patients and providers. For the first few weeks after the vaccine was released, non-hospital affiliated clinics were unable to get any answer as to when and how they might protect themselves and their staff.

There are isolated bright spots, for sure. When it became clear that Arkansas did not initially have a plan to provide for rural clinicians, Christus St. Michael, a health system in Texarkana, Texas, stepped up and provided vaccines to clinical staff from neighboring DeQueen, Arkansas. But doctors in Sheridan, Arkansas, do not have a community hospital to beseech in their area. So they wait, and worry.

North Carolina is, at first glance, a shining example in this chaos. The state has heard the alarm and mandated that independent primary care providers without health system affiliation receive vaccination, either through health systems or local health departments. But the distribution network is still intimidating to navigate. Health system sites in the state have the right to register as “closed” vaccination sites, which makes them accountable for vaccinating only their own employees. Jurisdictions with no “open” health systems sites must queue up at the local health department sites, which are understandably overwhelmed.

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If we exclude community primary care practices from vaccination plans or delay their own vaccinations, we risk crippling our healthcare system. If this workforce falls, we lose our ability to maintain community health. We lose our ability to keep patients out of bursting emergency rooms.

And we lose lives. A study published in July by Penn Medicine found that 55% of healthcare worker deaths from COVID-19 were among primary care physicians: emergency medicine doctors, intensivists and anesthesiologists accounted for 7.4% of deaths in this cohort. Every time we deny a primary care doctor a vaccine, or make them wait, we violate the CDC’s core vaccination principles. We let morbidity and mortality rise and put our healthcare system at risk of collapse.

The U.S. must not repeat the sins of the recent past. Primary care providers and their staff waited for protective equipment, and too many of them perished as a result. It is time to protect those who protect our families every single day.

Emily Maxson, M.D., is the chief medical officer of Aledade.