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Prioritization isn’t supposed to be about policing whether the right person shows up for vaccination in response to a cattle call. It’s supposed to be about doing the work to seek out high priority groups & bring vaccination teams to the places where they work & live.
As more doses come online, we should also be standing up mass vaccination sites w/ careful planning to get the right # of patients & right number of doses to the right place at right time. And we shouldn’t slow down that process with overly detailed efforts to verify eligibility.
These are two separate processes w/ distinct challenges. We need to be implementing the 1st while planning for the 2nd.
The 1st process should look like this: teams systematically visit every nursing home & assisted living facility in the state & vax all willing residents who meet medical indications, then do it again for 2nd dose. https://wvmetronews.com/2020/12/28/justice-all-nursing-homes-long-term-care-facilities-will-have-received-covid-19-vaccine-by-monday/
Or like this: teams of medical corps volunteers coordinated by state health dept working with local housing authority offers vaccinations door-to-door in a hard-hit zip code https://www.bostonglobe.com/2020/12/30/metro/central-falls-residents-get-first-doses-covid-19-vaccine/
Just as testing has been offered on-site in congregate residential & workplaces, vaccination should be.
The second process (mass vaccination, which should ramp up in earnest in the next month or so as more doses are shipped to more places) should use multiple outlets.
With 1000s of doses on hand (vs 100s now available), county health departments can open up large sites based on age. Using birth month or something similar to break into cohorts is an option. But also...
Primary care providers should have access to doses to offer to patients who meet age or underlying condition criteria (regardless of age). Pharmacies & urgent care centers are also important to reach people who aren’t connected to a regular source of care.
Soon, both processes (targeted outreach to highest-priority groups) & mass vax w/ looser prioritization) should be running simultaneously. But right now, when doses are very limited, it’s critical to focus on targeted outreach.
In most states there are still a lot of front-line health workers (especially those who aren’t affiliated with a large hospital system) & nursing home residents (especially those whose facilities opted into the federal CVS/Walgreens program) who haven’t yet been reached.
E.g., this is how the 1st process is *not* supposed to work: millions of doses shipped to mega pharmacy chains who said they’d send teams to nursing homes but aren’t managing to pull it off https://www.wfxrtv.com/news/health/coronavirus/virginia-nursing-home-operator-says-vaccine-rollout-is-frustrating-so-far/
The reasons this was a bad plan are pretty well covered in this piece from early December: https://www.latimes.com/politics/story/2020-12-04/covid-19-vaccine-rollout-relies-heavily-on-pharmacy-giants-cvs-and-walgreens
