Researchers: Provider Leaders Need to Step Up to Effectively Manage Nationwide Vaccination Efforts

Two physician researchers have examined some of the current challenges around the nationwide effort to vaccinate as many Americans as possible to protect them from COVID-19, and have published an analysis of what they see as the most important challenges facing clinicians and patient care organizations in the coming months, including building public trust around vaccines, managing the vaccination process, building broad public trust around healthcare system interventions, and engaging in the regional coordination of efforts with governmental and other institutions. Their work appears in The New England Journal of Medicine online.

In “Last-Mile Logistics of Covid Vaccination—The Role of Health care Organizations,” published online on Feb. 25, Thomas H. Lee, M.D. and Alice H. Chen, M.D., M.P.H., examine the constellation of challenges facing clinicians, administrators, and patient care organizations, in the moment. Dr. Lee is based at Harvard Medical School as well as at Press Ganey (both, Boston), and Dr. Lee is affiliated both with Covered California and the University of California-San Francisco (both San Francisco).

“The development, evaluation, and production of vaccines for Covid-19 was the remarkable success story of 2020; the challenge for 2021 is getting those vaccines into the bodies of a critical mass of the world’s population,” the physicians write. “This work is being compared with managing the last mile in other business sectors: once companies get products or information to regional hubs, they must deliver them to individual customers whose settings and habits are infinitely varied. Effectiveness in those last steps determines success. For Covid vaccination in the United States, that last mile is a difficult one,” they note. “About one third of U.S. ‘customers’ are unsure that they want the product and are worried that vaccination might be made mandatory. Most of the others are worried that they cannot be vaccinated soon enough because of limited supplies and uncertainty about how immunizations are being scheduled and managed.”

As the article’s author’s write, “The first task is earning the trust of people — both in the public and in the health care workforce — who are reluctant to be vaccinated. Though shrinking, this group is still sizable, particularly in the Black and Latinx communities, which have been disproportionately affected by Covid.” Yet even beyond the sphere of communities of color, they note that “There is also a core group of people who do not trust any vaccine, joined by skeptics who normally believe in vaccinations but have lost trust in the Food and Drug Administration because of the political pressure it faced to approve vaccines before the presidential election. Strategies and messages may need to be different for each of these groups. In this context,” they emphasize, “clinicians have a critical role in addressing vaccine reluctance, in part because of lack of trust in alternative messengers. Between mid-November and early January, only 37% of Press Ganey survey respondents indicated that they had confidence in government advice on vaccination, but 67 percent said they had confidence in their clinician’s advice.” Indeed, they note, the fact that Sandra Lindsay, a Black critical care nurse at Long Island Jewish Medical Center,” was the person in the U.S. to be vaccinated outside of a research trial, was helpful, as was the fact that the first person in Florida to be vaccinated was Leon Haley, CEO of the University of Florida at Jacksonville and a Black emergency physician; as was the fact that both leaders gave extensive media interviews about their trust in science. Clinicians in patient care organizations nationwide will need to continue to engage in what they call the “door-to-door fighting” of assessing patients’ attitudes toward vaccination and “working to persuade those who are resistant.”

Second, the authors write, the leaders of patient care organizations will need to become strategic about their immunization work in their communities. They cite as an example of leadership the efforts taken in the Geisinger Health System, based on Danville, Pa., to prepare to immunize the health system’s workforce in March 2020. Indeed, as they note, “In addition to doing the basics, such as acquiring storage for the vaccines and setting up high-throughput vaccination sites with Covid precautions, Geisinger spent months developing and communicating plans for who would be immunized first. They developed a scheduling system for both doses of vaccine and staggered the scheduling of frontline workers within each department to reduce the impact of absences due to side effects.” It is such careful and thorough planning, they note, that will make vaccination programs managed by patient care organizations work.

Further, they insist, the leaders of patient care organizations will need to engage in communicating with the public, going beyond “Frequently Asked Questions” posts on their websites, to “building trust. For example,” they write, “the community-facing Covid-19 site of Hartford Health has both nationally sourced and locally relevant news items, videos, and podcasts about Covid-related issues, including testing, recovery, and vaccination.5 Patients can sign up for vaccine updates by text. The goal is to provide one-stop shopping for information in various formats and to allow patients to have information pushed to them.”

As for the fourth area of activity, “Working with local government to set up sites for vaccinations at locations such as sports arenas and shopping malls and publicizing prioritization frameworks are two key steps,” the authors note. And, the public-private collaboration needed in this area could offer a pattern for how healthcare organizations and public agencies could work together in the future. As they conclude, “All four tasks represent new types of work for U.S. health care organizations, but the skills they learn as they adapt will make them better organizations in general. To be speedy and equitable in crossing that last mile, they have to build trust, manage operations well, communicate more effectively, and collaborate with other public and private entities. Covid vaccination is providing a stress test that will help organizations prepare for other challenges that lie ahead.”