By Jared S. Hopkins and Anna Wilde Mathews
CVS Health Corp. and Walgreens Boots Alliance Inc. are preparing to bring Covid-19 shots to long-term care facilities, but the effort will need to navigate rollout details that may vary by state, vaccines that require more than one dose and potential reluctance by staffers to get the novel shots.
An advisory panel to the U.S. government recommended on Tuesday that residents of long-term care facilities be included with doctors, nurses and health-care workers to be first in line for vaccines. States, which will ultimately decide how to allocate Covid-19 vaccine supplies, don't need to follow the guidelines, though they usually do. But logistics and other aspects of the effort may differ among states, even among those that broadly accept the panel's conclusions.
Vaccines are on track for federal authorization this month and could begin shipping within days of receiving clearance, U.S. officials have said. CVS and Walgreens will deliver most vaccine doses for the nation's approximately 15,600 nursing homes and 29,000 assisted-living communities.
Hospitals and other medical clinics are slated to serve as vaccination sites for health-care workers in the initial rollout, but pharmacy workers are expected to come to nursing homes and other adult-care facilities to deliver and administer the vaccines to residents and, likely, staff.
The long-term care rollout will be an early test of how quickly and efficiently CVS, Walgreens and governments can distribute Covid-19 vaccines, a campaign expected to last months. They are working to address storage and transportation issues for vaccines that need to be kept at colder temperatures than vaccines for other diseases, as well as concerns that some residents and staffers may decline the shots.
Many details of the government plans remain unclear, just weeks before doses might start being shipped, said nursing-home industry officials, and executives with CVS and Walgreens.
"There's a lot of uncertainty," said Richard Feifer, chief medical officer of Genesis Healthcare Inc., the largest U.S. nursing-home operator. Also, he said, "there is so much local autonomy," meaning plans and timing will vary among states.
Still, elder-care facility owners around the country are laying the groundwork for vaccines. Some are launching campaigns to inform residents, families and staffers, with the hope of persuading them to receive the shots. Nursing homes often have to get consent forms signed by family members, if residents aren't able to do so themselves.
Nursing home staff and residents have been especially hard hit by the virus. Last week the number of Covid-19 deaths in the U.S. linked to long-term care facilities surpassed 100,000, nearly 40% of the country's total.
There are around three million beds in U.S. long-term care facilities, according to the U.S. Centers for Disease Control and Prevention.
Nursing-home groups had pushed for their residents and staffers to be included among those first to get the vaccine, pointing to the losses caused by the pandemic and the rising number of Covid-19 cases in the facilities in recent weeks.
Nursing-home companies said they want their staffers to be able to get the vaccine at their facilities, at the same time as residents, though some states may not choose to do this.
The U.S. government in October picked CVS and Walgreens, which operate about 20,000 stores combined, to administer vaccinations at elder-care facilities, though other pharmacies can participate as well.
Public health experts like the plans, citing the chains' experience administering influenza vaccines at nursing homes. CVS runs its own long-term care pharmacy operation, Omnicare. Walgreens has a stake in another long-term care pharmacy provider, PharMerica.
Flu vaccines are easier to administer, coming in filled syringes and stored at refrigerated temperatures. The initial Covid-19 vaccines from Moderna Inc. and Pfizer Inc. and partner BioNTech SE, need to be shipped in subzero temperatures and require two doses, which means at least two trips to facilities.
"The details of the logistics for delivering these vaccines to long-term care facilities are far more complex than a simple influenza vaccination program, but that experience of doing those simple annual influenza programs will make it a little easier for people to learn the nuances of the Covid vaccines," said Kelly Moore, associate director of immunization education at the Immunization Action Coalition.
About 1,000 CVS pharmacies will serve as hubs to receive vaccines from the government or vaccine makers, with small teams of pharmacists visiting 25,000 facilities, said Chris Cox, a CVS executive who is overseeing the vaccination rollout for the pharmacy chain. He said CVS wants to deliver the first of two doses within a month once a state gives the go-ahead, but said that process will be sensitive since it is unclear when states will make those calls.
"The difficult parts of this are just working through the unknowns," said Mr. Cox.
Rick Gates, a senior vice president at Walgreens, said it too was planning to set up vaccine hubs around the country, likely around 800 to 1,000, to distribute shots to approximately 23,000 long-term care facilities. States may decide differently on how the vaccine should be distributed, he said, and they can also vary on how they prioritize the doses. Because of that, facilities in some states may get shots before those in others, he said.
Another challenge is keeping the vaccines cold until they are ready for use. The pharmacies must handle and transport them after receiving them from vaccine makers and the government.
To keep the vaccines cold en route and at the nursing homes, CVS said it will transport them in a special reusable cooling container about the size of a briefcase made by Rochester, N.Y.-based AeroSafe Global, which provides cold-chain services for pharmaceutical companies. AeroSafe is providing CVS with 4,000 containers, each capable of holding at least 250 doses, said Jay McHarg, AeroSafe chief executive.
On site, pharmacies will administer the shots, though public health experts say it will be key for them to limit visits, in part to curb exposure to the virus.
Both CVS and Walgreens are aiming to typically conduct three trips per facility to administer the vaccines.
Facility staff who are likely to bring the virus from the community should be vaccinated, said Dr. Moore. "The most critical people to protect in order to save the lives of the people in a long-term care facility are in fact the people who work there," she said.
Elder-care facilities also are preparing.
The Evangelical Lutheran Good Samaritan Society, which operates 147 nursing homes, has created a video for staffers and residents featuring a public-health expert talking about the benefits of the vaccines. Chief Medical Officer Gregory Johnson is planning a Facebook Live session to take questions from residents and family members. The nonprofit, part of Sanford Health, has also sent materials to its individual facilities to use as they reach out to families to discuss the vaccine and obtain consents.
"We're in an education phase," said Dr. Johnson. Still, Good Samaritan and Genesis both say they won't mandate staffers get the vaccine.
Legally, there may be little preventing most employers from imposing vaccinations, legal experts have said. However, they may have to contend with some concerns, including federal and state laws prohibiting discrimination in the workplace.
The Well-Spring Group, a Greensboro, N.C., nonprofit with two communities that include nursing homes, assisted-living facilities and independent living, is planning messages to residents and families, including from two retired doctors who live in one of its communities. "That will be rah, rah, you need to take this," said Steve Fleming, the nonprofit's CEO.
Well-Spring won't require all staffers to get the vaccine, but those with direct-care responsibilities will have to get counseling that includes data about the novel shot.
CVS and Walgreens are also gearing up for a broader role in vaccine distribution next year with other retailers once supply grows enough for the general population.
Write to Jared S. Hopkins at firstname.lastname@example.org and Anna Wilde Mathews at email@example.com
(END) Dow Jones Newswires