By Anna Wilde Mathews

Los Angeles County is pulling its nursing homes out of the federal program that is using CVS Health Corp. and Walgreens Boots Alliance Inc. to deliver Covid-19 vaccines to long-term care institutions, pushing hundreds of facilities to take over the administration of the shots themselves.

The decision by the public health department in the nation's most populous county, revealed Thursday in an emailed letter to nursing homes, means the facilities will receive vaccine doses directly, and "you will be doing the vaccination of your residents and staff on your own," likely starting the week of Dec. 21, the county said in the letter. The change "will support both quicker vaccination and higher vaccine coverage," the letter said.

Los Angeles County has 385 nursing homes, according to the California Association of Health Facilities. The letter referred only to skilled nursing facilities, and not other types of long-term care, such as assisted-living facilities.

On Friday, Barbara Ferrer, director of public health, said the county believes its plan is "the fastest path forward to actually be able to start vaccinating both residents and staff in skilled nursing facilities." She said the county would use strike teams to help administer vaccines in facilities that need it.

CVS and Walgreens have been preparing for weeks for a broad rollout under the federal program, which also involves some other pharmacies. The companies have said they would generally come to facilities three times to administer shots and follow-up doses to staff and residents. CVS said it is working with more than 40,000 long-term care facilities nationwide. Walgreens said it is working with around 30,000.

The county had heard from nursing homes that the federal program didn't offer the "flexibility that they need to vaccinate their residents and staff in the ways they would prefer," the letter said. The county said its new setup will allow facilities to vaccinate people without waiting to schedule a visit from a pharmacy, and to stagger administration of the vaccine over time as they choose, among other things. Some nursing-home officials want to space out when shots are given, so potential side effects don't affect too many staffers at the same time.

The change by Los Angeles County comes as the first vaccine is on the cusp of emergency-use authorization, with shots expected to roll out in the next few weeks. It creates a heavy lift for the county and the nursing homes to get organized quickly and manage a complicated logistical effort. The vaccines have sensitive requirements for refrigeration and administration, including the need for two doses.

The anticipated rollout of vaccines comes as the U.S. is experiencing a massive surge of Covid-19 cases and deaths, overwhelming some hospitals. The toll has also recently been rising again in long-term care facilities, which have been tied to more than 100,000 Covid-19 deaths since the start of the pandemic in the U.S.

The L.A. County letter said the county was planning for its nursing homes to use the Moderna Inc. vaccine, which has somewhat less complex requirements than those for the shots from Pfizer Inc. and partner BioNTech SE.

A spokeswoman for the California Association of Health Facilities said the county's move was "a complete surprise to us." She said the county's decision has "pros and cons." There are significant operational issues, she said, including that facilities will have to take over documentation and other requirements, instead of outsourcing the process. But the approach "will allow facilities to stagger the delivery of the vaccine, avoiding a scenario where everyone is experiencing side effects at one time," the spokeswoman said.

Michael Wasserman, former president of the California Association of Long Term Care Medicine, who was a member of a National Academies of Sciences, Engineering, and Medicine panel on vaccine prioritization, said he supports the county's move.

"The operational decision-making needs to be in the hands of the individual facility," he said, to set their own timing and work with staff and residents who may be reluctant to take the vaccine.

A spokeswoman for the Centers for Disease Control and Prevention didn't immediately respond to a request for comment.

A spokesman for CVS said it had seen the Los Angeles County email but hadn't officially been informed the county was opting out.

"As it currently stands, we're not aware of any jurisdiction that has opted out of the federal program," he said. "It's also unclear if a jurisdiction has the ability to carve-out a subset of long-term care facilities." CVS said it was willing to accommodate requests to stagger the shots, but the staggering would need to be done over the three visits outlined in its federal agreement.

A spokeswoman for Walgreens said the company is "confident we can support the rollout of these vaccines and are working with states almost daily to support their specific needs as they evolve." Walgreens is offering at least three visits to each facility and "can also accommodate special needs if additional clinics are needed," she said.

Write to Anna Wilde Mathews at anna.mathews@wsj.com

(END) Dow Jones Newswires

12-11-20 1814ET