The pace and scale of COVID-19 vaccination needed to curb the pandemic requires the use of conventional healthcare sites and high-throughput, mass vaccination events at stadiums, arenas and convention centers, Atul Gawande, MD, and colleagues write for the New England Journal of Medicine.
There are several reasons effective, swift and high-volume COVID-19 vaccine administration can overpower conventional healthcare sites and practices, three being:
- At least 25 percent of Americans lack a primary care provider, making the nation's primary care network and infrastructure unfit for the mass outreach needed to vaccinate millions of Americans as quickly as possible.
- Routine vaccinations are often delivered as a convenient add-on to existing appointments due to the shelf-stable standby supply of vaccines. The current scarcity of COVID-19 vaccine supply, however, means every last dose in multidose vials must be used, and allocations need to get in the arms of those in high-priority groups.
- Limited reimbursement for vaccinations may prevent smaller practices from developing financially viable models for delivering shots outside existing visits. Current Medicare reimbursement rates, $17 for a first dose and $28 for a second, are not enough to cover setup costs of vaccine site requirements — temperature and storage, observation staffing and space, scheduling and follow-up — if volume is limited.
"Mass vaccination sites offer a logical solution that addresses each of these challenges," write the authors, pointing to events at Gillette Stadium in Massachusetts, Dodger Stadium in California and State Farm Stadium in Arizona as recent models.
The Gillette event, which the authors are involved with, rolled out with customer experience designers, systems engineers, medical directors, informaticists, clinical and nonclinical staffing and scheduling experts, emergency medical services professionals, infection-prevention officers and communications specialists — an entire suite of skills and staff that is rarely found in health systems alone.
Mass vaccination sites should also be part of an overall plan — not one-off events — with involvement from state, regional and local officials and public and private stakeholders, the authors maintain, and smart site planning can help meet states' and cities' equitable distribution goals.
Dr. Gawande is the former CEO of Haven and served as a member of President Biden's COVID-19 task force during the presidential transition. He is currently a professor at Harvard Medical School and surgeon at Brigham and Women's Hospital, both in Boston. His co-authors for the New England Journal of Medicine piece are Eric Goralnick, MD, medical director of the Brigham Health Access Center and Emergency Preparedness in Boston, and Christoph Kaufmann, PhD, lead vaccine coordinator at CIC Health, a subsidiary of Cambridge (Mass.) Innovation Center.