“It’s simple math,” she said.
The doctors’ offices where most people get health care and independent pharmacies are eager for a role in distribution. Most state health departments designated well-resourced hospitals as vaccination hubs, in part because states were tasked with enrolling providers on a tight deadline without much federal funding.
States received $340 million for COVID-19 vaccines in two tranches in September and mid-December, about $1 per U.S. resident. The latest coronavirus relief package cleared by Congress provided another $8 billion. The first $3 billion of that was distributed in the last week of December.
While states awaited more funding, the Trump administration emphasized that providers should enroll to give the vaccine because they could eventually bill insurance companies and patients for an “administration fee.”
“The sense has been that if providers administer the vaccine, they can bill for it, and that’s the compensation mechanism. But it’s very difficult for providers to gear up and scale up without some kind of front-end funding,” said Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials.
Public health departments and hospital groups say it’s challenging to ramp up vaccinations at the same time that hospitalizations have surged.
“The health care workforce is incredibly strained and stretched right now because they are caring for people in hospitals that are overrun,” said Steven Stack, commissioner of the Kentucky Department for Public Health. “There’s not a lot of idle health care workers to draw upon.”
Powerful hospital groups have expressed uncertainty about how much responsibility they have to vaccinate people beyond their own staff.
“Hospitals are committed to be a central part of the vaccination effort, but hospitals alone cannot do it, especially as we care for burgeoning numbers of critically ill COVID-19 patients, and struggle to maintain sufficient staffing work to have enough personal protective equipment and other resources,” Richard Pollack, president of the American Hospital Association, wrote in a letter to Azar on Jan. 7. “We are aware that large chain pharmacies also have been enlisted, but it would be good to have a clear idea of precisely which organizations are engaged and for each to know what is expected of them to get to herd immunity.”
Federation of American Hospitals President Chip Kahn said it should be mostly up to pharmacies, not hospitals, to vaccinate non-hospital health care workers and the general public.