Vaccine Rollout: Combatting Denial and Distribution Disasters

The following interview was transcribed from an audio recording, and lightly edited for clarity by L. Esther Hibbs, Managing Editor.

What has your experience and role been so far in the vaccine rollout?

So far, my role has been passive. I am an emergency physician and I work at University of Maryland. I work at ten of our different hospitals. Even if those hospitals are underneath a bigger system the vaccine distribution plans have been handled by the individual hospitals. For example, I got offered to sign up for vaccination appointments and scheduling from about six different hospitals. Just comparing the rollout and the (dis)organization of those six hospitals underneath one umbrella of the University of Maryland, they were all different. The vaccine distribution to the institutions has been to hospitals, not necessarily to hospital systems. To explain, our system has about 26 hospitals. We run 14 of their ER’s. It’s hospital by hospital driven, so it is left up to each of the 26 hospitals to distribute and administer the vaccines they have received. So even in my three or four weeks’ experience in this so far, I have seen six different hospitals and their six different vaccination plans. They are all very different. I also moonlight at another hospital system, and it was similar to that too. Those are three different hospitals that handle it three different ways as well.

There are two companies, soon to be three, and there is this Operation Warp Speed that has been involved in developing the vaccine. There is no centralized distribution or administration network or protocol at all. Sometimes, it can be good to leave things to the last kilometer to handle and sometimes it is not good. The first time the vaccination was available to anyone in the US was around December 14. That was the first person who officially received that on Monday, the 14th. I got mine on Thursday the 17th. I was lucky-- I got mine before Vice President Pence and before 2020 President-Elect Biden.

Here is a story to describe bumps in the organization. I signed up right away, and was scheduled for the 22nd to get my first Pfizer vaccination. This was several weeks before the vaccinations were received-- around the week of the 7th. I found out on the second day of vaccine delivery that I was not going to be able to get my vaccination on the 22nd. So, the second day that our system started to give out its vaccinations, they announced they had only received 25% of the vaccines they had expected. They had no further information about when the rest were going to be received, and my date was cancelled and postponed to some unknown future date. I was disappointed, and it looked to me to be a sign of much further disorganization to come. So, I think that the assembling that we experienced further compromised a bunch of people’s opinions about what was going to happen. It doesn’t make you look good to stumble five feet from the starting block, even if it’s a good program. We found out a week or so later why that was: the government was intentionally withholding things and had a poor set of explanations for its own disorganization.

When I found out my date was cancelled, I was more worried that it was now probably going to take three weeks or five weeks or just another disorganized effort on behalf of the organization. So, I told the director of our program that I was keen to get this and they actually called me on the day of the 17th and said “We have one extra dose today, are you available to come?” This was after I had worked an overnight shift and had only slept for an hour. I woke up, drove an hour and a half to the hospital, went back home and back to bed. I am very lucky-- I am not complaining about it. Someone like me is pretty on top of the science, pro-vaccine, and vaccine trained in my public health school: not a naysayer at all. However, I was a little concerned about the distribution problem, even as someone who was raising his hand to be first in line.

I work with emergency doctors, nurses, respiratory techs, and other people in the hospital like ICU docs. I have seen and heard stories about emergency departments being covered by contract groups. These include physician-owned private contracting groups, not just the big ones. They cover the ER, so the doctors are subcontracted hospital employees. The hospital employs the group and the group employs the doctor. They are not considered hospital employees the same way the CEO or surgeons are. Those doctors are treated like second- or third- tier citizens.

Even though they are frontline workers, these physicians are having trouble getting into the distribution system because they are not technically hospital employees even though they work in the same hospitals. All the hospitals across the country got 0-25% of their promised vaccines. What doctors have described is that their own appointments were being cancelled. When they decided to just show up to the places where the vaccines were being delivered, they were seeing administrators, secretaries, non-clinical people who worked for the high offices in the hospitals, senior physicians like directors of departments who do not see patients, and non-COVID professionals like dermatologists in line to get vaccinations. They had been approved for these slots ahead of the emergency doctors. That is one thing we have been experiencing: we are kind of at the bottom in terms of hierarchy in terms of status (not the very bottom, but not at the top). Generally, emergency physicians are high in terms of risk but not in political power, let alone those ER doctors who do not officially work for the hospital. We are allowing hospitals to be in charge of their own distribution policies. They are then addressing the subcontractors as less important than their own employees. This is a common story across the country.

One of the themes of emergency medicine is being treated as shift workers rather than professionals, especially across the last 20 years. We do not have a 20-legged stool for our careers and professions the way some workers do. We have a one or two legged stool. Because of that, we do not have a lot of political strength and power. And of course, the hospitals regularly abuse us based on that relationship. Because I am a part of AAEM, American Academy of Emergency Medicine, we get all the emails and phone calls. We act as the sounding board for individual physicians. Our tagline is “champion of the emergency physician.” So, when people are being abused by their employers or their system, either individually or as a group, we hear about it. We have been hearing this all around the country: subcontracted emergency groups are having difficulty getting their vaccinations. It is not just because of the national distribution problems, but because of the politics and hierarchy that emergency physicians have been struggling with for a long time.

Could you talk about pushback and people’s decision whether or not to take the vaccine?

Right now, the vaccine is not available for distribution to patients yet, so I have not had a lot of patient pushback. It is really not an issue yet unless you are a high-risk patient in a nursing home, a cancer patient, etc. The vaccine is being made available to those people through different distribution networks. It is fully expected to become an issue, it just has not been yet because of the distribution.

The pushback I have been hearing is from the other staff. Because of the stumbling of the Pfizer deliveries and because of the other problems with Moderna and Pfizer, we are only doing one million vaccinations per week in the country. If we want 100,000,000 vaccinations in the first 100 days, we should be doing 3.5 million per day instead of one million per week, especially since we have to give people two shots. In short, we are way behind.

Part of the delay is because of the administration, but regardless is important to remember the phrase in immunology: “vaccines do not save lives, vaccinations save lives.” The delivery of the vaccine into someone’s arm twice is considered success. It does not matter if you have Operation Warp Speed if you have the vaccines sitting in a freezer. You have to go that final mile. Because of the stumbling, because of the politics surrounding all of this, and because of some natural, healthy skepticism (and some unhealthy skepticism), there is a lot of reluctance that I am seeing directly from emergency nurses, emergency techs, nurse practitioners, students… All the people we work with in the ER.

I hear these conversations in the background, or sometimes people ask me: “So, what’s going on with the vaccine? What should we do?” Other times, I hear people saying “my boyfriend told me ‘you’d better not get that vaccine’,” but I hear them talking in the hallway. So, there has been a higher level of reluctance to take the vaccine than I am comfortable with.

Where do you think that skepticism comes from?

I think most people, whether you are a PhD level scientist or just a regular person without this scientific training, tend to hold our beliefs based only partly on facts and information. Especially our fears: our fears tend to be based less on facts and information than other things. I think there are a whole bunch of reasons.

In general, public health has not been completely consistent across the 50 years. For example, are eggs good for you or bad for you? Is cholesterol? Protein? A vegan diet? What is “healthy”? Public health kind of swings from one extreme to another. It is not consistent in its messaging and findings. So, people who are not fully enveloped in the field tend to think that it is kind of a wishy washy set of recommendations and these scientists do not know what they are talking about because of changes over time. That is an honest criticism. When you get into the weeds, it is because science changes. Science is not an inalterable truth: it is a collection of evidence that then allows you to change based on the next evidence. What people see is a changing message, sometimes very changing, and they see that as uncertainty. Some of this is healthy.

Among vulnerable populations (low-income populations, certain minority groups such as African Americans, Latinx, and Native American groups), there is also a horrible history of having been abused by the public health system through things like the Tuskegee experiment, other pharmaceutical company or US government based direct abuses. There is a healthy skepticism and reluctance on behalf of some of these groups as a zeitgeist. I can understand that as well.

That is what everyone comes into this with: a healthy degree of skepticism based on human nature and based on previous interactions with the public health system. I have some of that healthy skepticism too. For example, in the early days of the varicella vaccine, the data was not good, so I did not offer it to my kids. Three years later, they had changed the varicella vaccines and the data was better, so I gave it to my kids. That was not being anti-vaccine, that was taking this specific vaccine and data and making a decision on it. So, what I think we should do with this healthy skepticism is approach the topic with an open mind to hear what the data is. That is where I think the door is closing for some people. Some people have unhealthy skepticism, which is being encouraged by politics, as well as healthy. They do not keep their mind open for the data about this vaccine or that one, this public health intervention or that one.

I hear a lot from the nurses-- directly speaking with them, listening to anecdotes from eight hours’ conversation five days a week, that there is a little bit of disbelief in the entire severity of the pandemic. Given that yes, this is a serious problem, with 330,000 deaths, it is also not like a television ER show where 90% of patients are dying in front of you. Even on the worst day in the ER, only 30%-50% of people are sick and dying. Therefore, the other half aren’t. Because this is not the worst thing people have imagined, they tend to downplay it.

To be continued… See next week’s publication for Part II. Subscribe here and be the first to see it!