Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.


In today’s COVID-19 Update, Marcus Plescia, MD, chief medical officer of the Association of State and Territorial Health Officials, discusses the benefits and challenges of mass distribution clinics and the importance of including the clinical community to ensure fairness and equity. Dr. Plescia also discusses how states are positioned to handle ever-increasing supply and what physicians can do to get involved in distribution efforts.

Learn more at the AMA COVID-19 resource center.

Speakers

  • Marcus Plescia, MD, chief medical officer, Association of State and Territorial Health Officials (ASTHO)

AMA COVID-19 Daily Video Update

AMA’s video collection features experts and physician leaders discussing the latest on the pandemic.


Unger: Hello, this is the American Medical Association's COVID-19 Update. Today, we'll be discussing vaccine distribution with Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials or ASTHO in Atlanta. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Plescia, this is I think your third time on the COVID-19 Update, that makes you officially a friend of the show in Stephen Colbert terms. So welcome back. It's great to talk to you again.

Dr. Plescia: Thanks for having me again, yeah.

Unger: First question, on a scale of kind of chaos to well-oiled machine, where are we and how would you characterize the vaccine rollout where we are right now?

Dr. Plescia: I would never say that it's a well-oiled machine. I think that's asking for trouble. And we've been trying to be pretty clear with everybody that there are going to be bumps in the road and glitches. I mean, we've never done anything of this scale before and the pressure is great. The outcomes are very important. We want to temper expectations that well-oiled machine is just probably not where we can be, but it's far from chaos. I mean, I think the whole rollout and scale up of the COVID vaccine program in United States has actually gone extraordinarily well. And I have to be honest, even in the beginning where people were saying, got off to a slow start, I really don't think that was true. I think that everybody was very eager to have the vaccine. There was a lot of anxiety about that, but I think that played out. But really, I mean, it does take a couple of weeks just to get things up and running and that's not a slow start, that's getting things up and running. And-

Unger: Yeah. As you point out, it's pretty complex to get that scale. And the numbers are definitely telling a very different story in terms of the number of people that are getting vaccinated every day and every week. What's driving that improvement?

Dr. Plescia: Well, I think the big thing that happened is that it became clear that the metric was going to be number, that we really needed to just vaccinate as many people as we could at least to begin with. And so we moved to this system of states really doing a great deal of these mass vaccination type clinics. And I hope we'll talk about that a little bit more during our time together because there's benefits to that. I mean, it's very, very efficient. But it also means we're not using the clinical community the way that I thought we would from the get-go and you lose things with that. I mean, I'm worried about equity and fairness of vaccination because I don't know the mass vaccination clinics are going to bring us that, and I'm hoping that we're going to shift back to an approach where we are using more of the clinical community and allowing for that intimate doctor/patient.

If you're a little bit anxious or hesitant about the vaccine, you need to be able to talk to somebody and who better to talk to than your doctor.

Unger: Yeah. We were going to talk about that later, but let's just kind of dig into that topic now because we hear from a lot of independent smaller practice physicians that they're feeling like they're not able to participate in this. And for those reasons that you outlined in terms of the kind of trust factor between physician and patient, we're not able to leverage that right now and there are real equity considerations there. What's it going to take to get to that.

Dr. Plescia: It's all about supply. And I think we're going to start to see a shift soon because clearly the supply picking up. And once we have more vaccine, then we can push it out into these other kinds of settings. Unfortunately, I think the demand may start to drop off a little bit too. You've got people who are really eager to get the vaccine, but at some point we're going to get through them. I don't know what the proportion or percentage is going to be. Hopefully, we'll get a big percent of the population before that happens. But at some point, the demand is going to be more challenging and that's going to be another reason to move it out into clinician offices because that may be a way to get some more of those people on board. But I think we probably need a few more weeks, a month, for the supply really to pick up, and then you're going to see states coming back out.

60% of influenza shots are given through medical practice settings. And I think ultimately we're going to see the same thing for COVID, but early on where there was this real anxiety and people really eager to get vaccinated. I think what we've learned is in a setting like that, the mass vaccine clinic is probably the thing to do at least to get things started.

Unger: Just clarify in terms of ETA on when we think that kind of supply situation will get fixed. Do you think it's two months, a month? Where do you think we are?

Dr. Plescia: Well, based on what we're hearing from the Biden administration about everybody who wants a vaccine will have one by May, I mean, if that's the case, then I think we're talking about three or four weeks we're going to start to see significant increases. With the new manufacturing coming in for Pfizer, Moderna, I don't remember which one now, there's good reason, and with the new Johnson & Johnson vaccine, there's good reason to realize there will be more vaccine. And so I think in three or four weeks, I think physicians in practice, a lot of them may start hearing from the state or the local health departments about, "Okay, can we bring you on now? Would you be willing to do some vaccinations?" The other good thing is with Johnson & Johnson, that vaccine is going to be a lot easier to get that thing out. It's not as delicate of a vaccine. It's just a single dose. That's probably going to be a lot easier vaccine to get out into physician practices.

Unger: Yeah. Given the storage requirements and kind of freezing temperatures that are required, that seems like that would kind of unlock a little bit there or knocked down a little bit as obstacle right now. Well, if we kind of go back to where we were kind of earlier in this process, there were a lot of questions about what was happening when the vaccine was getting to states and how much of that vaccine was getting into people's arms. There were these kind of questions about that gap. Do you feel like we're now much more in sync with supply and actually making it into people's arms?

Dr. Plescia: Yeah. I think we've equipped a bit a little bit better, but I also think that we've learned what to expect. I think everybody has now come to expect there's always going to need to be a little bit of play in the system. You can't get 100% of your vaccine and get 100% out. You've got to keep some vaccine sort of in reserve so that if you plan a clinic at the end of the week, you have enough vaccine to do that. And what we were finding was some of the providers systems that we were working with, they were reluctant to sort of overuse. They wanted to make sure they had a little bit of stock. And then there was the whole issue of wanting to make sure that there were doses in place for people when they came back for their second dose. And I think that's something that really rings true with physicians. It rings true with me.

I mean, we're advocates for our patients and we do want to make sure. We don't want to just leave it to the system that there's a vaccine. We kind of want to know that there's one sitting there or have some pretty good numbers that has a little bit of a fudge factor in there so that people are not going to get let down when they come back for their booster.

Unger: Okay. Well, you mentioned earlier the Biden administration and the plan to kind of get every adult who wants a vaccine vaccinated kind of mid to late May. I'm curious to find out, let's kind of talk about the math of that in terms of how many people are getting vaccinated every day, what needs to happen to supply to make this a reality?

Dr. Plescia: Well, it's probably going to have to be even more than 2 million a day, which is what we're getting towards now. So it's going to have to continue to ramp up. That probably does mean we will try to use mass vaccination clinics. I mean, it's very, very efficient and that's how you get your numbers through. And I don't mean this critically, but having people go through their doctor's office, I mean, it's not that kind of mass event and that's not what it's supposed to be. But my hope is that as there is more vaccine supply, we can supply these mass vaccination clinics, but we can start getting vaccine out into other kinds of settings, because I think we are going to run into the population that's vaccine hesitant. Or maybe it's not hesitant, it's just they're a little anxious. I mean, this is a new vaccine, it's made differently.

I think people are nervous about it. And I think we're going to hit a point where in order to get some of those folks vaccinated, that's where the clinical settings is going to be really important. So my hope is that we have both working in concert. The clinician/physician side is maybe bringing a little bit more of the equity and fairness, which I feel like we're missing right now. The mass vax is about trying to get as many people who want to be vaccinated, vaccinated by the time we get to May.

Unger: Yeah. And we are hearing, obviously efficiencies in that, but it does presuppose that you can get there and a lot of other kinds of assumptions that work against equity. Are you hearing kind of other obstacles in that regard?

Dr. Plescia: Well, the big thing that works against equity is when you go to a mass vaccination clinic, you go to get vaccinated. You don't go to talk about it. You've made the decision that you're going to get vaccinated and so you're going to this place where they'll give you the vaccine and some people are going to need to talk about it. And particularly when we talk about equity and particularly racial and ethnic communities, where we often see much more hesitancy, we've got to have ways to engage those people. I think the medical setting is one because people have this trusting relationship with their provider. I do think there's other venues we'll go to as well, other trusted sources. Faith community for many racial and ethnic groups is going to be very important. So again, as the vaccine supply picks up, I think we'll be able to use those resources more.

Unger: Do you think or do you see any examples of where there are really effective measures to address vaccine hesitancy?

Dr. Plescia: Yeah. I mean, the Centers for Disease Control in a lot of the states use this vaccine with confidence-approach and that's multifaceted. But one of the big pieces of that is the idea that people often will make their decision about getting vaccinated by talking to their provider. So the whole vaccine with confidence program is about really giving providers the skillset and talking points and education about when somebody asks you if they should get vaccinated, how do you make a really convincing case to them so that they will do it. And so I think that's a very good program and we've seen that work well. Clearly, some of these community-based organizations, we haven't reached out to them quite as much so far because we've got a limited supply of vaccine.

We've already over-promised this vaccine early on and caused a lot of frustration and chaos. I think we're needing to kind of titrate a little bit when we start to go to some of those groups because we don't want people to then become motivated to get vaccinated, then they can't get the vaccine for weeks.

Unger: Yeah. Do you have any advice for physicians that want to play a larger role in distribution and in vaccine efforts?

Dr. Plescia: Yeah. I mean, I would say, make sure that you have signed on with the state as a vaccine provider. There's sort of a formal agreement that you have to go through. It can feel a little cumbersome because of some of the reporting requirements, but then everybody who's watched the news probably realizes now why those reporting requirements are so important. I mean, we need to be able to show that as we bring on more providers systems, particularly we need to show that those are effective and that we are getting the doses that we're providing in those settings out into people's arms. But the important thing with the provider community is also if we can really fine tune some of the reporting so that we can show that by going to these settings, we're dealing with some of the equity issues.

And that's going to be things like really fine tuning, making sure that your systems, your EHR or whatever kind of data systems you're using to communicate back to the state, make sure that that you've got the race and ethnicity in there. One of the things I was hearing just this morning is that we think one of the challenges with the low percentage of data we have on race and ethnicity and the vaccination data support, we think one of the things is that the providers, they haven't collected that data when the patient first starts with them. A lot of times, the race and ethnicity question gets asked by somebody when they're there as a new patient and they're doing that whole enrollment thing. And once I'm seeing you as your doctor, I mean, you're sitting there with me, I kind of know who you are. And so a lot of clinicians may just not realize that the race and ethnicity piece is not in their system.

And so one of the things we're asking providers to do is, providers and practice managers, take a look at your system and sort of see how you are on that, and may be you need to do some updating on that even when established patients come back just to double check and make sure that that data has been collected. Because it's going to be very, very important if we want to really monitor and make sure we're doing this as an equitable way.

Unger: And that wouldn't necessarily, or would it be collected at a mass vaccination center where they're not starting with that kind of relationship to begin with.

Dr. Plescia: Because that's really sort of a new encounter and a new patient for them, I think they realize everything they want to know about that person, they're going to have to collect right there and then. I think the issue in practice setting is that a lot of clinicians just don't realize that... Some patient you've been seeing for 20 years, I mean, that may not have even been one of the data fields 20 years ago. So that's what I'm getting at is it's maybe some of the older patients that they just never really got into... When they got put into the system, that data wasn't collected. And so we think that could be a really good way to make that particular piece more complete.

Unger: Well, as we ramp up on vaccinations, public health officials have also warned states about lifting restrictions like mask mandates too soon. What are your thoughts on how states have been approaching the reopening and how do physicians play a role in states that have been moving what might be considered too quickly?

Dr. Plescia: Well, physicians are the trusted experts in states. My own experience when I was starting out as a physician in North Carolina and I would go and talk to my state legislator, I mean, he or she always took me very seriously and was very respectful of the perspective I brought. And I think we need more of that advocacy, more of that science and health side speaking out and saying, yeah, we know that everybody's eager to reopen. We know for whatever reasons that some people don't feel that wearing masks is some infringement on their freedom, but we've got to hang in there a little bit longer. And policy makers listen to physicians. I think we forget that, especially those of us who work in big medical care systems that are very sort of administrative and corporate, you may or may not feel like you get heard there, but when you talk to your policymakers, I think you'll find that they appreciate that expertise you bring because most of them want to make really good decisions.

Unger: That's absolutely true, and that's a big reason why we have the COVID-19 Update, is make sure those physician voices are heard. Any final thoughts on the vaccine rollout before we conclude?

Dr. Plescia: Well, I'd say just for those who are a little frustrated that they're not part of the administration yet, just hang in there, be patient. I mean, I think people are beginning to realize it is the supply and demand thing, but that's how we've always done it is using physicians, using medical care settings. And so we're going to go back to that and that's where the physician and medical practice is going to be so important. So be patient on that. And then the other thing is be ready to talk to patients about it because some of them are going to have questions and be anxious, and there's reasons to be anxious. And be ready for questions about things like, is one better than the other? That's going to have to be something you really think through because they are. We are lucky to have three excellent vaccines and we need to be really careful that J&J doesn't somehow get cast as being inferior because it's not.

But people will believe it when their physician tells them that, they may not believe it when they're hearing it through the media or other places.

Unger: That is so important. Well, thank you so much, Dr. Plescia, for being here today and sharing your perspective. That's it for today's COVID-19 update. We'll be back with another segment shortly. For information on COVID-19, visit ama-ssn.org/COVID-19. Thanks for joining us. Please take care.


Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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