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The U.S. Deserves a Better Vaccine Rollout than This

The pandemic offered Americans a rare glimpse of a world where vaccines could be distributed efficiently and access was relatively simple. Now we’re back to our old, too often clunky system.

New York City vaccination center
A mas COVID vaccination site at New York City’s Jacob Javits Center in June 2021. During the pandemic, shots were free for everyone and generally widely available within days of being authorized. (Xackery Irving/Shutterstock)
The rollout of this fall’s COVID vaccine has been frustrating. When CDC authorized the COVID shots for everyone 6 months and older on Sept. 12, the expectation was they'd be available within days. That hasn't proven to be the case. Instead, appointments seem readily available, only to be canceled at the last minute; surprise bills for vaccines touted as free abound; and the littlest children seem left out altogether.

Avoiding a tripledemic this winter hinges on public health officials striking the right message to consumers, one that emphasizes both the new COVID booster and a flu shot — and, for those eligible, one of the new RSV vaccines. But convincing people to roll up their sleeves won’t help without a shot ready to sink into their arms.

So what has gone wrong? A confluence of factors, some clearly avoidable. For one, pharmacies seem to have flubbed scheduling, allowing people to sign up when either shots or pharmacists weren’t available.

A few hitches were perhaps to be expected this year — it’s the first time insurers, rather than the government, is paying for the shot. But not every site accepts every form of insurance, and some insurers have yet to offer the needed billing codes for the vaccine.

It’s hard not to wonder if it all could (and should) have gone better.

Public health authorities in the U.S. already faced an uphill battle this season. Last year, only 17 percent of the population got the updated COVID booster, while CDC data shows just 46.9 percent of adults got their flu shot. And a new survey conducted by the National Foundation for Infectious Diseases found that just 40 percent of adults in the U.S. planned to get the new COVID shot, while 43 percent said they were unsure or did not plan to get a flu shot.

The pandemic offered Americans a rare glimpse of a world where vaccines could be distributed efficiently and access is relatively simple — the shots had one distributor (the government), were free for everyone at every site, regardless of insurance, and, for the initial rounds of boosters at least, were generally widely available within days of being authorized. Now, we’re back to our old, too often clunky system. “COVID has conditioned us to expect very rapid and efficient rollouts of an intervention into a very complex health care system,” says Larry Kociolek, medical director of infection prevention and control at Ann & Robert H. Lurie Children’s Hospital of Chicago. “That leads to some expectations that are difficult to meet.”

The challenge of finding a COVID vaccine has been particularly acute for parents. Nearly all of the roughly 300 kids signed up for seasonal vaccines at Elias Kass’s pediatric primary care practice in Seattle were supposed to get both COVID and flu shots. But the pediatric COVID shots have yet to arrive, and he’s spent hours trying to figure out when they will come in. The state’s department of health attributes the problem to a delay with the distributor, McKesson, but Kass says no one is offering clear guidance on when vaccines will become available or how many doses his practice will initially get.

Parents’ urgency comes as hospitalizations from COVID hit a recent peak. And while children are at low risk of the most serious outcomes of the disease, parents worry their kids will get the virus before the vaccine is finally available.

Being able to receive both shots at once matters to families, Kass says. Beyond the inconvenience of scheduling multiple outings — like missing work and taking kids out of school or day care — there’s also “all of the drama” that comes with coaxing sometimes fearful children to roll up their sleeves, he says. And while pharmacies seem to have some supply, the lion's share of kids tend to get their vaccines at their doctor’s office. Many states do not allow children under age 3 to be vaccinated at a pharmacy counter.

That leaves parents, particularly those with toddlers, in a frustrating limbo. Many have been told their best bet is to keep calling their pediatrician’s office or refreshing the provider’s website in hopes that appointments will magically appear.

Even more vexing, the situation might not feel much better next year. Distribution and insurance coverage should be more routine by then, but COVID continues to bedevil the world with its refusal to settle into a seasonal pattern.“You can be very confident that the flu is going to start sometime between November and February every single year,” Kociolek says. That provides some wiggle room if the fall flu shot rollout is delayed. Without that same predictability for COVID, vaccine supply could routinely arrive out of sync with demand. And that doesn’t bode well for improving uptake.

That would be a real shame. Vaccines that combine COVID and flu into a single shot could be one solution to the messiness, but are still several years away. Until then, more transparency about the status of the vaccine supply would help.

©2023 Bloomberg L.P. Distributed by Tribune Content Agency, LLC. Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

This column does not necessarily reflect the opinion of the Bloomberg L.P. editorial board or Bloomberg LP and its owners. Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.
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