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With high-risk populations, vaccinations lag at long-term care facilities

By one count nursing homes and assisted-living facilities account for about 6 percent of COVID cases but 40 percent of virus-related deaths. Now some state officials are worried vaccinations are moving on to other parts of the populations before long-term care residents and staff are inoculated. David Grabowski, health care policy professor at Harvard Medical School, joins John Yang to discuss.

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  • Judy Woodruff:

    As we reported, President Biden is trying to ramp up how quickly vaccines can be given to Americans and to increase the supply for this summer. That includes a plan to get 200 million more doses combined of the Moderna and Pfizer vaccines.

    From the outset, federal health officials have made vaccinating residents of long-term care facilities a priority.

    But, as John Yang reports, more than a month into the campaign, there are concerns about how long that effort alone is taking.

  • John Yang:

    Judy, to understand that priority, consider this. By one count, long-term care facilities — that's nursing homes and assisted living centers — account for about 6 percent of COVID cases, but 40 percent of virus-related deaths.

    And now some state officials are worried that vaccination are moving on to other parts of the population before long-term care residents are inoculated. As of today, the Centers for Disease Control and Prevention says that 2.7 million doses have been administered at long-term care centers. That's about 11 percent of all doses nationwide.

    David Grabowski is a professor of health care policy at the Harvard Medical School.

    David, thanks so much for joining us.

    Given this, that everyone acknowledges this is a high-risk population in high-risk locations, the CDC says inoculating these people will save lives, is this going fast enough?

  • David Grabowski:

    I don't think, John, it's actually going fast enough.

    You cited the number this the introduction right there. Roughly 40 percent of the deaths occur in long-term care facilities. This is the population we need to protect. We need to get this population and their caregivers vaccinated as quickly as possible.

    The 2.7 million vaccine doses, that sounds like a big number, but consider there are roughly three million individuals living in nursing homes and assisted living facilities. When you add their caregivers, you're up to about five million individuals that need to be vaccinated.

    Each of those individuals will need two doses. And so, yes, 2.7 is a big number, but it's probably just about one-fourth of the way there. And so we have a long ways to go in terms of vaccinating this population.

  • John Yang:

    What are the hurdles to moving faster?

  • David Grabowski:

    The hurdles are large.

    Unlike the general population, where you set up a vaccine clinic and the population goes to the clinic, here, you have to bring the clinics to the long-term care facilities. And there are 30,000 nursing homes and assisted living facilities around the country.

    And so, in order to get the population vaccinated, the federal government contracted with CVS and Walgreens. The good news is, those are big companies. And, in some states, that process is working relatively well. But, in other states, it's going far too slow.

    And in a number of parts of the country, those companies only have so much bandwidth. They can only be in so many long-term care facilities per day. So the process, John, is just moving too slow.

  • John Yang:

    You say the bandwidth is not wide enough. How do you solve that problem?

  • David Grabowski:


    So, by contracting with these two companies, CVS and Walgreens, they only have so many pharmacists and they only have the ability to be in so many nursing homes. It's actually interesting. The state that did the best in terms of vaccinating nursing home residents and caregivers was West Virginia.

    The interesting thing about West Virginia, they opted out of the federal program, so they didn't work with CVS and Walgreens directly. They went ahead and contracted with a series of pharmacies in order to vaccinate residents and their caregivers. They did end up working with Walgreens, but a bunch of other local pharmacies as well.

    They got the National Guard involved. It was an all-hands-on-deck approach, John. And it actually ended up working quite well. And they were first in the nation in terms of vaccinating nursing home residents.

  • John Yang:

    Another issue we hear a lot about is the hesitancy of the staffers, the caregivers at these long-term care facilities to get the vaccine. How do you solve that?

  • David Grabowski:

    This is a huge issue.

    So, the numbers we're hearing, about half of all staff aren't getting vaccinated. So that's much lower than the number of residents. We're hearing about 80, 85 percent of residents are choosing to get vaccinated, but far too few staff are getting vaccinated.

    Some facilities, it's quite good, but some facilities, it's 20 percent, 25 percent of staff. So, we have a long way to go there.

    How do we get better? I think we need to change the narrative here. The approach to date by the federal government has been, let's provide more staff with information. That's very necessary. We do need to convince them that this vaccine is safe and effective. They're quite worried about side effects. They're quite worried about safety.

    But they're also quite distrustful of nursing home management and leadership. They're distrustful of the government. It's not just the message they're hearing. It's who they're hearing it from.

  • John Yang:

    We're at a point where we're turning a page. We have a new administration coming in, rethinking this whole thing. If you were to be advising the new Biden administration, what would you tell them?

  • David Grabowski:

    I would tell them three things.

    First, we need to go faster. And CVS and Walgreens are doing a great job in some parts of the country, but it's going far too slow in others. Let's get other pharmacies involved in those areas of the country where things are moving too slowly.

    Second, we need to address the hesitancy. The rates among staff are far too low. We need to not just provide them with information. We also need to change who is providing that information. We need to rely on relationships, and we need to build trust with staff in terms of messaging.

    And then, finally, we have been flying blind. We have these national numbers on vaccine doses. We have very little information on the ground in terms of what's happening in facilities.

  • John Yang:

    David Grabowski, professor of health care policy at the Harvard Medical School, thank you very much.

  • David Grabowski:

    Thanks, John.

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