Primary-care physicians have unparalleled access to older patients with chronic conditions and communities of color. What they don’t have is a supply of COVID-19 vaccines
Family doctors are a trusted gateway to the health care system for scores of New Jersey residents — including many with underlying medical conditions — but they have so far played a limited role in the state’s efforts to distribute COVID-19 vaccines.
While short supply has hampered the immunization process from the start, physicians in New Jersey and elsewhere said they stand ready to assist as more doses become available. Primary-care doctors are uniquely positioned to help reach vulnerable individuals considered priorities for vaccination, they note, and have a long history of providing flu shots and other inoculations.
“New Jersey has a well-developed network of primary-care and internal medicine practices with the ability and capacity to administer hundreds of thousands of doses of the vaccines to residents over age 65 and all adults with chronic health conditions who are higher risk of disease,” Dr. Philip E. Kline, president of the Medical Society of New Jersey, said in a statement circulated to members earlier this month. “The federal and state public health officials must find a way to get vaccines into physician practices in order to meet the laudable vaccination goals set out by Gov. Murphy.”
Primary-care physicians ready to go
Dr. Mike Cascarina, the incoming president of the New Jersey Academy of Family Physicians agreed. “This is what we do every year,” he said, noting there are at least 10 clinicians at his Brick practice who are trained and ready to administer injections. “We could be vaccinating hundreds of people every week if we just had access to the vaccine.”
More than 1.5 million doses of COVID-19 vaccines have been administered in New Jersey since the state began immunizing people in mid-December, with nearly 437,000 people receiving the two doses required for maximum protection. The state is seeking to inoculate 70% of the eligible adults, or 4.7 million people, by this summer in an effort to provide effective community protection against the virus.
To get there, the state has established nearly 300 vaccination sites, including hospitals, large county or state-run operations, local public health facilities, drugstores and community clinics. Nearly 1,800 medical providers are registered with the state as administrators, according to the Department of Health, of which 575 are physicians. The list includes several large practice groups — including Riverside Medical Group, with offices in 11 counties, Hunterdon Family Medicine, Summit Medical Group and Vanguard Medical Group.
Health Department Communications Director Donna Leusner said the DOH chose large, mujlti-site physician groups with locations in areas where vaccine clinics were needed and had the capacity to safely store large shipments. (The Pfizer vaccine requires freezers that reach nearly 90 degrees below zero; Moderna’s version needs special refrigeration.) Some of these practices operated only temporarily, she said, before the state’s supplies ran short.
Vaccine shortages limit physician participation
Limited supply has also prevented DOH from adding more doctors’ offices to the list of administration sites, Leusner added. “As supply increases and new vaccines are approved, there will be opportunities to expand the network of vaccine providers including physician groups,” she said.
Cascarina, the family doctor in Brick, said the sooner the state can involve more primary-care providers the better. Patients ask him every day about how to get vaccinated, he said, and the storage issues aren’t a concern for facilities like his that have regular experience with these serums. “There’s no way we’d stock these things if we couldn’t properly house them or distribute them,” he said. “I just think the infrastructure isn’t set up at the state level to allow for distribution to small- or medium-sized practices.”
The DOH is also relying on 21 of the 23 Federally Qualified Health Centers to help reach low-income communities in urban and rural areas and improve the racial equity of vaccine distribution. The state has sought to prioritize people of color for the vaccine in hopes of offsetting the disproportionate impact the disease has had on Black and brown communities. Minorities are more at risk for infection because of their jobs and other factors and more likely than whites to be hospitalized or die from COVID-19.
But so far, this has proved challenging. Restrictive work schedules, transportation gaps and limited internet access are among the factors that experts said contribute to keeping Black and brown people from accessing vaccines. In New Jersey, more than half the vaccines have gone to white residents so far, while just over 5% have been given to Hispanics and barely 3.7% to Blacks.
Best way to reach Black communities
Some suggest that leveraging primary-care physicians is the best way to reach these communities and other vulnerable people prioritized for vaccination, like those with COPD, diabetes or heart disease. This will become even more important as vaccine supply increases, something that could start to happen soon if a one-shot serum from New Jersey-based drugmaker Johnson & Jonson receives emergency federal authorization as expected. (This vaccine only requires regular refrigeration.)
“Community based physicians can essentially identify who is most at risk,” said Larry Downs, the Medical Society of New Jersey’s CEO. If these providers aren’t used to distribute vaccines themselves, Downs and Cascarina suggested doctors should be empowered to recommend patients who are a priority for the vaccine by issuing them a prescription that gets them an appointment at an immunization site.
This conversation is taking place in other regions as well, according to those involved. Medical societies from a half-dozen northeastern states, including New Jersey, are expected to urge President Joe Biden to give community-based physicians a greater role in the vaccine distribution strategy nationwide.
Countries like England and Israel, with more developed systems of primary care, have given doctors a larger role in vaccine distribution, Dr. Ezekiel Emanuel, a University of Pennsylvania professor and previous coronavirus adviser to Biden, told the New York Times. Half of the roughly 500,000 primary-care doctors in the United States regularly administer vaccines, the article noted. But according to the nonprofit Primary Care Collaborative, one in five of these physicians is currently involved in the vaccine rollout nationwide.