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Lindsay Wiley Profile picture
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8 Jan, 4 tweets, 1 min read
Some extended thoughts re: the problems with Operation Warp Speed’s Pharmacy Partnership for Long-Term Care Program & whether WV’s success as the only state to opt out offers a model for future efforts to actively send mobile teams out for on-site vax of high-priority pops.
I can hardly express my disappointment w/ economists, MDs & others calling for elected officials to abandon prioritization. Given that we don’t have enough doses to achieve herd immunity any time in the next 6 months, prioritization is critical to achieving public health goals.
The key question is *how to implement* prioritization. An active approach with mobile teams sent to offer vax on-site at high-risk/high-priority worksites & residential locations is critical to public health success.
WV had health depts working directly w/ individual pharmacies to deploy teams to every nursing home in the state by end of December vs. Operation Warp Speed shipped doses to mega chains & said you take it from here (they’re still telling nursing homes to be patient in January).

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More from @ProfLWiley

Lindsay Wiley Profile picture
10 Jan
Unless we switch to untested 1-dose protocol, we currently have enough doses nationally to vax 40% of over 65s. 40 million doses remaining = 20 million vaccinated. And that’s only if we don’t vax any more under-65 high-exposure folks in health care, education.
If we release all doses from ultra-cold storage right now, it will take careful planning & oversight to ensure we don’t accidentally force the untested 1-dose protocol on a lot of people. I’m not saying it can’t be done, just that caution is warranted.
If more states proceed with opening up access to anyone over 65 (and no one under 65) regardless of exposure/risk, which 40% (or less) of that group *actually* gets fully vaxxed will determine how rapidly we can reduce hospitalizations & deaths.
Read 4 tweets
Lindsay Wiley Profile picture
10 Jan
Without high engagement of well-resourced local health depts, privately run, profit-focused health care institutions/mega-pharmacies will do whatever is easiest/most aligned with their financial incentives to quietly get doses out the door. This is going to be the story all year.
Right now many are giving 1a doses to their own nonclinical, low-exposure, low-risk WFH employees (because it’s easiest & helps their bottom line) instead of doing the work to reach unaffiliated front-line clinical workers w/ smaller, more independent & less integrated employers
For phase 1b & beyond, hospitals receiving doses are quietly providing access to “enrolled” patients, leaving patients who lack a regular source of care/receive care from smaller, more independent community providers at the mercy of underfunded county programs
Read 9 tweets
Lindsay Wiley Profile picture
10 Jan
Lots of focus on temporary residents (snowbirds) being permitted access to county-run vax sites in FL. Notably, Oklahoma seems to have adopted an address verification system that’s causing trouble & slowing down it’s vax campaign.
State residency status shouldn’t matter from a public health perspective & denying benefits on that basis might infringe on constitutional right yo interstate travel.
Note: no indication so far that these are “vaccine tourists,” but that could certainly be happening/start happening soon.
Read 4 tweets
Lindsay Wiley Profile picture
8 Jan
This is the predictable result of entrusting the lion’s share of doses to private, profit-focused health care institutions & overseeing them based exclusively on how quickly they burn through doses rather than how well they reach the 1a populations they said they would.
We’ll see a similar dynamic in next phases. Major hospital systems will vax anyone among their “enrolled” patient populations who arguably meets criteria rather than doing the work of reaching folks who don’t have a reg source of care or working w/ community providers/partners.
This will further entrench market concentration, harm smaller, more independent primary care practices, erode equity, & undermine public health goals unless more doses are shifted to community providers & local health departments who partner w/ housing authorities, employers, etc
Read 4 tweets
Lindsay Wiley Profile picture
30 Dec 20
It’s not (just) fairness. Goal = reduce cases/hospitalizations/deaths as much as possible w/ scarce doses. Haphazard delivery to any readily available arm rather than doing the work to get it right -> running out b4 we reach those whose vax will most improve the situation for all
If we have (or expect very soon to have) enough doses for all, then by all means, take a shotgun approach (while tracking who gets what so appropriate follow up/2nd dose can be ensured) but we don’t have enough doses to do that yet.
If doses have been thawed & need to go somewhere ASAP, better to get them in any available arm than toss them. But even better to plan to avoid that scenario if possible.
Read 5 tweets
Lindsay Wiley Profile picture
30 Dec 20
This was predictable. This was predicted. Public health experts & state & local leaders have been sounding the alarm for months. We knew state & local govts needed fed funds to build vaccination infrastructure. Trump knew. McConnell knew. They didn’t care. Receipts attached.
July 2020, @NACCHOalerts letter to Congress. naccho.org/blog/articles/…
September 2020, @KHNews @LizSzabo
khn.org/news/health-of…
Read 8 tweets

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