Thread by @ProfLWiley

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.

https://twitter.com/jasonlschwartz/status/1348265192791175168

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

That’s already happening in many places & will be coming soon to many more.

Hospitals should absolutely play a big role in the vax campaign. Offering access to their enrolled patients through a “push approach” (we’ll call you to schedule an appt when it’s your turn) makes sense & supports efficient, records-based eligibility/prioritization. BUT...

US health care system is HIGHLY fragmented & segregated by race, ethnicity, SES, immigration status, etc. The big, monopolistic hospital systems receiving lots of doses have worked to ensure their “payer mix” is favorable (plenty of private-ins, not too many uninsured/Medicaid).

Meanwhile, the local health departments competing for (publicly purchased) doses with major private hospital systems have partnerships, expertise & mission-focus on the needs of the most vulnerable/marginalized but are (not at all coincidentally!) chronically underfunded.

Good news though: Congress finally appropriated funding for vaccine roll-out at the end of Dec & more competent, better-intentioned fed leadership is on the way. Now, next week, next month, we must insist that state & local public health depts get that $ quickly.

We must insist that a bigger share of doses go to (or are directed by) local health depts in future shipments, particularly those partnering w/ local high-risk worksites, housing authorities, depts of corrections, etc to send teams to places where high-priority groups live & work