Is the U.S. healthcare system ready to take on the enormous responsibility of administering an estimated 300 million COVID-19 vaccinations?
Healthcare professionals will face challenges, experts from insurance broker Aon say. Most of those giving the injections will have experience administering vaccines, although some may not. They will have to follow strict guidelines from the manufacturers for storage and handling of the drugs. They will rely on the guidance and training from the Center for Disease Control (CDC), including how to return patients for their second shots.
While there is government protection, health care providers and institutions still face potential liability issues during the program, even as they struggle to vaccinate their fellow frontline workers simultaneously.
Aon has a dedicated health insurance and risk services practice that has served the industry for 35 years. Insurance diary Two experts – Neal Mills, chief medical officer at Aon, and Gigi Norris, co-leader of Aon's infectious diseases task force – asked their views on the health care challenges posed by the ongoing COVID-19 vaccine program.
Who is going to take the actual photos?
Mills: Doctors, nurses, doctor's assistants, nurse practitioners, pharmacists, pharmacy technicians will be the main providers of vaccinations. In some cases, dentists, optometrists, and students from various health professions can also administer vaccines.
What kind of training, license, authorization, etc. are required of those giving shots?
Mills: Licensing and authorized vaccine providers depend on federal and state guidelines, which are still under development.
Do you expect these requirements to be relaxed?
Mills: Expect temporary and / or emergency permits for relaxed vaccine supplier eligibility criteria for many states and territories in the United States. 300 million Americans have yet to be vaccinated.
Will it be challenging to keep an eye on patients who receive the first shot and need to be contacted for the second shot?
Mills: Keeping track of who hasn't gotten the second dose is going to be a huge challenge for the healthcare industry. Look for comprehensive systems with some built-in redundancies to ensure the 2nd dose is delivered, including reminder cards delivered with the vaccine, digital prompts, and state and federal registries.
CDC has provided requirements and expectations of vaccination administrators and vaccination program providers on pages 35-41 of CDC COVID-19 Vaccination Interim Playbook (https://www.cdc.gov/vaccines/imz-managers/downloads/COVID-19-Vaccination-Program-Interim_Playbook.pdf) with regard to documentation, reporting, second dose reminders, and immunization information system requirements, and those requirements and expectations may be further adjusted at the jurisdiction level.
It appears the vaccines are being shipped to CVS stores and Walgreens, as well as hospitals, clinics and other suppliers. Are they all equipped and trained to handle, store and administer vaccines?
Norris: The vaccine will be administered by licensed healthcare professionals. Enrolled COVID-19 vaccination providers must have identification / license in the jurisdiction where vaccination takes place, and sign and agree to the terms of the CDC COVID-19 Vaccination Program Provider Agreement. (See pages 21-24 in the CDC COVID-19 Vaccination Interim Playbook for requirements and expectations: https://www.cdc.gov/vaccines/imz-managers/downloads/COVID-19-Vaccination-Program-Interim_Playbook.pdf, as well as requirements and expectations at the state and local levels where the CDC guidelines are adapted to the local situation – see https://www.cdc.gov/vaccines/covid-19/covid19-vaccination-guidance.html for links to State Playbook Executive Summaries and https://www.kff.org/policy-watch/how-are-states-prioritizing-who-will-get-the-covid-19-vaccine-first/ for links to updated details for individual states.)
Norris: Training of COVID-19 vaccination providers is essential to ensure the success of the COVID-19 vaccination program. CDC will have many educational resources available for use, but immunization programs may develop or use other materials in conjunction with CDC materials.
Jurisdictions must determine the most efficient methods of delivering and conducting training. Jurisdictions are not required to provide training to federal entities and commercial partners receiving direct vaccine assignments from CDC. (See page 22 https://www.cdc.gov/vaccines/imz-managers/downloads/COVID-19-Vaccination-Program-Interim_Playbook.pdf).
CDC has put together a number of clinical training courses and resources for health care providers who will be working with the COVID-19 vaccine. https://www.cdc.gov/vaccines/covid-19/downloads/COVID-19-Clinical-Training-and-Resources-for-HCPs.pdf. For more information on CFS and Walgreens for the long-term care vaccination program, see further CDC guidelines at https://www.cdc.gov/vaccines/covid-19/long-term-care/pharmacy-partnerships.html.
As we understand from our healthcare clients, who are currently receiving and administering vaccines, their vaccination programs will be based on plans previously developed for previous public health events, such as H1N1 and Ebola, as well as on their own internal flu vaccination campaigns.
Are there specific requirements for storage, handling and administration of these vaccines compared to previous vaccines?
Mills: Yes. Each candidate vaccine has specific storage and handling requirements. We expect this information to change depending on which vaccine (s) the Food and Drug Administration approves or approves.
What should healthcare providers pay attention to and what should they do after receiving the vaccines?
- Inspect and replenish the dry ice pellets within 24 hours of receiving the shipment
- Wear special gloves to protect against injury when handling the dry ice pellets during re-freezing (see the Laboratory Safety: Guide to Cryogens and Dry Ice (PDF) of the Occupational Safety and Health Administration for more information)
- Ice again every five days, limiting openings to two openings per day to maintain ultra-low temperatures
- Ice again up to three times.
- After 15 days in the thermal shipper, you can store the vaccine for an additional five days in a refrigerator at 2 ° C to 8 ° C.
There are limited guidelines for additional security requirements that hospitals and clinicians must comply with.
Do typical insurance policies expect to handle such a program?
Norris: The public health emergency declarations in many states and local jurisdictions, as well as the federal PREP law, may provide some measure of legal immunity to healthcare providers involved in conducting COVID-19 countermeasures. Healthcare professionals and healthcare entities also typically purchase healthcare professionals liability policies designed to provide cover for bodily injury / property damage in the event of injury to the patient, including such injuries related to the administration of vaccines.
Also, the federal government recently set up an outgrowth program, the Countermeasures Injury Compensation Program (CICP), to provide compensation to individuals injured by the COVID-19 vaccine administration process. CICP is intended as a payer of last resort and can only reimburse or pay for medical services or items or foregone employment income that is not covered by other third party payers, such as health insurance, Veterans Affairs benefits or Workers' Compensation.
Drug makers are protected from liability for the vaccines, and any claims for damages go to a taxpayer-funded federal program. However, are there areas where the cause of injuries could be uncertain or due to a healthcare professional's error?
Norris: Yes. Injuries or adverse events can occur if a health care professional improperly administers the vaccine. For example, damage to the muscles, nerves and tendons in the upper arm and shoulder can occur during the administration of a vaccine administered in that area. This usually occurs when the person administering the vaccine injects the patient too high on the shoulder or too deep into the deltoid muscle. For individuals diagnosed with injuries as a result of routine vaccinations, compensation may be available through the National Vaccine Injury Compensation Program (VICP). The federal government has recently established an outgrowth program called the Countermeasures Injury Compensation Program (CICP), as discussed above.
How do healthcare employers approach vaccinating their own employees? Do they need this from most employees?
Mills: Most employers are not expected to require the administration of a vaccine if long-term studies have demonstrated neither efficacy nor safety. Millions of doses must be administered before this action is considered by employers. The vaccine offers an opportunity to protect the health of entire worker populations. Most employers will lead in their community by educating what we do know about the vaccine, through emerging campaigns, pledges and ensuring that it is covered at no cost to the worker or their families. This crucial mission is now underway.