CT COVID vaccination rates are half that of flu as availability is limited to certain pharmacies

CT Insider – Saturday, October 26, 2024
By Jordan Nathaniel Fenster

The days of free and easy access to COVID-19 vaccines with pharmacy pop-up and drive-thru inoculation sites are over, and many are finding it difficult to get and pay for a shot, sending vaccination rates tumbling to half that of seasonal flu shots, health officials say.

Scott Roberts went to get his child vaccinated against COVID-19 in 2022 and had more trouble than he expected. 

“I couldn’t find a pharmacy that offered it to that age group, and I had to either find a traveling van that the state offered, or I had to go to a health district an hour away,” Roberts said, noting the U.S. Centers for Disease Control and Prevention and the state both endorsed his child being vaccinated.

Roberts is, in fact, a health care professional and an infectious disease specialist. As associate medical director of infection prevention at Yale New Haven Hospital, he thought it wouldn’t be much of a problem. 

“I was like, I have connections at the state,” he said. “If this is this hard for me, how the heck is a patient supposed to get somebody vaccinated?”

While the shift to pharmacy-first COVID vaccinations was touted as an effort to increase access, some health care providers see that move to privatization as contributing to lower vaccination rates.

Though state Department of Health spokesman Chris Boyle said providers are still the main channel for vaccinations, states have largely outsourced vaccinations.

The belief is that somehow the private sector could do it, said Mark Masselli, president, CEO, and founder of Community Health Centers.

“The private sector is never going to spend one extra dollar going door-to-door into communities,” he said. “To some degree or another, they’ve taken the easy route of, ‘Hey, we’re here for you, but we’re not going to get into the debate.’”

Vaccine rates down

When the latest formulations of the COVID-19 vaccine was released, large pharmacy chains had them in stock a week or more before doctors or hospitals.

That wasn’t always the case. When COVID-19 vaccines first became available during the height of the pandemic, Connecticut residents were vaccinated en masse. 

Parking lot-sized vaccination sites were dotted across the state, pop-up vaccine vans were not an uncommon sight, and providers went directly into nursing homes, senior centers, homeless shelters and churches to bring the vaccine to people who might otherwise not get vaccinated. 

“We ran the four mass vaccination sites: Danbury, Stanford, Middletown and East Hartford, and then we had 20 seven-day-a-week COVID sites,” Masselli said. “During that one-year period, maybe a year-and-a-half, 832,000 unduplicated Connecticut residents came through our doors” to get a shot.

Then, in 2021, President Joe Biden announced the Federal Retail Pharmacy Program for COVID-19 vaccination, a “public-private partnership with 21 national pharmacy partners and networks of independent pharmacies representing over 40,000 pharmacy locations nationwide,” according to a White House Press release. 

Three years later, COVID vaccination rates in Connecticut are half of those formulated against flu. There have been 406,145 flu vaccinations given since Aug. 3, and 202,189 COVID vaccinations since Aug. 31, according to state data. 

There are probably lots of reasons for that. State health Commissioner Manisha Juthani said recently that because COVID has not been as seasonal as the flu, people have been getting COVID here and there throughout the year, and perhaps don’t think they need a COVID shot or booster later on. 

“Certainly, there’s a bit of COVID fatigue,” she said of the guidance on when to get vaccinated against COVID. 

But some health care providers argue that the shift to pharmacy-first COVID vaccinations is another reason why vaccination rates have stagnated. 

“The role that public health in Waterbury or Middletown or Stamford would have played in the past, those programs have been emasculated,” Masselli said. “We’ve lost this network out there that would be roaming all the neighborhoods. They’d be at the senior centers, they’d be out there. That just has been lost.”

The case in favor of shifting to pharmacies

There is some evidence that the shift to pharmacies benefited the goal of wider access to vaccination.

According to the CDC, of the 59.8 million COVID-19 vaccine doses administered in the United States between Sept. 1, 2022 and Sept. 30, 2023, 67.7 percent were administered by pharmacies participating in the federal partners program.

“FRPP partnerships were critical in ensuring access to bivalent COVID-19 vaccination services in the United States and could serve as a model to address vaccination services needs for routine vaccines and during future responses to vaccine-preventable disease emergencies,” the CDC wrote. 

A 2022 study from researchers at the University of Minnesota, published in the Journal Innovations in Pharmacy, found that “Community pharmacists are uniquely positioned to fulfill this mission by being a point of contact for the COVID-19 vaccination efforts.”

But that study also found that the FRPP suffered limitations that impacted its effectiveness. 

For example, “Discrepancies in vaccine allocation led to pharmacies not knowing when they would receive the vaccines and, therefore, could not accurately track inventory,” the study said. 

The study also found a lack of trained workforce at the pharmacies tapped to distribute vaccines. 

“There was insufficient vaccination training at the onset, and pharmacists became burnt out over the increased vaccination workload. Inadequate training of pharmacists in dispensing the COVID-19 vaccination led to vaccine waste,” the study showed. “Less than 28 percent of states have adequate licensed staff to give vaccinations, leading to a workforce being ill-prepared to handle the surge of patients, which led to long wait times at pharmacies.”

Loss of funds also an issue

In 2021, a total of $88.3 million in federal funds were distributed to local community health care organizations to fight COVID-19, according to data from the federal Health and Human Services Agency.

A year later, that funding had dropped to $1.1 million.

“It was just too much money all at once, in too short of a time. No long-term strategy,” Masselli said. Then states looked around and said, “‘Hey, we’re basically out of the money. What are we going to do?’ They then punted on this and brought in the CVS and said they’re going to do it.”

Amy Thibault, a spokesperson for CVS, said, “Pharmacists have been administering vaccinations — like the flu shot — for years, long before COVID-19 emerged,” delivering more than 88 million COVID vaccinations since the pandemic began. 

“Since the pandemic began, the work of our store, pharmacy and clinic teams was not only extensive, but potentially lifesaving for the millions of patients we served,” she said. 

Boyle agreed. “Pharmacies played a huge role in vaccinating the population during the COVID-19 pandemic, supporting the rollout while providers were dealing with sick appointments, staffing issues, etc.,” he said. 

“Additionally, the public became accustomed to the convenience of scheduling vaccinations at times most convenient to them during the pandemic,” Boyle said. “This might be one reason why more people are seeking vaccinations at pharmacies.”

Recently, CVS, RiteAid and Walgreens — all three of which have been part of the federal pharmacy partnership since its inception — have announced deep cuts. 

Walgreens has announced plans to close 1,200 pharmacies over the next three years. RiteAid closed more than 520 stores since October 2023 and only recently emerged from Chapter 11 bankruptcy. CVS has also announced a series of layoffs, though Thibault said “impacted positions are primarily corporate roles.” 

“The reductions will not impact frontline jobs in our stores, pharmacies, and distribution centers,” she said.

But David Cadden, a professor emeritus at Quinnipiac University’s School of Business, told CTInsider that, “CVS, RiteAid and Walgreens all overbuilt in Connecticut. As a result, I expect more than 25 percent of their stores aren’t making money right now. And that will result in the poor getting shortchanged in terms of health care once again.”

COVID vaccines are also no longer free, with the end this year of federally funded programs subsidizing vaccination. That, Roberts said, should work to the pharmacies’ advantage.

“It should be the pharmacies’ incentive to get people vaccinated, because they can monetize that,” he said. 

But Masselli believes the opposite is also true. If pharmacies can’t make money on vaccinations, they won’t promote them. 

“If you’re not getting your return on the investment, you’re not going to spend any dollars,” he said.

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