COVID-19 vaccine rollout relies heavily on CVS and Walgreens

Plans to begin delivering COVID-19 vaccines this month to millions of vulnerable Americans will depend not on public health departments, but largely on the two largest for-profit pharmacy chains in the country.

CVS Health and Walgreens Boots Alliance were chosen by the Trump administration to vaccinate more than 3 million residents of nursing homes and other long-term care facilities, who are expected to receive the first wave of vaccines around the next week. .

This role highlights the power and reach of the two companies, which together have about 20,000 pharmacies across the country. It also highlights how, after years of underinvestment in public health, the United States relies heavily on companies for critical public services, such as immunizations.

“We’re in a situation where we don’t have a public sector that can do something like this,” said Jeffrey Levi, former director of the nonprofit Trust for America’s Health. “We have to work with the system we have.”

Federal officials say the partnership with drug companies is a model that will get vaccines quickly to patients in need.

“I am incredibly confident that these public-private partnerships are ready to go,” US Army General Gus Perna told reporters this week. Perna is the chief operating officer for Operation Warp Speed, the federal initiative to support the development and distribution of COVID-19 vaccines and drugs.

However, some public health leaders remain wary of the heavy reliance on multi-million dollar corporations, whose primary duty is to their shareholders, especially as the companies’ full scope of vaccine distribution remains secret.

CVS, Walgreens and the US Department of Health and Human Services would not provide copies of the agreements signed between the companies and the federal government.

“Ultimately, these are businesses,” said Lori Tremmel Freeman, who heads the National Association of city and county health officials. “They are not the same as a health department, whose duty is to keep people safe. Health institutions have no other motive. They do not care about the end result ”.

Various health experts have warned that while CVS and Walgreens may have the logistical capacity to bring the vaccine to thousands of nursing homes and assisted living centers across the country, they may not be the best option to help other populations. vulnerable, including low-income and minority communities most affected by the pandemic.

“We’ve learned over the years that the private sector, in general, does a very poor job of reaching at-risk populations,” said Christopher Koller, former Rhode Island state insurance commissioner who heads the Milbank Memorial. Fund, a nonprofit organization that supports health system research.

Walgreens, while advertising itself as a “health and wellness company,” continues to sell cigarettes and other tobacco products, despite repeated requests from public health officials to end the practice. (CVS stopped selling tobacco products in 2014).

Senior executives at CVS and Walgreens insist they are dedicated to the public health effort.

“We are a company that is meant to help people on the path to better health,” said CVS Vice President Chris Cox, who is working with the federal government on the vaccine distribution effort.

Rick Gates, vice president of Walgreens, noted that vaccination clinics “are critical to what we do.”

The initiative has been welcomed by the long-term care industry, who complained for months that the federal government failed to bring vital protective equipment to its facilities.

There is little controversy about the importance of immunization. The pandemic has devastated long-term care facilities since the first major outbreak at a nursing home was recorded in February in Kirkland, Washington.

More than 100,000 residents and staff of these centers have died, representing approximately 40% of deaths from COVID-19 in the country, according to a count by the nonprofit Kaiser Family Foundation.

The vulnerability of these institutions led the Centers for Disease Control and Prevention to advise states to prioritize nursing home residents and health care workers when vaccines are available. Federal officials explained that they selected CVS and Walgreens because of the companies’ vast network and experience in servicing long-term care facilities, many of which already work with them to obtain annual flu vaccines.

“We solicited input and had conversations with many different potential partners, the vast majority of whom told us that they just couldn’t keep up with this volume,” explained Paul Mango, deputy chief of staff for the federal Department of Health and Human Services.

Under the CDC’s Pharmacy Partnership for Long-Term Care program, nursing homes and other facilities were invited in October to select one of the pharmacy chains to deliver and administer the vaccine to its residents and staff. More than 25,000 facilities selected CVS, according to the company. About 23,000 chose Walgreens, Gates said.

Federal officials and company leaders anticipate that once the first vaccines gain regulatory approval from the Food and Drug Administration, they will ship in a day or two. In many cases, vaccines are likely to go to distribution centers set up by pharmacies, which in turn will send teams to the facility, to begin immunizations.

Vaccines purchased by the federal government will be administered at no cost to patients and care facilities. But CVS and Walgreens can charge for the administration of the vaccines.

The Medicare payment rate is $ 16.94 for the first injection and $ 28.39 for the second, according to the fee schedule from the federal Centers for Medicare & Medicaid Services. Both Pfizer and Moderna, whose COVID-19 vaccines are expected to get approval first, require two injections.

That means CVS, which plans to vaccinate more than 2 million nursing home residents, most of whom are likely covered by Medicare, will receive a payment of at least $ 90 million. Walgreens declined to reveal how many people it hopes to vaccinate.

Significantly, companies will need to report vaccination data to local, state and federal public health officials, a key component of any initiative of this caliber.

With Pfizer’s vaccine scheduled to be reviewed by an FDA panel next Thursday, the first shipments could take place the following weekend, according to federal health officials. Moderna’s is scheduled for review the following week.

Dr Moncef Slaoui, Operation Warp Speed’s chief science advisor, informed reporters this week that there should be a large number of vaccines to reach the 3 million residents of long-term care facilities, before the end of year.

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