By Holly Vossel | December 1, 2020

With coronavirus vaccinations currently in the works, the federal government is developing a framework for equitable allocation. Hospices are among the providers waiting for access to a vaccine, with concerns mounting about availability, efficacy and distribution. These concerns are coming to the forefront as the U.S. Centers for Disease Control and Prevention (CDC) has indicated that health care workers and nursing home residents would be the first to receive a vaccine as soon as one is approved by the Food & Drug Administration.

Since the beginning of November, three large drugmakers have announced development of promising vaccine candidates. COVID-19 vaccines are in testing and development at British-based pharmaceutical and biopharmaceutical company AstraZeneca (NASDAQ: AZN), Massachusetts-based Moderna Inc. (NASDAQ: MRNA) and pharmaceutical giant Pfizer Inc. (NYSE: PFE) in partnership with German BioNTech SE (NASDAQ: BNTX).

All three companies are seeking regulatory clearance of their vaccines. Another COVID-19 surge is hitting the nation hard as more than 167,000 new cases and 1,251 deaths occurred in the last week, according to reports from the CDC.

“We want to make sure that hospice providers are seen as a high-priority population as vaccines become available,” Hannah Yang Moore, chief advocacy officer for the National Hospice & Palliative Care Organization (NHPCO), told Hospice News. “We’ve been working with the Operation Warp Speed team to work through the planning for the allocation of vaccines, and we are pleased and comforted to know that they determined health care workers should be at the top of the list of ‘essential critical infrastructure workers.’ Hospice workers are included in that category.”

The U.S. Department of Health & Human Services (HHS) developed Operation Warp Speed to expedite production and delivery of 300 million safe and effective vaccine doses nationwide by January 2021, with the CDC among the health departments and partners working to develop vaccination distribution plans once one becomes available. Federal agencies have been pushing for accelerated development of a vaccine since the pandemic first hit the nation and has since claimed more than 267,300 lives over the last 11 months.

A coalition of national stakeholders organizations in home care and hospice submitted a letter today to the CDC’s Advisory Committee on Immunization Practices (ACIP) supporting draft recommendations pending the prioritization of vaccine access. The letter included signatures from the NHPCO, National Association for Home Care & Hospice (NAHC) and the Council of State Home Care & Hospice Associations, among others.

According to the letter, home care and hospice staff of all disciplines are included in the first group (Phase 1a) subject to access to the COVID-19 vaccine because the workforce is included in CDC’s Advisory Committee on Immunization Practices’ (ACIP) definition of health care workers.

Hospice staff are frequently in high-risk environments hardest hit by spread of the coronavirus as they access patients in hospitals, nursing homes and assisted living facilities. Those serving community-based patients also face a slew of risk factors from caregivers and family members in the home. Already understaffed with a depleting hospice and palliative workforce, many providers have been strained to support employees during the pandemic.

“We’re experiencing another surge and seeing more team members out with illness or quarantining because of exposures they might have had,” said Elizabeth Fowler, president and CEO of hospice and palliative care provider Bluegrass Care Navigators in Kentucky. “If we get sufficient vaccines and we are able to give our first and second doses to immunize staff between December and January, then February might look like a whole different scenario for us. A vaccine would be transformative to us and allow us to care for patients with less fear and risk of infecting them or being infected ourselves.”

The first 6.4 million doses of Pfizer’s coronavirus vaccine could become available as soon as mid-December, according to a report from The Washington Post. The federal government plans to issue the doses within 24 hours of regulatory clearance, with frontline health care workers to receive top priority, as well as nursing home residents.

The expediency and proportion of vaccines distributed to each state will be based on federal recommendations using population data of regional hotspots and infection rates. Federal agencies, state governments and the private sector have collaborated to produce an advisory list that states can use to inform their allocation efforts, according to Moore.

“The hard part is going to be access. How many vaccines we can get and how quickly we can get them,” said Balu Natarajan, M.D., chief medical officer of Seasons Hospice & Palliative Care, headquartered in Illinois. “As we get information, we will study it and make sure that we are transparent about that information to our staff by being as fair and balanced as possible in how we have these conversations around vaccines. Our staff have been exposed to the highest risk patients, the frail, elderly, and those already deemed terminal. The number one staff concern is whether they will get COVID, and number two is whether they are going to be the one bringing it to the patients.”

An additional concern among hospice providers is the efficacy of a first wave of COVID-19 vaccines amid the rush to bring them to market. Each of the three companies leading the way in vaccine development have reported high efficacy rates in preventing COVID-19 among participants in clinical trial studies. Pfizer and BioNTech were the first among them to announce that their vaccine was found to be more than 90% effective, with AstraZeneca announcing the same of its vaccine last Monday. Yesterday brought the most recent data with a report from Moderna reflecting that its vaccine’s efficacy against COVID-19 was 94.1% against mild cases of COVID-19 and 100% effective against severe cases.

The Pfizer vaccine requires two doses to achieve highest efficacy, according to the company, with protection achieved “28 days after the initiation of the vaccination,” which is required to be stored at cool temperatures. The capacity to store and track distribution of a COVID-vaccine may mean that hospices will need to work closely with their local pharmacies and state and federal agencies as they vie for supplies.

Hospice providers are assessing their internal distribution processes to determine prioritization among staff, with several turning to flu shot vaccine protocols for guidance.

“We are working with retail pharmacy partners to see what options they might have available for our organization,” said Christine Simmers, vice president of clinical logistics and resource utilization for Seasons. “We have protocols in place and work to ensure all staff get vaccinated in line with [the U.S. Centers for Medicare & Medicaid Services], state, and local guidance,” Simmers told Hospice News. “We have had a robust partnership with local consumer pharmacies to provide flu shots for the past several years with a mix of onsite clinics and vouchers when needed for our staff. We track and document flu vaccine administration for all staff, as well as have robust internal communications plans promoting flu vaccines and infection control during the flu season. We do anticipate these being a roadmap for a COVID vaccine once one is available.”

With news and updates still evolving rapidly on the transmission and treatment of COVID-19, hospices may need to band together to endure the pandemic as 2020 comes to a close. Partnering with other local providers may add strength in numbers in competing for vaccine supplies as they become available before the end of December. Regional partnerships among hospice providers could prove to be mutually beneficial in sharing and allocating vaccines among staff.

“Each day we are learning more information, it is like the ocean flowing into the shore, it is ever-changing,” said Sharon Branham, president & CEO of Appalachian Hospice Care. “The most frightening to me is that we still have so much to learn, how to best treat those we care for who are infected, how to protect our staff and their families. Partnering with other providers is a way to support obtaining vaccines, as there is more effectiveness in many voices together rather than singular providers trying to obtain just enough vaccines for their staff.”