It was a relatively quiet week on the COVID front—so quiet that President Biden held his first White House press conference last week and wasn’t asked a single question about the pandemic, which continues to be a race between vaccinations and virus variants.
Not that nothing happened this week: it was a rocky week for AstraZeneca, which was hoping to change the narrative over its vaccine, which has stumbled in its rollout in Europe, by reporting positive results from US trials.
After a press release announcing that the vaccine was found to be 79 percent effective against symptomatic COVID, an independent review board called the results into question, pointing out that the report was based on data that had not been fully updated. That earned a swift and unusual rebuke from the National Institutes of Health (NIH), forcing the company to correct its findings—to 76 percent.
A relatively minor difference, but the dust-up served to further undermine confidence in the company’s COVID jab, especially troubling in Europe where hesitancy and distribution have been a vexing problem, and concerns about blood clots associated with the AstraZeneca shot caused several countries to pause inoculations. Given the supply of already-approved vaccines from other manufacturers in the US, it’s not clear that the AstraZeneca shot will play a big role here, but it is critical in other parts of the world, especially as part of the global COVAX initiative targeted at developing countries, since the vaccine can be stored at normal refrigerator temperatures.
The company’s set-to with American regulators also highlighted another challenge that’s become common during the COVID pandemic: conducting scientific review by press release, as the global emergency has required the otherwise slow-moving research community to move at lightning pace.
Meanwhile, back at that relatively dull White House press conference, one piece of encouraging news:President Biden doubled his “first 100 days” goal for vaccinations to 200M shots, a goal that seemswholly achievable, given that 2.5M Americans are being vaccinated every day, on average.
Top public health experts and officials are developing new strategies to reach out to the conservatives most skeptical of or hesitant about receiving a coronavirus vaccine.
The efforts are targeting supporters of former President Trump, who have emerged as the most significant hurdle to widespread vaccination.
The officials and experts are making appearances on Fox News and Newsmax and taking part on panels with prominent conservative politicians to reach out to vaccine skeptics on the right.
And the public health experts are not taking an antagonistic approach either. They say many conservatives have legitimate questions about COVID-19 vaccinations that are worth listening to and answering.
“These are folks who really feel disrespected. They feel that COVID and the vaccines and the response has been politicized and weaponized, in their words,” said Tom Frieden, the former director of the Centers for Disease Control and Prevention under President Obama. “They feel deeply alienated from the government.”
Up to now, the main problem with increasing vaccinations has been one of supply and demand, but administration officials expect that to change shortly.
“We are approaching the point where we will have a sufficient supply of vaccines for everybody in the United States to have the chance to get immunized by the end of May,” Francis Collins, director of the National Institutes of Health (NIH), said in an interview with The Hill on Wednesday.
At that point, convincing skeptical conservatives to get a shot could mean the difference between the U.S. achieving herd immunity and resuming normal life or variants of COVID-19 getting second and third winds, leading to new lockdowns or restrictions on life.
As Collins puts it, “the hesitancy will begin to become the defining factor on whether we reach herd immunity or not.”
“I think that means this has to be the moment where we really pull into this conversation all of the trustworthy voices,” he added.
A recent CBS poll found a third of Republicans said they would not be vaccinated, compared to 10 percent of Democrats. A “PBS NewsHour” poll showed similar results: Nearly half of U.S. men who identify as Republicans said they have no plans to get vaccinated.
The underlying mistrust comes after a year in which Trump and his allies played down the severity of a virus that has killed more than half a million Americans already.
Circumstances have conspired to allow that skepticism to grow: The coronavirus arrived later in more rural, conservative enclaves than it did in liberal metropolitan areas like Seattle, New York and Detroit, giving some the sense that they had been locked out of the economy to protect against a virus that was not yet present in their community.
Julie Morita, executive vice president of the Robert Wood Johnson Foundation, who advised the Biden transition team on COVID-19 issues, said she has been surprised to see how political vaccine hesitancy has become.
In the past, Morita said, public health officials have focused on race and ethnicity. “We didn’t really look at politics or political affiliation,” she said.
Morita said her message remains the same, but that she has had to focus on where to deliver it. She recently co-wrote a Fox News op-ed answering some of the common questions about the available COVID-19 vaccines and urging people to get the shots when they’re available.
“Whether you’re a community of color, or whether you’re a conservative, these are the questions that people ask and want to have the answers to before they get vaccinated,” Morita said. “I don’t feel like that’s a shifted message as much as maybe we’re just able to get it into a more conservative news outlet.”
Convincing a group of people who did not vote for the president presents a challenge to a Democratic administration. So President Biden has been outsourcing the message.
Appearing on Hugh Hewitt’s radio show this week, Anthony Fauci, the director of the National Institute for Allergy and Infectious Diseases, said he doesn’t shy away from conservative outlets that may not be friendly.
“I say yes to a wide variety of requests. I’ve been on Fox multiple times, so I don’t shy away from that, no,” Fauci said.
Health officials are increasingly convinced that successful messaging is not going to come from politicians or government officials but from doctors, clergy and trusted community leaders.
Last month, Frieden participated in focus groups with vaccine-hesitant Republican voters led by veteran GOP pollster Frank Luntz.
The groups, first reported by The Washington Post, showed vaccine-hesitant conservatives were not swayed by Republican politicians like House Minority Leader Kevin McCarthy (Calif.) or former New Jersey Gov. Chris Christie — or even by Trump himself.
Instead, Frieden said, the message that moved the hesitant to the accepting hit closer to home: Their doctors took the vaccine when it was offered.
“You listen to the audience, you understand where they are and you address their concerns. And that’s the same thing we have to do for Trump voters who are reluctant to get vaccinated or African Americans or Latinx or vegans who don’t want to get vaccinated,” Frieden said.
Morita said she thinks the same efforts and resources that go into convincing communities of color should also be directed at conservatives.
“High-level government officials espousing the importance of vaccines and sharing their experiences with it is really important but it’s not sufficient,” Morita said.
Support for Trump and a distrust of the government is not the only reason conservatives might be reluctant to accept the vaccine. Many are concerned about how quickly the vaccines were developed.
Still others object on religious grounds, which is where Collins, the NIH director, comes in.
A devout Christian who is open about his faith, Collins has become an ambassador to the faith community. He spends hours a day talking to faith leaders, assuring them of the vaccine’s soundness and science.
Collins told The Hill he frames the decision to get vaccinated in religious terms.
“Is this a love your neighbor moment? Yes, it is,” Collins said. “And whatever faith you are, the Golden Rule seems to apply, and the Golden Rule would say, for your neighbor or for your family, for your neighbors down the street who may be vulnerable, this is something you can do for them.”
Roanoke, Va.-based Carilion Clinic is suing its insurance provider, American Guarantee and Liability Insurance Co., after the insurer allegedly refused to cover the system’s losses tied to the COVID-19 pandemic, according to WSLS.
Carilion Clinic says it has lost more than $150 million because of the pandemic. American Guarantee allegedly refused to provide coverage or properly investigate Carilion Clinic’s losses, according to the complaint filed March 18.
“To cushion the impact of the coronavirus and COVID-19, Carilion Clinic turned to its property insurer, AGLIC, to whom Carilion Clinic had paid nearly $1 million in premiums in exchange for $1.3 billion in property damage and time element (also known as business interruption) coverage effective June 1, 2019 to June 1, 2020,” the lawsuit states. “AGLIC, however, declined to fulfill its obligations to Carilion Clinic under the policy.”
Carilion is seeking damages for breach of contract and a judgement declaring the scope of American Guarantee’s obligation to cover the losses under the policy.
As of March 24, American Guarantee had not filed a response to the complaint.
Some countries have stockpiles. Others have nothing. Getting a vaccine means living in the right place — or knowing the right people.
A 16-year-old in Israel can get a vaccine.
So can a 16-year-old in Mississippi.
And an 18-year-old in Shanghai.
But a 70-year-old in Shanghai can’t get one. Older people are at high risk for severe illness from Covid-19. But Chinese officials have been reluctant to vaccinate seniors, citing a lack of clinical trial data. Neither can an 80-year-old in Kenya. Low vaccine supply in many countries means only health care employees and other frontline workers are eligible, not the elderly.
Nor a 90-year-old in South Korea. Koreans 75 and older are not eligible until April 1. Only health care workers and nursing-home residents and staff are currently being vaccinated. The government initially said it was awaiting assurances that the AstraZeneca vaccine was safe and effective for older groups.
Anyone in Haiti.
Anyone in Papua New Guinea.
Anyone in these 67 countries. These countries have not reported any vaccinations, according to Our World in Data. Official figures can be incomplete, but many countries are still awaiting their first doses.
It wasn’t supposed to be like this: Covax, the global vaccine-sharing initiative, was meant to prevent unequal access by negotiating vaccine deals on behalf of all participating nations. Richer nations would purchase doses through Covax, and poorer nations would receive them for free.
But rich nations quickly undermined the program by securing their own deals directly with pharmaceutical companies. In many countries, they have reserved enough doses to immunize their own multiple times over.
Anyone who can afford a smartphone or an internet connection in India and is over 60 can get one. Mostly wealthy Indians are being inoculated in New Delhi and Mumbai, hospitals have reported, since vaccine appointments typically require registering online. Less than half of India’s population has access to the internet, and even fewer own smartphones.
And anyone who can pay $13,000 and travel to the U.A.E. for three weeks and is 65 or older or can prove they have a health condition.
A member of Congress in the United States. Friends of the mayor of Manaus, Brazil. Lawmakers in Lebanon. A top-ranking military leader in Spain. The extended family of the deputy health minister in Peru. The security detail to the president of the Philippines. Government allies with access to a so-called “V.I.P. Immunization Clinic” in Argentina. Around the world, those with power and connections have often been first in line to receive the vaccine — or have cut the line altogether.
A smoker in Illinois can get one.But not a smoker in Georgia.
A diabetic in the United Kingdom can. A diabetic in Connecticut can’t.
Countries have prioritized different underlying health conditions, with the majority focusing on illnesses that may increase the risk of severe Covid-19. In the U.S., health issues granted higher priority differ from state to state, prompting some people to travel across state borders.
A pregnant woman in New York.Not a pregnant woman in Germany. Up to two close contacts of a pregnant woman in Germany. Pregnant women were barred from participating in clinical trials, prompting many countries to exclude them from vaccine priority groups. But some experts say the risks to pregnant women from Covid-19 are greater than any theoretical harm from the vaccines.
A grocery worker in Texas, no. A grocery worker in Oklahoma, yes.
Many areas aim to stop the virus by vaccinating those working in frontline jobs, like public transit and grocery stores. But who counts as essential depends on where you live.
A police officer in the U.K. A police officer in Kenya. A postal worker in California. A postal worker in North Carolina. A teacher in Belgium. A teacher in Campeche, Mexico. Other jobs have been prioritized because of politics: Mexico’s president made all teachers in the southern state of Campeche eligible in a possible bid to gain favor with the teacher’s union.
Medical staff at jails and prisons in Colombia. A correctional officer in Tennessee. A prisoner in Tennessee. A prisoner in Florida. The virus spread rapidly through prisons and jails, which often have crowded conditions and little protective equipment. But few places have prioritized inoculating inmates.
An undocumented farm worker in Southern California. A refugee living in a shelter in Germany. An undocumented immigrant in the United Kingdom. Britain has said that everyone in the country is eligible for the vaccine, regardless of their legal status.
A Palestinian in the West Bank without a work permit. Despite leading the world in per-capita vaccinations, Israel has so far not vaccinated most Palestinians, unless they have permits to work in Israel or settlements in the occupied West Bank.
An adult in Bogotá, Colombia. An adult in the Amazonian regions of Colombia that border Brazil. In most of Colombia, the vaccine is only available to health care workers and those over 80.
But the government made all adults in Leticia, Puerto Nariño, Mitú and Inírida eligible, hoping to prevent the variant first detected in Brazil from arriving in other areas. A police officer in Mexico City. A teacher in rural Mexico.The government of populist president Andrés Manuel López Obrador has prioritized vaccinating the poor and those in rural communities, despite the country’s worst outbreaks occurring in major cities.
Native populations not federally recognized in the United States. The pandemic has been particularly deadly for Native Americans. But only tribes covered by the Indian Health Service have received vaccine doses directly, leaving about 245 tribes without a direct federal source of vaccines. Some states, including Montana, have prioritized all Native populations.
Indigenous people living on official indigenous land in Brazil.
These 43 countries, mostly high income, are on pace to be done in a year. These 148 countries, mostly low income, are on pace to take until next year or even longer. Countries like the U.S. continue to stockpile tens of millions of vaccine doses, while others await their first shipments.
“The vaccine rollout has been inequitable, unfair, and dangerous in leaving so many countries without any vaccine doses at all,” said Gavin Yamey, director of Duke University’s Center for Policy Impact in Global Health.
“It’s a situation in which I, a 52-year-old white man who can work from home and has no pre-existing medical conditions, will be vaccinated far ahead of health workers or a high-risk person in a middle- or low-income country.”
When Jeff Goldsmith and Ian Morrison talk, people listen (apologies to E.F. Hutton…Goldsmith and Morrison are old enough to get that reference, anyway). These two lions of health policy and strategy came together recently to pen an editorial in Health Affairs examining the impact of large integrated health systems on the nation’s response to COVID-19. Morrison and Goldsmith admit to often finding themselves on opposite sides of consolidation issue, but looking back over the past year, both agree the scale systems have built over decades has been foundational to their effective and rapid response to the pandemic, which they rate as “better than just about any other element of our society”.
Larger health systems were able to mobilize the resources to secure protective gear as supplies dwindled.They responded at a speed many would have thought impossible, doubling ICU capacity in a matter of days, and shifting care to telemedicine, implementing their five-year digital strategies during the last two weeks of March.
This kind of innovation would have been impossible without the investments in IT and electronic records enabled by scale—butsystems also exhibited an impressive degree of “systemness”, making important decisions quickly, and mobilizing across regional footprints. Given the financial stresses experienced by smaller providers, consolidation is sure to increase. And the Biden healthcare team will likely bring more scrutiny to health system mergers.
Morrison and Goldsmith urge regulators to reconsider the role of health systems. The government should continue to pursue truly anticompetitive behavior that raises employer and consumer prices. But lawmakers should focus less on the sheer size of health systems and rather on their behavior, considering the potential societal impact a combined system might deliver—and creating policy that takes into account the role health systems have played in bolstering our public health infrastructure.
Many physician practices weathered 2020 better than they would have predicted last spring. We had anticipated many doctors would look to health systems or payers for support, but the Paycheck Protection Program (PPP) loans kept practices going until patient volume returned. But as they now see an end to the pandemic, many doctors are experiencing a new round of uncertainty about the future. Post-pandemic fatigue, coupled with a long-anticipated wave of retiring Baby Boomer partners, is leading many more independent practices to consider their options. And layered on top of this, private equity investors are injecting a ton of money into the physician market, extending offers that leave some doctors feeling, according to one doctor we spoke with, that“you’d have to be an idiot to say no to a deal this good”.
2021 is already shaping up to be a record year for physician practice deals.Butsome of our recent conversations made us wonder if we had time-traveled back to the early 2000s, when hospital-physician partnerships were dominated by bespoke financial arrangements aimed at securing call coverage and referrals. Some health system leaders are flustered by specialist practices wanting a quick response to an investor proposal. Hospitals worry the joint ventures or co-management agreements that seemed to work well for years may not be enough, and wonder if they should begin recruiting new doctors or courting competitors, “just in case” current partners might jump ship for a better deal.
In contrast to other areas of strategy, where a ten-year vision can guide today’s decisions, it has always been hard for health systems to take the long view with physician partnerships.
When most “strategies” are really just responses to the fires of the day, health systems run the risk of relationships devolving to mere economic terms.Health systems may find themselves once again with a messy patchwork of doctors aligned by contractual relationships, rather than a tight network of physician partners who can work together to move care forward.
After a rollercoaster year of living with COVID-19, consumer confidence has returned—and remained largely stable during the winter surge of the pandemic, according to the latest data from a Healthgrades’ consumer attitudes and behavior survey.
The graphic above depicts Healthgrades’ “Consumer Comfort Index”, a measure based on survey questions that assess comfort in specific healthcare settings (e.g., visiting your primary care doctor) and “everyday activities” (e.g., going grocery shopping or dining inside a restaurant). The index reveals that consumers continue to feel more comfortable with in-person medical-related activities than most everyday activities, with 65 percent now feeling comfortable in healthcare settings—up from 40 percent last April. There are, however, some obvious “everyday” outliers: for example, people still feel more comfortable going to the grocery store than getting an in-office medical procedure.
A second survey, by Jarrard Phillips Cate & Hancock and Public Opinion Strategies, findsconsumers are much more willing to seek in-person medical care in the next six months as compared to last summer. Health systems and physicians should leverage this return of consumer confidence to reach out to patients who have delayed or missed screenings and other important care across the past year.
The financial challenges caused by the COVID-19 pandemic forced hundreds of hospitals across the nation to furlough, lay off or reduce pay for workers, and others have had to scale back services or close.
Lower patient volume, canceled elective procedures and higher expenses tied to the pandemic have created a cash crunch for hospitals, and hospitals are taking a number of steps to offset financial damage. Executives, clinicians and other staff are taking pay cuts, capital projects are being put on hold, and some employees are losing their jobs. More than 260 hospitals and health systems furloughed workers in the last year, and dozens of others have implemented layoffs.
Below are six hospitals and health systems that are laying off employees in the next 2 months. Some of the layoffs were attributed to financial strain caused by the pandemic.
1. Sacramento, Calif.-based Sutter Healthis laying off hundreds of employees, most of whom work in information technology. In a filing with the state, Sutter said it plans to lay off 277 employees on April 2. The 277 jobs being eliminated include 92 analysts, 43 engineers and 28 project managers, according to the Sacramento Business Journal, citing the system’s filing with California’s Employment Development Department.
2. Plattsburgh, N.Y.-based Champlain Valley Physicians Hospitalplans to cut 60 jobs. The hospital, which is facing a $6.5 million deficit in fiscal year 2021, said the cuts include 10 people who were laid off or had permanent hour reductions, 12 people who are planning retirement, and the rest are open positions that will not be filled.
3. Hialeah (Fla.) Hospital is closing its maternity ward and laying off 62 employees April 5, according to a notice filed with the state. Most of those affected by the layoffs are registered nurses.
4. The outgoing owners of Providence Behavioral Health Hospitalin Holyoke, Mass., are laying off the hospital’s 151 employees, effective April 20, according to MassLive. Trinity Health of New England, part of Livonia, Mich.-based Trinity Health, is selling the hospital to Health Partners New England, which plans to take over the hospital April 20.
5. Olympia Medical Center in Los Angeles is slated to close March 31. The closure will result in the layoffs of about 450 employees.
6. Minneapolis-based Children’s Minnesota is laying off 150 employees, or about 3 percent of its workforce. Children’s Minnesota cited several reasons for the layoffs, including the financial hit from the COVID-19 pandemic. Some layoffs occured in December and the rest will occur at the end of March.
Wealthy nations — including the U.S., the U.K. and the EU — have vaccinated their citizens at a rate of one person per second over the last month, while most developing countries still haven’t administered a single shot, according to the People’s Vaccine Alliance.
Why it matters:As higher-income countries aim to achieve herd immunity in a matter of months, most of the world’s vulnerable people will remain unprotected.
Experts say that mutations that may arise while the virus spreads could be a danger to us all, vaccinated or not.
The big picture: Even though more vaccines will arrive in developing nations soon, only 3% of people in those countries are likely to be vaccinated by mid-2021.
At best, only a fifth of their population will be vaccinated by the end of the year, per the People’s Vaccine Alliance.
What we’re watching: Three dozen countries have bought several times the amount of vaccine that they’ll need to vaccinate their entire population.
The U.S. alone has ordered more than a billion extra doses, Science Magazine reports. Global health leaders are saying it’s time to figure out where all of these excess doses will go.
“Over the next year or two, U.S. surplus doses and those from other countries could add up to enough to immunize everyone in the many poorer nations that lack any secured COVID-19 vaccine,” Science writes.
HENRY KOTULA 