Could Dollar General help dramatically expand vaccine access?

Posted on by • Posted in Access & Quality of Healthcare, Centers for Disease Control & Prevention (CDC), Health Equity, Health Inequity, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Public Health, Retail Clinic, Retail Healthcare, Retail Pharmacy, Rural Health, Social Determinants of Health, Vaccination, Vaccine, Vaccine Distribution, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply, Vulnerable Populations • Leave a comment

https://mailchi.mp/94c7c9eca73b/the-weekly-gist-april-16-2021?e=d1e747d2d8

CDC in Talks With Dollar General to Expand Vaccinations

For some time, we’ve been focused on the efforts of Walmart to launch and grow a care delivery business, especially as it has piloted an expanded primary care clinic offering in a handful of states. We’ve long thought that access to basic care at the scale that Walmart brings could be transformative, given that more than half of Americans visit a Walmart store every week. Along those same lines, we’ve always wondered why Dollar General and Dollar Tree—each with around four times as many retail locations as Walmart—haven’t gotten into the retail clinic or pharmacy businesses.

(Part of the answer is ultra-lean staffing—this piece gives a good sense of the basic, and troubling, economics of dollar stores.) Now, as the federal government ramps up its efforts to widely distribute the COVID vaccines, it turns out that the CDC is actively discussing a partnership with Dollar General to administer the shots.

A fascinating new paper (still in preprint) from researchers at Yale shows why this could be a true gamechanger. The Biden administration, through its partnership with national and independent pharmacy providers, aims to have a vaccination site within five miles of 90 percent of the US population by next week. Compared to those pharmacy partners, researchers found, Dollar General stores are disproportionately located in areas of high “social vulnerability”, with lower income residents and high concentrations of disadvantaged groups. Particularly in the Southeast, a partnership with Dollar General would vastly increase access for low-income Black and Latino residents, allowing vaccine access within one mile for many, many more people. And the partnership could form the basis for future expansions of basic healthcare services to vulnerable and rural communities, particularly if some of the $7.5B in funding for COVID vaccine distribution went to helping dollar store locations bolster staffing and equipment to deliver basic health services. We’ll be watching with interest to see if the potential Dollar General partnership comes to fruition.

Examining the economic pressures facing healthcare workers

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https://mailchi.mp/94c7c9eca73b/the-weekly-gist-april-16-2021?e=d1e747d2d8

As health systems look to address the “social determinants of health”, one obvious but often overlooked place to start is with their own employees. The left side of the graphic below shows forecasted employment growth and salaries across a range of healthcare occupations. Many of the fastest-growing healthcare jobs—including home health and personal aides, medical assistants, and phlebotomists—are among the lowest-paid.

Case in point: home health and personal care aides are among the top 20 fastest-growing occupations in the US, and median wage for these jobs is only about $12 per hour, or around 200 percent of the federal poverty level—well below the living wage in many parts of the nation. (Note that this analysis does not include support staff who are not healthcare specific, like custodial or dietary workers, so the number of low-wage workers at health systems is likely higher.)
 
Among of the many struggles lower-income healthcare employees face is finding affordable housing. Using fair market rent data from the US Department of Housing and Urban Development, the right side of the graphic shows that healthcare support workers, even at the 90th percentile salary level, struggle to afford rent in the majority of the 50 largest US metros areas. In particular, home health aides in the top decile of earners can only afford rent in 14 percent of major cities.

These disparities have caught the attention of lawmakers. The $400B in President Biden’s proposed infrastructure plan devoted to home healthcare for seniors includes tactics to increase the wages and quality of life for these caregivers. But as we await policy solutions, health systems should pay careful attention to issues of housing insecurity and other structural challenges facing their workers and look to increase wages and provide targeted support to these critical team members.

Two steps forward, one step back on vaccinations

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Community Spread, Coronavirus, Coronavirus Mutation, Food and Drug Administration (FDA), Herd Immunity, Immunization, Pandemic, Public Health, Public Opinion, Public Perception, Vaccination, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Safety, Vaccine Skepticism • Leave a comment

https://mailchi.mp/94c7c9eca73b/the-weekly-gist-april-16-2021?e=d1e747d2d8

Eradicating global infectious disease: Two steps forward and one step back? | Science Policy For All

As states rush to fully reopen businesses, and Americans leave their masks at home in greater numbers, it appears that the feared “fourth surge” of COVID is now underway in many parts of the country. Coronavirus cases are up in half of all states, and up nationally by 9 percent compared to last week. While the latest wave appears to be much less deadly—largely targeting younger people who haven’t yet been vaccinated—it adds urgency to the effort to get shots in arms as quickly as possible.

The good news: that’s happening. Today the US surpassed the milestone of 200M vaccinations given, with nearly a quarter of the population now fully vaccinated (including nearly two-thirds of those over age 65). The progress on vaccines comes as the Johnson & Johnson COVID jab is sidelined, over safety concerns stemming from a small number of rare blood-clotting cases in younger women that caused the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) to urge states to pause the use of the shot. Wednesday’s inconclusive meeting of the FDA’s Advisory Committee on Immunization Practices meant an additional 7 to 10 days of limbo for the J&J vaccine, drawing criticism from experts who warned that the negative publicity could undermine confidence in vaccines among the general population, both in the US and around the world.
 
Count us among those skeptical of the decision to pull back on the J&J vaccine, which plays a pivotal role in the campaign against COVID, given that it’s a single-dose vaccine that can be stored at normal refrigerator temperatures, making it more easily distributed than the two-dose mRNA vaccines. While the blood clotting cases are serious, and merit investigation, the odds of suffering a vaccine-related blood clot are far outweighed by an individual’s risk of death or severe complications from COVID itself, let alone the chances of getting a blood clot from other medications (such as oral contraceptives). 

It was a big week for innumeracy, unfortunately: headlines abounded about the CDC’s discovery of 5,800 “breakthrough” COVID cases, in which fully vaccinated people still contracted the disease. Unsurprisingly, the numerator got the headlines, not the denominator—the 80M people who’ve been fully vaccinated. Your chances of hitting a hole-in-one as an amateur golfer are better than the chances of getting COVID after being fully vaccinated. Furthermore, of those 5,800 people infected after being fully vaccinated, only 7 percent were hospitalized, and 74 died. Each a tragedy, to be sure—but we’ll take those odds any day.

Get vaccinated as soon as you can.
 

Cartoon – No Vaccine for Stupidity

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Facebook Cracks Down on UK and Romanian Fake Accounts, Anti-Vaccine Posts | National News | US News

Cartoon – One Vaccine Prevents Disease & Another Conspiracy Theories

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Hands on Wisconsin: Facts are the vaccine for conspiracies | Opinion | Cartoon | madison.com

Cartoon – Anti Vaxx Message is Spreading

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Political Cartoon on Twitter: "Graeme Keyes on Doctors worried as anti- vaccination messages escalate from social media misinformation to personal threats - political cartoon gallery in London https://t.co/dePcTdnXF6… https://t.co/UH1eOU4nPh"

Cartoon – Vaccination from Making Decisions based on Politics

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Marshall Ramsey: Vaccination | Mississippi Today

Cartoon – A Shot of Common Sense

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Vaccines must NOT be Feared” – STEM: From Roots to Fruits

Cartoon – Things you can’t get vaccinated for

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Facebook Cracks Down on UK and Romanian Fake Accounts, Anti-Vaccine Posts | National News | US News