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Vaccine distribution nationwide continues to ramp up, with nearly 2-million shots being given daily. President Biden has now said that every adult could be vaccinated by the end of May. A big promise that brings with it hope... a light at the end of the COVID-19 tunnel.
But when will COVID vaccination be as simple as getting a flu shot? Many of the doses currently being given are at mass-vaccination sites. Will local and national pharmacies be able to simplify the process?
The government still controls the supply and distribution of COVID-19 shots. We wanted to understand what that process looks like and when they expect to offer vaccines on-demand. Rina Shah, PharmD, group vice president, for pharmacy operations and services at Walgreens, joins us on this week's episode to answer those questions.
The following is a transcript of her interview with "Track the Vax" host Serena Marshall:
Marshall: Dr. Shah, I think the biggest question for Americans: When can I go get a COVID vaccine at Walgreens as easily as I can go get a flu shot?
Shah: I think that's the top number one question. When can I get a vaccine? It is definitely a hot topic. With the vaccine currently and it continues to build an inventory, but right now vaccine continues to be limited. There isn't enough vaccine, the way that we have for flu. Where flu there's enough vaccine for the entire country right at the beginning. With the COVID-19 vaccine, there's still inventory that continues to build and every week it gets better and better, which is fantastic.
But because inventory is limited and vaccine availability is limited. It does vary by state if you're eligible. Eligibility is determined by the state and the federal government. Once you're eligible to receive the vaccine. So in certain states, it's those that are 65 and older.
Most recently there has been an indication where teachers, school, staff members, educators are able to get the vaccine. So you can go online, select if one of the criteria is that you fit into and if you are eligible, you can sign up for an appointment. Now appointments are limited in nature because vaccine is limited, but every week we're getting more and more vaccine. And so I would just encourage everyone to be as patient as possible. And we're hopeful that as the manufacturers are giving more and more vaccine, that we'll be able to expand access hopefully soon.
Marshall: So explain for us how this process works with one of your pharmacies. What does the contract mechanism look like? What does the communication process that goes on to getting the vaccines into your stores?
Shah: So the CDC and the federal government pretty much own the vaccine. The federal government, purchased all of the vaccine. They're the ones that are determining who, and when.
Marshall: And that's different, right, than normal vaccines?
Shah: Yes, that's very different than normal vaccines. Normally, we would at Walgreens purchase the vaccine and we would then be able to say, okay, first come first serve. Or walk into your store and get a vaccine.
In this situation, there's multiple factors. One to your point, the government bought the vaccine, which is great because it's free then to all customers, which is what we want, because cost is a barrier to sometimes individuals getting a vaccine. And then, the federal government and the state authorities determine where that vaccine goes. And so we are one of many other pharmacy providers that have been selected in a subset of states to offer a vaccine. And every week we find out from the federal government and CDC how much vaccine we're going to get.
Marshall: You don't find out until that week.
Shah: The week before. Yep.
Marshall: Wow. Okay.
Shah: Yeah. And so you can imagine this is all being managed like week by week on how much vaccine we get.
The great thing is that there's a baseline. And then it just continues to build. And so we know that we're going to get a bare minimum. And then we just, if there's more of that, that week, then we can then allocate appropriately. And it's divvied up by state. So we also aren't deciding on that either. The government's deciding how much is going to each state and then we allocate it to the stores. And then at that time we open up appointments based on how much vaccine we have. And so, as you can tell, there is a sequential process; but it is being managed on a week by week basis based on the inventory that's available.
Marshall: And you guys had an agreement also when it came to distribution with long-term facilities. So you were distributing these vaccines before you started the process in your stores?
Shah: It's been an incredible process. So a couple of months ago, and many people may have not known this, that 40% of the deaths that had occurred across the country were happening in long-term care facilities. And so when the administration and CDC and the government came to us, they asked, this is the most complex, the most vulnerable population, would you be able to go ahead and immunize that population?
There were 70,000 plus locations. So we were assigned 35,000 locations and our pharmacists and team members were able to begin around mid-December when the first vaccine started becoming available.
And even then every state managed it differently. Some states wanted everyone to be immunized all at once. Some states wanted a subset of skilled nursing facilities. So we managed it state by state. And we were contracted to support three separate clinics and to date, which has been great, between the long-term care program and what we've been able to support on the federal pharmacy program, we've administered close to 4.5 million vaccinations.
Marshall: And this sounds like it's definitely a more complicated process than what you typically would do at Walgreens. Having to coordinate, not just with a distributor to get the vaccine, but the federal government, the state partners. Is this new territory in a way for you guys?
Shah: So the foundation and the infrastructure has been there, which is great. Because we've been providing vaccinations for over 10 plus years. Our pharmacists, our technicians have been trained in being able to administer a vaccine. What is new is the fact that vaccine is so limited in nature and the demand is so great.
When vaccine is this limited being nuanced on the population you want to administer vaccines first to; and following the state and federal guidelines and the fact that every state is different. So it is complex on managing it state by state. So there are nuances to it, but we've been able to build upon the foundation that we were able to establish for the last couple of years.
Marshall: I like to ask our listeners to participate in our conversations. And so we had some listeners sending questions...specifically about how they can get the shot. And one of the things that we've heard a lot, Dr. Shaw, is that there's conflicting guidance. You have the state versus the county guidance versus the provider guidance.
They have patients that have been turned away because they're in a 1C group that the state is in, but perhaps the county isn't in. Is there another way that perhaps make it easier for folks?
Shah: The website is the best part, because you're able to understand the nuances of what's happening. We have shared that the best way to get shots in arms is to simplify the process across the board. And we've shared that with all of our key stakeholders may it be at the state level or local jurisdictions, all the way to the CDC, as well as the federal government.
With the federal retail partnership program, what has made it simpler is that those states have shared with us their eligibility criteria that covers the entire state. And so that wouldn't have to then go county by county. Its allowing us to manage it at the state level. So that is a part has been helpful for all of the pharmacy providers, so that we can make sure that we're immunizing as many people as possible.
Marshall: So they are taking some of your suggestions?
Shah: Yeah. You know, we're learning as we go. So every day there's something new that comes in and we share that with our key stakeholders and then try to, to make it better. And communication is so critical through this entire process. And that's how we've been able to get to 4.5 million vaccinations.
Marshall: Has that logistical challenge been the biggest challenge for you guys? And if not, what has been with the rollout?
Shah: One of the areas that we've continued to work on is the vaccine continues to be limited. And there's so much, you know, there's quite a bit of interest on getting appointments and being able to get vaccinated. And so the biggest area that we've been focused on is communicating to our patients and our customers the need to be patient. And as more vaccine comes about, the more we can administer to patients across the group.
So right now, even though we have presence across the entire country, we're in, currently, in 27 jurisdictions and we have about close to 500,000 doses. It's around 480,000 doses that we get on a weekly basis, and so across the 27 jurisdictions.
And it's confusing to those that aren't in those states to wonder, can I go to that Walgreens or not? And so every week we're just expanding. Next week it's going to be probably the 35 jurisdictions and eventually it'll be all the entire country, but that is, you know, one of the logistical challenges is all because, you know, we're waiting for more and more vaccine.
The silver lining in all of this is: who would have thought we would've had three vaccine manufacturers across the country and within a year? It's fantastic to see the science and the manufacturing to get there. And so every week it just seems like we're getting more and more production, which is great to see.
Marshall: When do you expect you'd be in all 50 states then?
Shah: You know, I wouldn't be able to speculate. I wish I was in the manufacturing rooms. But I am similar to all of you just waiting to see how much we get. To what we discussed earlier, we were getting a weekly allocation and we find out the week before. And so it's growing week by week. That's what I can let you know, but we don't know when we're going to be able to get across the country
Marshall: When you go into a pharmacy to get the vaccine, you talked about signing up and making the appointment. Is there an option to pick which vaccine you want?
Shah: At this time, because vaccine is so limited, the recommendation from the CDC, as well as all of the providers, is whatever vaccine is available at that location is what's being administered. So we don't have the ability at this point to be able to pick one or the other, unless there's a contraindication. Then we would try to find that specific vaccine that, you know, you might be not allergic to, or, there might be a gap there, but at this time it would be whatever's available. That's what we'd administer.
Marshall: And one of the big questions, also a lot of people have is, we've heard stories, we talked to somebody here at "Track the Vax" who was just in the right grocery store at the right time and was able to get a vaccine. So how do you guys handling things like vaccine waste to ensure none of those vials go to waste?
Shah: Yeah. That's a great question because the way the vaccines are built there isn't a lot of flexibility. So once you puncture the vial, you really only have six hours to be able to get through all of those doses. And so we have a policy in place where we don't waste a single dose. And the intent is, is that in case there's an extra dose, we do have eligibility criteria so that we can reach out to those patients that may be eligible to get a vaccine.
And we have backup plans in case we can't get ahold of someone to get vaccinated because we have individuals that may or may not have been there. So we've been able to ensure that we're not wasting a single dose when that does happen. Luckily, the vials are in five doses or 10 doses. And so we can plan appropriately.
Marshall: So what does that list look like? You said you had some lists in place?
Shah: Well, we have patients that come to us every single day. So we would make outreaches to those patients that are eligible just to ask if they've gotten a vaccination and if they haven't, if they could come in and get vaccinated. In addition to that, we've been able to plan out appointments appropriately. So if someone had scheduled an appointment and you know, there the next day, we can call them and see if they can come earlier and get back.
Marshall: And Dr. Shaw, but a lot of people are wondering, could I just go to my local Walgreens that is vaccinating and ask to be put on some kind of a wait list?
Shah: You know, we don't have lists like that, a waitlist at every store. It's more or less making sure that we can get those that have signed up and just move them up earlier. But, we do have on our website a way to get the most up-to-date information. So if you go to walgreens.com, if you sign up on that website, we'd be able to send the most up-to-date information that's pertaining to your area on eligibility and any additional information around COVID-19 vaccine. And so that is a great way for individuals to at least get that information. And as eligibility changes in your state, or if there's new enhancements that are coming out, that's a tool that we use to communicate to patients.
Marshall: And definitely for those who want to get in line and get the vaccine, that's a great tool to have. But what about those who are hesitant to give you this personal information? One of the big differences between a mass vaccination center and getting your shot at a Walgreens is, you're also gaining a customer. So how important has the COVID vaccine program really been to the bottom line?
Shah: When we signed up to go ahead and provide vaccinations, it was primarily a public health perspective. Not a marketing or acquisition standpoint. Because at the end of the day, we're all going through -- what our mission stands for is to ensure that every patient is getting their vaccination. That they're staying healthy and that we're helping them through their journey.
And so much of this that we've been able to administer thus far has been primarily focused on making sure patients are able to get equitable access to care and are able to get their vaccine as quickly as possible. Which is why, many of the focus areas that we've had have actually been focused on hardest hit communities, for example, communities of color, driving equitable access.
And in that situation patients may not have access to digital capabilities, which is why we've been able to stand up our 1-800-WALGREENS number, or you can go into a store and be able to schedule an appointment with appointments that are available. And so it's not so much about getting the new customers, it's how can we ensure that everyone is getting access to get vaccinated and then get the protection that they need.
Marshall: I'm really glad you brought up equitable access. I want to come back to that. I'm just one more question though, on the way to sign up with the website and whatnot. Are you worried that having to give personal information might disincentivize people from getting a shot?
Shah: The intent of the information we're collecting is actually because it's a healthcare service we're providing. So imagine coming to a Walgreens to get your prescription, your vaccination, or going to your doctor for any service that you're providing. When we collect this information, there is actually a line between your personal pharmacy services area and anything we do from a marketing standpoint.
And so from a pharmacy standpoint, when you go ahead and get a vaccination, it's actually an immunization record. We want to make sure we're communicating that information to your doctor, and then if there's any follow-up that needs to happen, we're able to do that. And so when you sign up or are scheduling for an appointment or getting the vaccination, the intent is to actually treat that as a health record.
And that's the goal of that so that we can make sure we can follow up for a second dose reminders or anything of the sort. So with the privacy, you know, data pieces, there are lines that are there to ensure that we're protecting patient privacy when you select to get a healthcare service with us.
Marshall: That's a big distinction then. So when you sign up for your shot, you're not suddenly going to be signing up for all the marketing emails, as well?
Shah: Yeah, unless you've opted in for that and you want to get a deal on, you know, any sort of water bottles or anything like that. Then that's great. But, yeah, the intent is to ensure that you're staying healthy and that's the goal and it's exactly what we would do for your prescriptions per se.
Marshall: So let's go back to equity and barriers to access. You mentioned that you have a couple of forms and ways for people who don't have technology, wifi access to make sure to sign up and get notice and appointments. I know also you guys are partnering with Uber to make sure people can get to the site as well.
Shah: Yep. So we've stood up a vaccine equity task force. And the reason why we did this was because we already had a pretty comprehensive effort to address health equity or health inequities that was happening across the country. And especially after this past year with COVID.
There was definitely a spotlight that was put on communities of color, underserved communities, where we were seeing disparities in access to affordable health care. Because of COVID-19 and when vaccine was coming around the corner, we realized we needed to do something around vaccine proactively.
And so there's three pillars of what we've stood up. One is education and information. What we've done is we've worked with various organizations, including the CDC, and leveraging our pharmacists and our tools to ensure that we're educating about the importance of getting vaccinated. And then leveraging thought leaders in the community, maybe faith based communities or other organizations to help share information on how you can get vaccinated and where you can go.
The second is access. And so one of the biggest issues that we've seen uncovered is transportation. A lot of individuals don't have transportation to get to the store or go to a clinic. And that's where the partnership with Uber has really come in. And that's where we're looking to be able to solve for those ways. So that individuals that may not have the ability to get to the store once they sign up for a vaccine, then they would have the ability to have a solution like Uber to be able to get to the site, to get vaccinated and then get back home.
And then the third is around partnership. We know we can't do this all by ourselves. And so the intent is for us to be able to offer not only clinics and in-store offerings to offer immunizations. But then even being able to go out to community centers, faith-based organizations and be able to leverage partnerships, may it be local officials or various organizations like the Chicago Urban League, so that they can get the word out.
Marshall: So you'll be taking the vaccine to the populations that maybe can't get an Uber or get to one of your pharmacies?
Shah: That's right. Our stores are located within five miles of 80% of the population that's out there. But you know, there's 20% that we would have to go into the community or sometimes five miles is too far. And so in that situation, we've been able to partner with organizations. And we've hosted clinics in Chicago and Atlanta and other communities where we've been able to have mass clinics and individuals are able to sign up for an appointment.
Marshall: Will people who perhaps have to take that Uber ride to get there who are living further away to come in and be able to say: Oh, I just want the one shot because it's so hard for me to get here?
Shah: We would love for the ability, once we got plentiful vaccine, that we could allow for that. But at this point we just don't have enough vaccine to commit to say, you could pick one or the other. But, you know, understanding there's benefits with each one of the vaccines, if it's a single dose or two dose.
But at this point it is what's available there. Even the Johnson & Johnson product, we know that we'll be receiving 190, I think 185 to 190,000 doses this week. But then there's still, we are not getting any more vaccine for a couple of weeks after that. So there's still intermittent vaccine supply.
Marshall: So have you considered any scenario or is this something you guys are already doing where you share your vaccine with perhaps mom and pop pharmacies? We know, for example, in West Virginia, that they have more than 250 independent community-based pharmacies that serve the rural populations and fewer than 150 of Walgreens, CVS pharmacies. They are really looked at as the model when it comes to COVID vaccination so far. Is there a scenario in which you'd partner with those smaller groups you said earlier, healthcare is local. Is that something you're working on?
Shah: Ultimately, when the vaccine comes to us, there's a bit of chain of custody that comes there. But I know that there are states that are working with the local pharmacies, to see how they can partner. And in certain situations, especially when there is mass vaccination clinics hosted by the state, that's when many of the local healthcare providers, whether may be pharmacies or other providers, are able to participate. Because vaccines are so limited at this point, we don't have plentiful vaccine to go ahead and start distributing to other areas. We don't technically own the vaccine. It's actually the government's vaccine. So we are pretty much limited on what we can do after.
Marshall: So that would be up to the government to work with the local mom-and-pop community pharmacies?
Shah: Yeah. The states have been able to work with the local pharmacies, especially when vaccine becomes much more plentiful.
Marshall: When do you expect that anyone who walks into a Walgreen's would be able to get the shot if they wanted to?
Shah: The goal is, that in general, that every patient that wants to get a vaccine would be able to schedule an appointment and do that when vaccines are available. I would love to give you a timeframe, but unfortunately, I don't have a timeframe of when vaccine would be available. I'm hopeful that by the summer, that would be the case. But, I will be with all of you watching to see how much more inventory will be coming so that we can vaccinate.