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Vaccinate the masses against Covid-19 is full of challenges. Despite the deployment in sophisticated healthcare facilities, less than 46% of the available vaccine stock has reached the arms of U.S. residents since its emergency release last month. Even more daunting will be the administration of vaccines to the general population. It makes sense to rely on hospitals, health care centers and physicians’ offices to maximize the rate of inoculation to health workers and those who frequently interact with the medical system. For most, however, accessing these locales is a downside. We need to meet people where they are, in their communities.
One suggested idea is to recruit private pharmacies. Unfortunately, such facilities were not created to address such a monumental public health challenge as the provision of massive inoculations. Their distribution within the communities is inconsistent. “Pharmacy deserts” exist in the very communities that have both high infection rates and high coronavirus mortality, and whose populations often have limited access to transportation. Relying on pharmacies alone is unlikely to give the best results. It is even more illogical when a system with the infrastructure, staff and experience to respond to emergencies is ignored in the process.
Fire departments and emergency medical services (EMS) agencies are much better prepared to meet the challenge. The two have long-standing community relationships and are distributed based on population density rather than consumer spending. Both are already responding to local and regional emergencies on a daily basis. They were created precisely to serve as an essential part of our emergency safety net. The existing lines of communication with public health authorities already exist. The vast majority are made up of paramedics who administer injections and are trained to respond to and manage acute allergic reactions, a rare consequence of immunization. They have well-established medical surveillance. Their fixed stations are already in use for various community activities, such as voting and food drives. When not responding to emergencies, paramedics on duty can augment designated teams providing vaccines. EMS even has mobile resources to meet the needs of residents who cannot get to a fire station / EMS.
The legality of this approach is well established. Here in Massachusetts, for example, paramedics protocols in place to administer seasonal flu shots. (Many other states have similar protocols.) Adding coronavirus vaccines to the list could be done with the stroke of a pen in each jurisdiction.
Taking advantage of these existing assets will shorten the time to vaccine-induced herd immunity. There are some 52,000 fire stations in the USA. Let’s say it takes 20 minutes to treat, vaccinate and observe each individual: a single paramedic in a fire station could vaccinate 30 people per 10-hour day. Across the country, this represents 1,560,000 vaccinations per day, or nearly 11,000,000 per week. With this strategy alone, the EMS would contribute to inoculation of 50 percent of the vaccinations needed to achieve vaccine-induced herd immunity within six months. These numbers are likely to significantly underestimate the number that could be vaccinated: most stations would have more than one paramedic assigned to this task at a time. With other active vaccination strategies working in parallel, the time required to achieve vaccine-induced community immunity would be considerably shortened.
Thorough coordination will be necessary. However, unlike pharmacies, firefighters / EMS are already coordinated with each other and already have lines of communication with public health authorities, and could be put in place more quickly. The federal government should develop a computerized documentation process overseen by state public health authorities and implemented locally. Federal protocols must be established and may be modified by local medical surveillance to meet local circumstances. Supply chains for disposable supplies, waste management, clinical and non-clinical staff, and other resources like computers for documentation can be coordinated locally.
Although the onerous cold storage requirements for vaccines currently authorized for use must be taken into consideration, this challenge is present wherever vaccines are administered. Few of the sites have regular cooling facilities required for the Pfizer / BioNtech product, and contingencies will need to be set up in any location.
Local EMS systems will need to ensure that there are adequate redundancies to maintain emergency response. It is a place where the existing inter-agency collaboration will prove essential. Public education about the process and its interaction with it should be managed collaboratively by federal, state and local authorities. All of this should be funded by the federal government as needed, to ensure that there are no gaps in implementation due to lack of funding.
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