Thursday, April 8, 2021


I have started asking every patient I see, for whatever reason, if they have received or intend to receive one of the three available U.S. vaccines against COVID-19. In less than two weeks, every adult in every state will be eligible to get the shots, and in the next few months the Pfizer vaccine should become available to children as young as age 12. There is no question in my mind that getting vaccinated as soon as possible is the right choice to protect my patients and their loved ones and communities from the ravages of the virus. But like most primary care physicians, I don't have access to a supply of vaccines for use in my office - instead, I must direct patients to a website to sign up for an appointment to get it at another time, somewhere else. And for vaccine-hesitant patients or those who for whatever reason are unable to find the time to do this, this obstacle may leave many unvaccinated who (at least when they saw me) were perfectly willing to get the shot. In a recent Medscape commentary, I argued why "it's time to hand the [vaccine supply] baton to primary care for the final leg of the race to end this pandemic."

I ran track relays in high school: the 4 X 400 meters and 4 X 800 meters. The latter distance is long enough that baton-passing technique makes little difference in the final result, but in the shorter relay (just short of a mile in total) it matters. We runners on deck were taught two techniques: accepting the baton from a standing start or a running start. A standing start usually ensures a clean exchange, but the runner then loses time by being unable to accelerate until the baton is in hand. A running start ensures that momentum transfers smoothly from one runner to the next, but if not executed precisely, it can result in a botched handoff (either a dropped baton or disqualifying exchange outside of the legal zone), dooming the team's hopes. The running start also requires a lot more practice to get right.

What I and family physician colleagues are seeing across the U.S. right now, as primary care practices are gradually becoming involved in vaccination efforts in Maryland and other states, is handoffs from a standing start. Even though many practices went to great lengths to identify and reach out to their patients at the highest risk of complications in anticipation of being able to administer vaccines (running start), the belated recognition by the federal government and state health departments of their critical role in reaching more reluctant patients has forced them to halt these efforts while they wait for adequate supplies to trickle in. This is a huge lost opportunity, and I fear that this lack of coordination between public health and primary care will result in unnecessarily prolonging the pandemic.