After nine months of the public health emergency, a major breakthrough took place last week when Pfizer announced that one of its experimental COVID-19 vaccines was more than 90% effective in trials. Similarly promising results from a Moderna vaccine soon followed.
Both vaccines still need to be authorized for emergency use by the U.S. Food and Drug Administration (FDA). Once that happens, the home should be one of the central points of vaccine delivery, experts believe.
Roughly 2 million seniors are permanently homebound, according to the American Academy of Home Care Medicine. For seniors that fall under this category and certain others, receiving care outside of the home can be difficult — or out of the question entirely.
“[For this population], just going to the clinics, to the hospitals, to the drive-thru testing centers, wherever the COVID-19 vaccine is going to be made available, is a challenge,” Marc Rothman, chief medical officer of Signify Health, told Home Health Care News.
Signify Health is a Dallas, Texas-based tech-enabled provider of at-home care solutions. The company is one of the largest providers of house calls in the U.S., conducting more than 1 million house calls annually.
Not being able to receive the vaccine at home could create avoidable barriers to delivery for a population that already faces the highest risk of adverse events associated with contracting COVID-19, according to Rothman.
For added context, 80% of COVID-19 deaths have been adults who are 65 and older, according to the Kaiser Family Foundation.
Now more than ever, there’s an incredibly large home-based care workforce in patient’s homes. Rothman believes that utilizing this workforce for the purposes of administering the vaccine to patients who receive care in the home is a crucial next step.
“Even in the days of Marcus Welby that people harken back to, there was not remotely the same sheer number of providers in patients’ homes as there is today,” he said. “As we try to deliver what, I think, is supposed to be 300 million doses to the U.S. population over the next six to …12 months, we really should be taking advantage of the home-based provider workforce.”
Aside from increasing access, administering vaccines in the home setting — a safe and private environment — could also help ease fears.
“Just because the vaccines have been politicized, there has been a little fear put out there that it’s been rushed,” Dr. Thomas Cornwell, executive chairman of the Home Centered Care Institute (HCCI), told Home Health Care News. “I can tell you that this is being done in the most scientific, safe ways.”
Schaumburg, Illinois-based HCCI is a nonprofit organization that advocates for the expansion of home-based primary care.
More than half of surveyed Medicare beneficiaries recently expressed that they felt comfortable getting a vaccine when one is made available, according to a recent poll from eHealth. That means 47% felt uncomfortable.
A reluctance to take even the most well-known vaccines, such as the flu vaccine, is not uncommon, Rothman noted.
“We know that vaccination rates for things like influenza, which is really just a routine annual vaccination, are only in the 40% ranges,” he said. “There’s a concern that people will fear the COVID-19 vaccine and then not want to go get it. In our minds, what better way to ensure that people feel that they can trust this potentially life-saving medication then to have it potentially delivered in their home by someone they trust.”
Still, one challenge will be figuring out how to administer the vaccine in the home setting on a wide-scale.
Rothman again cited the difficulties of administering the flu vaccine as an example of what providers might be up against.
“We know that home health care organizations — lots of home-based primary care organizations — have not been giving annual flu vaccines to all of their patients because, logistically, it’s complicated,” he said. “There’s transport issues, packing issues, cold-chain storage issues. Many organizations have backed off from making that part of their daily work, knowing that a lot of people will eventually make it to the doctor’s office or to the local grocery store.”
In the case of the Pfizer vaccine, for example, the medication needs to be stored at about minus 75 degrees celsius. This is about 50 degrees colder than any vaccine currently used in the U.S. As Rothman pointed out, doctors’ offices, pharmacies and state labs don’t have freezers that go that low.
One move for providers may be forming strategic partnerships in order to accomplish this. Home-based primary care providers, in particular, might consider working with pharmaceutical companies, biopharma companies and logistics companies.
But providers may need to make these moves sooner rather than later.
Out of the 30 or 40 companies that began to develop vaccines back in the spring, there are now 11 that are in large-scale trials with broad populations, according to Rothman.
Last week, Pfizer said their messenger RNA-based vaccine is estimated to be 90% effective. This is based on an interim analysis of a study of 43,000 patients. On Wednesday, the company said updated results showed their vaccine to be 95% effective.
Pfizer plans to file for authorization with the FDA “within days.”
“Nothing’s ever guaranteed until it happens, but it is looking so positive based on this Pfizer vaccine,” Dr. Cornwell said.
This week, Moderna announced that its vaccine was more than 94% effective at preventing COVID-19. The company conducted a 30,000-patient study.
“If even one or two of the other organizations are successful, because of decisions made to ramp up productions facilities even before the vaccines were approved, we could potentially have millions of doses of vaccines circulating by the spring,” Rothman said.
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