A Letter To President Biden COVID-19 Leadership Team

From Dr. Cecil Bennett Dr. Cecil Bennett is a Diplomat of the American Board of Family Medicine, and a practicing Family Physician in Atlanta, GA.
 
 

To: The President Biden COVID-19 Leadership Team Xavier Becerra Jeff Zients Vivek H. Murthy MD

Why are there so many issues with distribution of the COVID-19 Vaccines? Public Health per the plan: “Expand the U.S. public health workforce and increase clinical care capacity for COVID-19. In addition to supporting the surge in health care workers for vaccination efforts detailed in Goal Two, the federal government will also build and support an effective public health workforce to fight COVID-19 and the next public health threat.”

TheProblem

Unfortunately, the public health sector has shown that it is underfunded, undermanned and has no ready infrastructure to manage a project of this magnitude. We can clearly see the evidence of this so far, which has been crashed websites and a confused public.

I have traveled to over 25 countries to discuss medical education related issues. Most of these countries had Parliamentary governments with a Ministry of Health. The Ministry of Health had nearly 100% control of the health care system in the country with providers in every section of the country. If there was a national health emergency like an epidemic the Health Ministry could quickly mobilize in place medical assets quickly.

The private sector, not the public health sector, plays the greatest role in the US health system. Public health does not have the infrastructure. A pandemic is not the time to build their resources.

Family Physicians a better option Who better than a family doc to discuss with patients their fears and concerns and convince them to get the vaccine? Seniors know and want to be vaccinated by their Primary Care Physician (PCP)

We will need to vaccinate 75% of the population to get to herd immunity. PCPs see 75% of the population. (i). Another objective of the plan is to “Restore trust with the American people.” Patients already trust their family physician. Patients will listen to their PCP and get vaccinated.

There are over 300,000 PCPs, Nurse Practitioners (NP), and Physician Assistants (PA) in the US. (ii).

We are in all communities:

We are in Black and Brown, rural, small and hard to reach areas. Why set up tents in parking lots, recruit retired healthcare workers and deploy the military, when you already have PCPs on the ground, ready right now to vaccinate America? PCPs should play the lead role in vaccine administration. Not the health department. Not pharmacies. If PCPs were the focus of vaccine distribution, with pharmacies second and the health department third, we could get to herd immunity in 3 to 4 months not 12 months. Just do the math.

Pharmacies do not vaccinate America The plan calls for pharmacies to play a key role in vaccine administration. “Leverage storefronts, including retail locations, groceries and pharmacies.” PCPs vaccinate America, not pharmacies. Per a recent survey (iii) that asked where people went to get their flu shot in 2020: 37% of folks went to their doctor for their flu shot, 20% went to a pharmacy, 4% went to the state health department. 300,000 PCPs see 75% of America. There are about 50,000 pharmacy and chain supermarkets nationally. PCPs are the best option to vaccinate America quickly. How do we get vaccines to

PCPs?

There are about 70,000 active family physicians in the American Academy of Family Physicians (AAFP), with branches in all states. Governors could access their state Family Physicians (FPs) via an AAFP web portal and send vaccines directly to their offices.

Money

The Biden COVID distribution would require billions of dollars to states for distribution and will require Congressional approval. (iv). Using PCPs as the primary resource of distribution would not require any significant additional funding. Thus, avoiding congressional grid-lock and inevitable delay in getting the vaccine distributed.

Considering the immerging more contagious variants what may dominate the US soon, the coming peak of the flu season and a tired and weary public, we cannot wait for Congress to act. Again, there is no time.

Mask and Rapid testing. Per the Plan: “Implement masking nationwide by working with governors, mayors, and the American people…Scale and expand testing…Effectively distribute tests and expand access to testing.” Give PCPs N95 and KN95 masks to give our patients. Cloth and surgical masks do not protect a responsible person from an irresponsible person. Just look at what happened at the Capitol during the insurrection on January 6th. Responsible legislators wearing masks were at the mercy of irresponsible legislators when all were confined to one space. If all are not wearing a mask at one’s workplace or school, cloth and surgical masks are of limited use. KN95 and N95 masks protect both ways. Use the Defense Production Act (DPA) to make more masks quickly. More masks given out by PCPs means less hospitalizations and deaths. But most importantly, it buys additional time to get the vaccine distributed.

Regarding testing: There are several companies that submitted Emergency Use Authorization to the Food and Drug Administration for rapid antigen testing approval months ago. These tests could be distributed widely to pharmacies and supermarkets as a tool to identify and isolate community cases rapidly.

In conclusion:

If the State and Federal governments continue to ignore the value of PCPs in the distribution of vaccine, it will take longer to vaccinate America. The longer the vaccination administration process, the more people that will die unnecessary, especially black and brown people who are already 3 time more likely to be hospitalized and die once infected. (v)

Cecil Bennett MD DAFM

(i) www.reuters.com/article/us-health-pcp-trends/declining-numbers of-americans-have-a-primary-care-provider-idUSKBN1YK1Z4
(ii) bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand/
primary-care-practitioners#:~:text=By%202020%2C%20for%20primary%20care,in%20
demand%20to%20241%2C200%20FTEs
(iii) www.singlecare.com/blog/news/flu-shot-survey/#where-to-get-flu-shot
(iv) statescoop.com/biden-pandemic-relief-state-local-350-billion/
(v) www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/ hospitalization-death-by-race-ethnicity.html

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