The Biden administration has stepped up its role in the distribution and administration of coronavirus vaccines, boosting federal stocks with more doses and more vaccination sites in recent months in preparation for the increased supply and the next phase of the campaign. vaccination in the United States.

Officially entering that phase on Monday, in which everyone over the age of 16 can be vaccinated, Biden administration officials said they estimate that 90% of Americans now live within five miles of a facility. vaccination, as a result of the expansion of federal channels. Nearly 40,000 pharmacies are now equipped to deliver vaccines through a federal direct-to-pharmacy vaccine program, compared to just a few thousand when the program was launched two months ago.

Together, the federal vaccination system – which includes the retail pharmacy program, three dozen federally-run mass vaccination centers, and 1,470 federal health centers – now handles more than a third of the doses shipped. every week, more than tripling his weekly dose ratio since early February.

Vaccination speed and fairness of distribution

The change gives the White House more control in determining the speed, location and recipients of vaccines, a process that has largely been managed exclusively by governors and local officials who receive per capita dose allocations from the government. federal.

Senior officials in the Biden administration said the widening of the federal route helps ensure that the infrastructure is ready to handle an increasing volume of doses and that vaccines are distributed more equitably. While the United States continues to struggle with racial equity in vaccination, in which minorities are underrepresented among those vaccinated, federal channels are outpacing the national average, according to data provided by the White House.

«We want to make sure […] As we move into this moment we are prepared to have the scale we need, ”said Sonya Bernstein, Senior Policy Advisor on the White House Covid-19 response team. “This is an unprecedented scale ahead of us and so we want to make sure that we are supporting states and localities and making sure that we are getting vaccines quickly, in the same way that we are trying to do it fairly.”

Biden administration officials highlighted the success of these federal channels – in terms of the speed of vaccination and their ability to meet equity goals – but say they are not trying to take control of the state’s vaccination process. . Several state officials told Citizen Free Press that they agree that federal channels are an added value, but some of those same officials are wary of the White House taking control of more of the vaccine dose allocations and believe they continue. being better positioned to maximize vaccinations in their own states.

“I think it’s a good balance, but I wouldn’t want it to be changed more,” said Arkansas Governor Asa Hutchinson, a Republican who is vice president of the National Governors Association. “I would not want to reduce the role of states any more than it is now, I would not want to reduce the allocation of states.”

Officials in the Biden administration declined to project what the breakdown will be from now on between the federal and state vaccine channels, calling it a “week-to-week” decision.

But what is clear is that the White House sees pharmacies as a key part of the way to vaccinate citizens and overcome the pandemic, and the expansion of the federal pharmacy program is part of a change in which Americans are vaccinated. increasingly outside mass vaccination centers.

Officials said the federal pharmacy program is more efficient at vaccinating, administering 86% of the doses delivered, compared to a national average of 78% of the doses delivered, according to figures provided by the White House.

Nearly 36 million doses have been delivered through the program since the second week of February, when it was launched.

The White House has also taken note of polls that Americans prefer to get vaccinated at a pharmacy or doctor’s office, and the fact that doses are available in close and familiar places could help dispel some doubts about vaccines.

«Our pharmacies are not just empty spaces. They have pharmacists who are – in many communities – huge sources of information about drugs and treatments and therapies and even vaccines, “said Dr. Cameron Webb, Senior Advisor for Equity Policy in the White House coronavirus response team. “By connecting people to a space that many people often associate with vaccination, it helps to normalize this vaccination process.”

Although states are also transferring some of the doses they receive to local pharmacies, the federal pharmacy program puts the Biden administration at the forefront of determining where the doses are administered in an attempt to make vaccination more representative of the demographic composition of the United States.

Vaccination of vulnerable populations

So far, black Americans and Hispanics have been vaccinated against COVID-19 at a lower percentage than their population. Of the people who have received at least one dose of the vaccine, only 11.5% are Hispanic and 8.5% are black, according to data from the US Centers for Disease Control and Prevention ( CDC), even though they make up 17.2% and 12.4% of the US population, respectively.

Through the federal pharmacy program, the Government has brought doses closer to the most socially vulnerable populations, as nearly half of the top 30,000 participating pharmacies are located in zip codes ranked in the highest category on the Index of CDC’s Social Vulnerability, which ranks communities based on more than a dozen socioeconomic factors.

The pharmacy program narrowly surpassed national racial demographic averages, with 38% of people vaccinated through pharmacies identifying themselves as non-white, according to an administration official, compared to 35% nationally.

Although the private pharmacy program handles the vast majority of the doses distributed through the federal system, 3.5 million doses have also been administered through three dozen federally run mass vaccination centers in 26 states. .

By establishing those sites closer to socially vulnerable populations and working with community groups, mass vaccination sites run by the Federal Emergency Management Agency (FEMA) have helped improve equity goals.

FEMA officials said 58% of vaccine doses at those sites have been given to non-white people, compared to an average 35% nationwide.

FEMA Acting Administrator Robert Fenton said his agency achieved those figures by establishing those sites closer to socially vulnerable populations and working with community organizations to spread the word. He plans to share best practices with state officials and said lessons learned at federally-run centers will inform vaccination strategies at the more than 1,000 state-run mass vaccination centers that the federal government supports. with personnel or resources.

“The simple act of opening vaccination centers and allowing anyone to enroll does not always focus on those who may be the most vulnerable or those at greatest social risk,” Fenton said in an interview, pointing to some centers that allowed people from certain zip codes pre-register for access.

Federal health centers

A third, smaller federal avenue, that of federal health centers, targets minority communities even more directly, administering about 70% of vaccines to non-white people, according to the White House.

As the White House has worked to expand the federal vaccine system, senior officials in the Biden administration said they have worked closely with states to ensure they are not duplicating efforts, with CDC officials coordinating with the state health officials to decide which partner pharmacies will be active.

North Carolina Secretary of Health Mandy Cohen said that to ensure vaccines are properly distributed in her state, she has sometimes diverted doses from areas with a higher concentration of federal partner pharmacies, like Walgreens, for example.

Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, described similar decision-making in his state and coordination not only with the CDC, but directly with federal partner pharmacies.

“The supply from the pharmacies complements, it does not compete with the state supply,” Shah said. “We have been able to work with them to activate certain stores first and defer others in areas where we had no need.”

While the federal pharmacy program is, on average, more efficient at delivering vaccinations, a different picture emerges in certain states like Arkansas, where Hutchinson said the federal pharmacy program has underperformed.

“I wouldn’t say we should back down,” Hutchinson said. “But if we had to start all over again, it would have kept (all the doses) within the state, because we could use all those federal partners within our own allocation.”

A senior Biden administration official pointed to the data showing that the federal pharmacy program is generally more efficient, but said, “If there are places where the pharmacy program is not moving supplies as quickly as the states, we must wait to see that change. ”

As government officials have built the federal pharmacy program, they have used the two-month process as an opportunity to solve common problems, streamlining supply chain efforts, ensuring that pharmacies have the storage capacity. cold need for certain vaccinations and even making sure pharmacies are adequately staffing certain branches to meet demand.

While the federal government currently assigns doses to pharmacies based on the population of those states, a senior administration official said they plan to be more flexible in the future, requiring that only 80% of the doses be distributed over a per capita basis.

And while all individuals 16 and older are now eligible to be vaccinated, federal channels could still be a way for the White House to meet certain goals and ensure that mass vaccination occurs fairly. Some federal program pharmacies, for example, contact high-risk patients to let them know when the vaccine is available at their pharmacy. Others have partnered with ride-sharing companies to get underserved populations to pharmacies.

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