Dr. Russell S. Phillips has a 97-year-old patient who recently snagged an appointment at a mass vaccination site. That’s good news in a way, but Phillips isn’t sure how the elderly man will make his way to Gillette Stadium, and he wishes he could just give the shot in the comfort of his office.
But Phillips can’t get any doses.
Primary care doctors, long the mainstay of vaccination efforts, say they’ve been left out and left in the dark when it comes to battling the coronavirus. They have no information for the patients calling daily with pleas for the vaccine. Yet they believe their involvement is essential to counter the misinformation that could undermine the whole effort.
“Our patients are calling us wanting to get the vaccine from us,” said Phillips, director of Harvard Medical School’s Center for Primary Care and an internist at Beth Israel Lahey Health in Boston. “It’s not clear they’ll accept it from anyone else.”
Not every medical practice is equipped to store and administer the vaccines. But among those eager to provide them, only a handful have been able to get any doses, Phillips said.
State health officials say that, given the demand, they’re focused on high-volume sites. Some larger doctors’ offices have already received vaccine doses, and a spokeswoman for the COVID-19 Response Command Center said the state is working on “an equitable distribution process” for providers — but remains at the mercy of the supply flow from the federal government.
And the state hasn’t totally ignored private practices. Last week, it sent a survey to physicians gauging their ability and willingness to administer vaccines; results haven’t been tabulated. It also has set up a “hospital depot” program in which smaller practices can pick up vaccine doses and supplies from a local hospital to vaccinate eligible employees and patients.
Still, Dr. Ghary Gappelberg, a Wilmington internist, said he’s “mystified” by the state’s failure to deploy its primary care workforce from the get-go. These doctors have plenty of experience giving shots for flu, pneumonia, and tetanus.
“We could have been giving out vaccine every day. We could have helped,” he said.
Gappelberg and others say the mass vaccination sites are needed, but more people could be reached, and faster, if primary care physicians could join the effort.
Such doctors can readily pull up lists of patients who qualify for shots at each phase of the rollout. They know how to reach them. And they have their patients’ trust.
People are more likely to accept a vaccine from their own trusted doctor, said Dr. George M. Abraham, a Worcester internist who is president-elect of the American College of Physicians, the national organization of internists.
But Abraham said that only a minority of primary care physicians — he guesses 20 to 30 percent — can manage the logistical challenges.
For example, he said, each vial of the Moderna vaccine has 10 doses, and once the vial is open, the vaccine lasts only five hours.
“If I can’t have 10 people lined up simultaneously, I would have to discard the rest, which is a criminal waste of precious vaccine,” said Abraham, who is chief of medicine at St. Vincent’s Hospital.
Additionally people must be monitored for 15 or 20 minutes after receiving the vaccine in case they have a rare allergic reaction, and doctors need space for them all to wait, at a safe distance from others. Not every office can store the vaccines; Moderna’s requires freezing, and the Pfizer vaccine has to be kept in special ultra-cold freezers.
Phillips, of the Center for Primary Care, said plenty of doctors are up to the job — 40 percent of them, according to a recent survey done through several professional organizations of primary care doctors in Massachusetts. Doctors, he said, have already demonstrated they can respond creatively to the pandemic; they quickly adopted telemedicine, set up tents for testing, and opened respiratory clinics for patients with COVID-like symptoms.
“We can innovate in the same way to deliver vaccine,” he said.
For example, Dr. Dana Ann Delegianis Mann, a family doctor in Middleton, put up heated tents in her parking lot in March and constructed a permanent drive-through canopy in the fall. This setup has been used for COVID-19 testing and flu vaccinations — and could be the site to administer 900 coronavirus vaccines a week, if only Mann’s practice could get some. The practice has freezers capable of storing both the Moderna and Pfizer vaccines, and a list of patients eligible and eager.
Dr. Wayne J. Altman, a family doctor in Arlington and chair of family medicine at the Tufts University School of Medicine, gave shots in his office’s parking lot after receiving 20 vaccine doses in January, preparing for a bigger effort later. To ensure patients stuck around for the mandatory 15-minute monitoring, he wrote the time they could leave in washable paint on their windshields and had them pull over and wait to receive the cards documenting the shot. Recently Altman acquired an additional 200 doses, and all 200 slots filled up within hours.
Dr. Christopher Garofalo, an Attleboro family physician, is also among the few who have received vaccine. He’s designated a morning when eight of the 12 exam rooms in his practice will be set aside for vaccinations and monitoring. Garofalo said he has received 100 doses from the state and expects to receive another 100-dose batch every week or two, as needed.
In addition, he’ll finally get to use the 70 doses left over after his staff was vaccinated four weeks ago, now that vaccination eligibility has expanded. Much to his frustration, he said, state officials previously wouldn’t let him offer the extra doses to dentists and physical therapists working in his building, and told him to put them back in the freezer. “I never got an answer why we couldn’t give it to them,” he said.
Meanwhile, large medical groups are gearing up. Atrius Health and Beth Israel Lahey Health posted on their websites that they plan to offer the shots but don’t yet have enough vaccine. These organizations plan to provide the vaccine, by invitation, at their own high-volume sites rather than in individual physician’s offices.
Dr. Chris Andreoli, chief operating officer/chief transformation officer at Atrius, said the group is poised to vaccinate. “We have built and are readying an infrastructure to offer a vaccine to our patients in whatever quantity it comes and whenever we get it,” he said.
While Atrius plans to start with large sites, later it may provide local options, he said.
Andreoli has had a different experience with the state than some other doctors. “We have nothing but great things to say about our interactions with the state. We were invited in from an early point and have felt very comfortable with the communication,” he said.