Back in March, when most people hunched over laptops for hours, frantic to schedule a vaccine appointment, John Brenner got a phone call that made it all so easy.
It was his doctor, family physician Wayne Altman, inviting him in for a COVID-19 shot. On a Sunday morning, he drove 10 minutes to the doctor’s office in Arlington and received the vaccination in his car from a staff member he knew well. “It couldn’t have been easier,” said Brenner, a retired biology teacher who suffers from an anxiety disorder that makes it difficult to mingle with strangers.
Brenner knows he’s lucky. None of his friends could get the vaccine from their own doctors. That’s because — to the longstanding frustration of many physicians — the state is distributing doses to very few primary care practices.
Seeking to vaccinate many people quickly, the Baker administration has favored hospitals, pharmacies, mass vaccination sites, and community health centers in the vaccine rollout. Only 4 percent of the doses given out so far were administered in private primary care practices. Early in the distribution effort, health officials say, some doctor’s offices received the vaccine but couldn’t move it fast enough and were cut off.
But now, some doctors want the state to shift priorities from speed to access. The system so far has favored people with the skills and motivation to get a vaccination. What’s left are the people with doubts, obstacles, disabilities, or just too much else to do. And primary care doctors say they’re the ones who can coax and assist those people.
Vaccinating “the first 40 to 60 percent, despite the hard work it took, was really the easy part,” said Dr. David A. Rosman, president of the Massachusetts Medical Society. “It’s the last half or so that is much more difficult. . . . We’re at a really good time to make the shift to a more personalized approach.”
Dr. Howard Koh, a professor at the Harvard T.H. Chan School of Public Health and a former Massachusetts public health commissioner, said studies show that in times of crisis, “one’s personal doctor and primary care physicians in particular represent the most trusted messenger.”
Often patients don’t oppose vaccines, but just haven’t gone to the trouble of getting one, said Dr. Russell S. Phillips, director of the Center for Primary Care at Harvard Medical School. With such people, he said, “Simply having the recommendation of the primary care doctors and the opportunity to get a shot is going to be sufficient.”
Altman, the doctor who called Brenner about his shot, has been receiving 400 doses a week to administer at his Arlington practice. Vaccination, he says, is something primary care doctors routinely provide already.
”We’re used to doing this,” said Altman, who is chair of family medicine at the Tufts University School of Medicine. “We are ready to rise to the occasion.”
And with COVID-19, primary care doctors can quickly identify and reach their most vulnerable patients — the elderly and disabled, people with limited English proficiency or transportation difficulties, and people like Brenner who would be reluctant to visit a mass vaccination site.
Recent polling by the Kaiser Family Foundation found that many people prefer to get vaccinated by their own doctor. In one poll 75 percent of respondents said they’d be “very likely” to get the vaccine if it were available at the doctor’s office, preferring their own doctors over all other sources. And among people who want to “wait and see” before getting vaccinated, half said they would be more likely to accept the vaccine if it were offered during a routine medical visit.
“We need to reach the folks who are more ambivalent. That can be successfully done through the close relationship that patients have with primary care physicians,” said Dr. Elisa Choi, governor of the Massachusetts Chapter of the American College of Physicians, which represents internists.
Dr. Lloyd Fisher, a Worcester pediatrician and president of the Massachusetts Chapter of the American Academy of Pediatrics, said he isn’t aware of any pediatrician in Massachusetts who has been able to get vaccine doses, even though teens age 16 and up are now eligible.
“So many patients, especially teenagers, are expressing a desire to obtain the vaccine in the place where they receive all their other vaccinations,” he said. Fisher had three patients ask for COVID-19 vaccines during routine visits just the other day, and he worries that they won’t take the trouble to sign up for it at another site.
The Baker administration, facing tight supplies and an urgent need to vaccinate a lot of people, has favored what it calls “high-throughput sites.” That includes the mass vaccination sites and hospital-run clinics. The physician-leaders interviewed said they had received no indication that the state will change its approach, and a spokeswoman did not answer questions on whether it intends to provide vaccines to more doctors or address their arguments.
“Due to supply and storage requirements, the Commonwealth distributes vaccines to those providers who can properly store and administer doses,” said Kate Reilly, spokeswoman for the COVID-19 Response Command Center. “The administration will continue to work with providers as a critical partner in vaccine distribution.”
The state has been providing doses to a few primary care practices that agreed to also vaccinate people who were not their patients and could administer 85 percent of the doses received each week.
In the state’s January survey of primary care providers in Massachusetts, 83 percent of the 505 respondents were willing to provide the vaccine, but only 25 percent felt they could offer it to the general public, rather than just their patients, often because of logistical challenges.
The vaccine must be kept cold and doctors have to make sure they’ve scheduled enough patients to use up all the doses in every opened vial. Also, they need to have space for patients to wait — distanced — for the mandatory 15 minutes of monitoring.
Initially the Pfizer vaccine needed to be stored in ultracold freezers, but it was later found that the vaccine could survive for up to two weeks in conventional freezers. And the Johnson & Johnson vaccine, authorized after the state’s survey, just needs a normal refrigerator.
“We have lots of examples where primary care practices are managing the cold storage issues and patient flow,” said Phillips, of the Center for Primary Care. “Almost every primary care doctor I’ve spoken to is actually eager to be able to administer shots to patients.”
Dr. Michele C. Parker’s practice in Gardner has been providing 100 doses a week since January, when she persuaded the state to give her vaccine because her community had a high infection rate. “I feel like we’re meeting a need that isn’t met elsewhere in the community,” she said.
Her vaccine patients include people who don’t have Internet access, can’t get to a mass vaccination site, or have health issues they need to discuss. One was a deaf man who wandered the clinic in confusion until Parker spoke to him with an app that translates her words into text.
“Within two minutes, he was heading out the door with his appointment to come back,” she said. “He said, ‘Wow, that was easy.’ ”