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Health

Nursing home leaders prepared to face resistance when administering COVID vaccines

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JOEL SAGET / AFP via GETTY IMAGES
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Appearing before the Michigan Legislature’s Joint Select Committee on the COVID-19 Pandemic last week, state health department director Robert Gordon said that residents and staff in long-term care facilities would be one of the first groups to receive a COVID-19 vaccine when it becomes available. 

Many nursing homes will be receiving their doses free of charge from a large pharmacy chain, through a program organized by the CDC.

The Meadow Brook Medical Care facility in Antrim County is already signed up with CVS, but administrator Marna Robertson says willingness to get vaccinated varies among her staff of roughly 200.

“I’ve got some go, ‘Yeah, no, I want to get back to normal, I want to do this,’” she explained. “And then there’s some folks that are going, ‘Ehhh, I don’t know.’ And then there’s some folks, staunch, that are going, ‘No, I’m not doing it unless you make me.’”

During last week’s committee hearing, when asked by Representative Jack O’Malley (R-Lake Ann) whether the Michigan Department of Health and Human Services was considering a vaccine mandate, Gordon’s answer was terse: “No.”

When exactly residents and staff can get their shots depends on the vaccine's availability. MDHHS spokesperson Lynn Sutfin says after prioritizing frontline health care workers "such as EMS, staff who work on general medical floors, ICUs, or emergency departments," the department will turn to congregate care facilities — "hopefully by January."

Like at Meadow Brook, opinion among staff at the Oasis at Adrian, which is signed up with Walgreens as part of the CDC program, is mixed.

“I have some staff that are definitely down with it,” said Jeff Wangsness, the nursing facility’s administrator. “And then I have some staff that are like, ‘No, I don’t want it.’ There seems to be — I don’t know, I don’t want to say a bit of paranoia — but distrust.”

Both Robertson and Wangsness say it’s harder to gauge residents’ appetite for early inoculation, though research suggests they could be on the fence as well.

A recent survey from the University of Michigan’s Institute for Healthcare Policy and Innovation found that while 66% of older Americans (those between 50 and 80) said they would get the vaccine eventually, only 20% wanted their shots as soon as they became available. 

46% of respondents said they were uncomfortable with how quickly the vaccines were developed. Both Pfizer and Moderna, whose vaccine candidates have so far shown over 90% effectiveness, have applied for emergency use authorization from the FDA.

In a presentation last week, the chair of the FDA’s Vaccines and Related Biological Products Advisory Committee, Dr. Arnold Monto, emphasized that the accelerated development and production would not compromise safety. 

“We are doing exactly what we ordinarily do with vaccine development, but on a shorter timeline,” said Monto, who’s also a professor at UM’s School of Public Health.

Dr. Mark Gloth, the chief medical officer at ProMedica Senior Care, which owns 16 skilled nursing facilities in Michigan, says staff at those facilities who wish to forego the vaccine will have a “one-on-one counsel” with their medical director so they can make a fully informed decision.

“We are certainly not mandating this, but we want to make sure that every opportunity is given and that they are fully educated as to the risks and benefits,” he said.

On December 1, the CDC’s Advisory Committee on Immunization Practices voted 13-1 to include not only staff, but also residents in long-term care facilities in the very first phase of vaccine distribution. That priority list is guidance, with distribution ultimately up to the states. 

The group’s lone dissenter, Dr. Helen Keipp Talbot, who studies vaccines in older adults, explained her vote to STAT News, saying she worries that health events following vaccination — much more likely in the frail long-term care population — could be interpreted by the public as adverse reactions to the vaccine and therefore damage confidence in its effectiveness.

She advocates studying the vaccine in that population specifically (as has been done with the general U.S. adult population, through clinical trials) before rolling it out wholesale.

As of last week, nursing home residents made up 27% of Michigan’s total deaths from the disease. For all licensed long-term care facilities, which include adult foster care facilities and homes for the aged, the share of deaths was 35%.

But because not all those facilities are reporting to MDHHS, that’s likely an undercount.

Sutfin, from MDHHS, says they do not know "at this time" how many nursing homes and other long-term care facilites have signed up to receive vaccines as part of the CDC's pharmacy partnership. 

Correction: A previous version of this article incorrectly stated that the survey of vaccine opinions among older adults was from the University of Michigan's School of Public Health. In fact it comes from the UM Institute for Health Policy and Innovation, which is part of Michigan Medicine.

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