More on Strategic Planning

AHA urges HHS to better coordinate COVID-19 vaccine rollout

Officials expected to have 20 million doses allocated by the end of 2020, yet so far less than 6 million people have received their first dose.

Mallory Hackett, Associate Editor

The American Hospital Association is calling on the Department of Health and Human Services to make its COVID-19 vaccine rollout a more coordinated and transparent undertaking.

In a letter sent Thursday to HHS Secretary Alex Azar, the advocacy group raised concerns over the administration's goal to have at least 75% of Americans vaccinated by the end of May. It calculates that to meet that mark 1.8 million individuals would need to be vaccinated every day between January 15 and May 31, including weekends and holidays.

AHA pointed to the slower-than-expected initial rollout of vaccines that have taken place in the first few weeks of its administration. Operation Warp Speed officials expected to have 20 million doses allocated by the end of 2020, yet less than 6 million people have received their first dose, as of January 7, according to the Centers for Disease Control and Prevention.

In some cases, the AHA said, not enough vaccine doses were sent that were scheduled to be sent.

"To deliver millions of doses of vaccine at the pace necessary requires that tasks be simplified and standardized. Otherwise, unnecessary confusion and complexity will slow down the effort and may lead to errors," the letter said. "In short, to accomplish our vaccination goal will require consistent and effective communication and coordination among stakeholders."

The vaccine rollout continues. This week, Operation Warp Speed Chief Operation Officer Army General Gus Perna said by the end of the quarter he believes that both Pfizer and Moderna - the two companies currently approved for a vaccine - will meet the requirement of 100 million doses each.


The letter implored HHS to create a vaccine distribution plan that allows for national coordination between all states, jurisdictions and stakeholders.

Changes at the federal level may take place after President-elect Joe Biden is inaugurated on January 20. While Operation Warp Speed coordinates the federal response, distribution is left to states and governors.

The first prong of the AHA request is for HHS to share and be more transparent of its goals.

Each of the 64 jurisdictions have a microplan, which allows them to determine their own strategies for distribution. However, there is currently no way for the jurisdictions to compare their distribution data against the broader goal for each location, the letter said.

"Without this comparison, it is impossible to know whether sufficient progress is being made by those engaged in the effort or more help is needed. We all need to know this to know if our efforts are sufficient or need to be improved," AHA said. "Further, this information will become more crucial as more and more organizations are added to the list of those offering vaccinations to the public and greater numbers of Americans become eligible to get vaccinated."

The letter also called for stronger communication among stakeholders.

The jurisdictions' microplans have "substantial variation" that might not have been necessary to address the differences among the jurisdictions. These variations have made it difficult for health systems that serve more than one state because they say it can be difficult to manage the different prioritization rules in each jurisdiction. AHA also said that some hospitals received fewer vaccine doses than what was requested and needed, while others received more than they could give out for the first-priority individuals.

To minimize any further issues and to address questions that arise during distribution, AHA suggested taking on a national real-time leadership role.

"It is unclear who is responsible for answering questions or by what mechanism all interested parties will receive the answers to these questions that should shape their actions going forward," the letter said. "Hospitals and all of the other stakeholders need a clear understanding of both how to communicate with HHS when critical issues arise and how decisions will be made that will impact the work we are doing to administer vaccines."

This central position could also be effective in dispersing lessons learned and best practices discovered among the jurisdictions.


The AHA letter comes one day after HHS and the CDC announced they are releasing more than $22 billion in funding to help states, territories and localities provide testing and vaccinations. Over $3 billion of it will be made available in an initial award to jurisdictions through the existing CDC Immunization and Vaccines for Children cooperative agreement. The funds will be allocated by a population-based formula. 

In another effort to ensure a smooth vaccine rollout, HHS and the Department of Defense purchased another 100 million doses of Pfizer's COVID-19 vaccine at the end of 2020. The hope is that with these additional vaccines there will be enough for every American who wants one by June.


"We urge you to establish a process within HHS with the ability to be able to coordinate the national efforts among all of the states and jurisdictions and the many stakeholders; answer all of the questions expeditiously; establish and maintain effective communication among all involved; and identify and resolve barriers to the rapid deployment of millions of doses of vaccines," AHA said.

Twitter: @HackettMallory
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