Wyoming County’s only geriatrician is Edward Zurad, who over three decades built a practice of more than 7,000 patients ages 65 to 100, all of them eligible to receive the COVID-19 vaccine.
“We have folks at home, my older patients, very poor computer access, they have very limited resources, and they don’t want to die of COVID,” he said. “Some people are calling every day.”
His rural county of 28,000 just west of Scranton has reported more than 1,100 coronavirus cases since the pandemic began. He was aggressive, he said, about ensuring his practice in Tunkhannock was approved to carry the vaccine, even though being a provider will likely cost him money. So far, though, all his requests for vaccine doses from the Pennsylvania Department of Health have been denied.
Meanwhile, the department allocated more than 12,000 doses to pediatric offices statewide. The Food and Drug Administration has not authorized emergency use of the Pfizer-BioNTech vaccine for anyone younger than 16, or the Moderna vaccine for anyone under 18. Older teens must have serious underlying health conditions to get the vaccine now.
Pediatric offices have a lot of expertise doling out vaccines, and they do have older teen and even adult patients who might qualify. But what puzzles many doctors is why practices that cater to seniors — the most vulnerable to serious illness and death from COVID-19 — weren’t able to get doses.
“I honestly don’t know what the distribution method is because it just seems so random,” said Tracey Conti, a physician with University of Pittsburgh Medical Center and president of the Pennsylvania Academy of Family Physicians.
The 12,200 doses sent to 29 pediatric offices from Dec. 21 to Feb. 23 are a fraction of about 3.1 million shipped to Pennsylvania, and reallocating them couldn’t have eased the state’s distribution woes. But they’re a frustrating symbol to doctors who spent months preparing to offer doses for their elderly and seriously ill patients.
“Folks like myself and other internists and family doctors try to play by the rules, we wait in line, we try to do all the state conferences, we do webinars, read the emails from the state,” said Zurad. “Obviously it’s led nowhere.”
Difficult allocation decisions, state officials said, are necessary because the vaccine is so scarce.
“We encourage people to have patience,” said Maggi Barton, a Department of Health spokesperson. “Right now there is not enough vaccine to meet the demand in Pennsylvania, or any other state.”
The department has said the vaccine shortage is the primary reason requests for doses are denied. The department’s formula to determine how to disburse the limited supply considers the area’s population, the number of people 65 and older, the percentage of positive COVID-19 test results, and the death rate, according to a letter the department sent Zurad denying his vaccine request.
The state needs about eight million doses to provide the required two shots to each person currently eligible, more than twice as much as it has so far received. Pediatricians’ experience handling vaccines makes them a particular asset in the battle against COVID-19, officials said.
“We are experts in storing, handling, documenting,” said Kate Tigue, secretary and treasurer of the Pennsylvania chapter of the American Academy of Pediatrics and a pediatrician practicing in Lackawanna County. “It makes perfect sense for pediatric providers to be part of this rollout for vaccine.”
The state invited Tigue’s practice to apply to carry vaccine in the fall, she said, in part due to its participation in the Vaccines for Children program, a federal initiative which seeks to ensure vaccinations for children who are underprivileged or are Native American or Alaska natives.
Young people frequently continue seeing their pediatricians into their early 20s, Tigue said, and she has hundreds of teens and young adults with conditions like cancer, diabetes, and compromised immune systems.
“I think there’s been a little bit more of a struggle for them and their families, making decisions about whether to attend college or not” during the pandemic, she said. “These pose real struggles to families making decisions.”
She received one order of 100 vaccine doses at her office, Pediatrics of Northeast Pennsylvania, a third of what she requested in late January. Some went to patients, other doses to parents and grandparents eligible to receive shots. If she had more, she would have provided doses throughout the community, not just for her patients.
“I can do a flu clinic on any given Saturday in the fall and give 400 doses in three hours,” Tigue said. “I think there’s a role to just recognize pediatricians have the knowledge and expertise as well as the community knowledge and relationships to do a significant number of vaccinations.”
The trickle of doses stops
Christine Meyer began taking steps in the fall to ensure she would be able to provide doses at her Exton practice of 20,000 patients, of which at least 5,000 are now eligible for vaccination due to age or health conditions. She got confirmation from the state Department of Health that it had received her application, but has heard nothing since. Frustration over her helplessness to get vaccines for her patients prompted her to create a Facebook group where volunteers scour online registration sites to schedule thousands of people seeking vaccination.
Meanwhile, she said, her husband’s pediatric office, which also participates in the Vaccines for Children program, was approved on Feb. 6 to receive doses.
The Department of Health acknowledged that a large number — but not all — of its approved vaccine providers were practices participating in the Vaccines for Children program, which is not exclusively available to pediatric offices.
And now, to private practice physicians’ great frustration, the state’s plan has shifted again, toward hospitals, federally qualified health centers, county health departments, and pharmacies.
“We must concentrate the vaccine among the providers who can move first doses as quickly as possible to protect Pennsylvanians,” state Health Secretary Alison Beam said in a news conference this month.
Vast clinics — like the one at Philadelphia’s Liacouras Center last weekend run by the Black Doctors COVID-19 Consortium that inoculated 4,000 people in 24 hours — offer the efficiency health officials are seeking. But they aren’t enough, say doctors in private practice.
Patients trust their doctors, who are in the best position to identify and contact the people most in need of doses, said Conti, the head of the state’s family physicians association.
Yet physicians have found the state’s decision-making to be inscrutable, she said.
“Some physicians’ offices applied and never received vaccine and they did not receive vaccine even though they’re in vulnerable areas,” she said. “We have had physicians not in vulnerable areas who have had multiple shipments of vaccine.”
After receiving her first shipment of vaccine in late January and using it all within a week, Tigue still has young patients eligible for the shots. Yet requests for more doses for her pediatric practice have been denied. She doesn’t know why.
Zurad wears many hats in Wyoming County, one of which is that of medical director for the Procter & Gamble plant there. He has arranged for an auditorium to be converted into a vaccination clinic, he said, where he planned to vaccinate hundreds, including emergency responders working for the company and employees 65 and older. Now that the state has tightened who can carry the vaccine, he doesn’t know when he’ll be able to use the now-empty auditorium.
“After all the time we put into creating a registry of my patients to create a vaccination site ... ,” he said. “I did not submit any further requests [for vaccine] because we were told they wouldn’t be honored.”