- CVS Health and Walgreens will play a bigger role in the Covid vaccine effort as a federal program ships doses to retail pharmacies.
- The rollout will test the major pharmacy chains' commitment to expanding health-care access in Black and Hispanic communities.
- For vaccine distribution, equity is not only a matter of fairness. It's also a crucial way to slow the spread in communities where Covid-19 cases, hospitalizations and deaths are higher.
Dr. Virginia Banks says if the U.S. really wants to bring the pandemic to an end, it's going to take mobile vans of vaccines in neighborhoods where people don't have transportation — and even giving shots at hair salons and barber shops.
As thousands of pharmacies get shipments of doses and start vaccinations at their stores this week, the country is taking a significant step toward reaching more Americans. Public health officials and advocates, however, say that won't go far enough in communities where people have been the sickest.
More Black and Hispanic Americans have been hospitalized and died from Covid-19. They often face bigger barriers to get vaccine, too: A lack of transportation. A juggle of multiple jobs. Hesitance because of past mistreatment by the medical community.
CVS Health and Walgreens will play a bigger role in the effort as a federal program ships doses to more of their stores and those of other retail pharmacies. The expansion represents a business opportunity for the nation's two largest pharmacy chains as they get paid for each vaccine and draw more foot traffic to stores. The vaccine rollout will also test the companies' commitment to expanding health-care access in Black and Hispanic communities.
Banks, an infectious disease doctor in Ohio, is part of an interest group of the Infectious Diseases Society of America that's made up of Black physicians, scientists and public health officials focused on addressing health-care disparities. She said health-care providers will have to get creative and show commitment. She said they should set up clinics in familiar places, such as churches, and enlist "trusted messengers" like pastors and community leaders.
"You've got to look at from a cultural standpoint 'Where are we?' and come to us," she said.
More than fairness
The vaccine's rollout in the U.S. has been slow and complex. Demand for doses has far outweighed the number of shots available to jab into arms. Online appointment systems have been tricky to navigate and bogged down by heavy traffic. Only two vaccines have emergency authorization from the Food and Drug Administration so far, and they must stored at cold and ultra-cold temperatures. And only some Americans qualify for the shot, with each state having slightly different criteria to weigh factors like a person's age, medical conditions or job.
About 48.4 million vaccines have been administered in the U.S. as of Friday, according to the Centers for Disease Control and Prevention. Nearly 12.1 million people have received both doses of the vaccine — just a small fraction of the 331 million people who live in the U.S.
The country's goal is to vaccinate between 70% and 85% of the U.S. population — or roughly 232 million to 281 million people — to achieve herd immunity, according to Dr. Anthony Fauci, the president's chief medical advisor.
The messy rollout has led to some getting shots and not others. Most of the nearly 13 million people given at least one shot of a Covid-19 vaccine within the first month of the drugs' distribution were women, age 50 or older and likely non-Hispanic and White, according to a CDC study.
For vaccine distribution, equity is not only a matter of fairness. It's also a crucial way to slow the spread in communities where Covid-19 cases, hospitalizations and deaths are higher. Black and Hispanic Americans are 3.7 times and 4.1 times more likely be hospitalized from Covid than White Americans, according to data reported by the CDC in late November. Both of the minority groups are 2.8 times more likely than White Americans to die from the disease.
In a hard-hit neighborhood, each shot's impact can be even greater — reaching people who are more at risk as they work in grocery stores or at other frontline jobs or live in a dense apartment or multigenerational households.
Vaccine hesitance is higher among Black and Brown people, too, stemming from the medical community's history of mistreating minority groups and opening fewer health-care practices in their neighborhoods. A poll of New York residents, conducted by the Association for a Better New York, found that 78% of White residents would take the vaccine as soon as they could compared with 39% of Black residents, 54% of Hispanics and 54% of Asians.
'Put their money where their mouth is'
For providers like CVS and Walgreens, having more doses of the vaccine is a business opportunity. They will get paid for each vaccine and the government will pick up the cost if a person does not have health insurance. Jefferies estimated that each shot will have a $13 to $15 gross margin and could yield about $1 billion in incremental gross profits for CVS over the next year.
Both drugstore chains have pinned their strategy on adding more health-care services from primary care clinics to diabetes screenings. They have also stepped up commitments to address racial inequities in response to George Floyd's killing and nationwide protests. CVS plans to invest nearly $600 million over five years to support public policy initiatives and internal efforts, such as mentoring Black employees and offering free health screenings for blood pressure and cholesterol at stores.
Walgreens started a pilot project in the Chicago area that aims to reduce hospitalization rates by making it easier for patients to take their medications, get free deliveries of prescriptions and have more regular contact with health-care professionals about their medical conditions. It recently hired former Starbucks Chief Operating Officer Roz Brewer as its next CEO. When she steps into the role in mid-March, she will be only Black woman leading a Fortune 500 company.
Karyne Jones, CEO of the Washington, D.C.-based National Caucus and Center on Black Aging, said expanding vaccines to hard-hit communities is a way for CVS and Walgreens to "put their money where their mouth is." Her organization is a founding member of the Covid-19 Vaccine Education and Equity Project, a coalition of nonprofits and trade groups that's backed by vaccine-maker Pfizer.
Jones said she would like to see CVS and Walgreens open 24-hour vaccination sites and set up tents in neighborhoods where people don't have transportation.
"If you really want to show good corporate responsibility, this is the time to say we have got to put resources toward alleviating this pandemic," she said.
Banks, the infectious disease doctor, said it will take outside-of-the-box strategies, such as rerouting bus routes to go by vaccine clinics. She pointed to an effort where pharmacists paired up with barber shops to detect high blood pressure when Black men went for a haircut — a clinical study that helped detect the condition and intervene earlier.
She said she's hopeful that the Johnson & Johnson vaccine — which requires just one dose and can be transported more easily — could be a game changer for distribution and make it easier to give shots where people are. The company requested emergency use authorization from the FDA last week.
"We have pharmacy deserts," she said. "We have grocery store deserts. We don't have church deserts."
Doses in more neighborhoods
Walgreens and CVS have given Covid vaccines at thousands of nursing homes and assisted living facilities. They have administered shots at some stores after getting vaccine doses from states. With the federal program, they will offer shots in more neighborhoods.
Walgreens has Covid vaccines at stores in 15 states and two additional jurisdictions, New York City and Chicago. It will provide shots in 1,800 stores as part of the federal program — or roughly 20% of its U.S. stores, a company spokeswoman said.
CVS has them in 18 states and Puerto Rico. As of Friday, about 420 of its approximately 9,900 stores will give the shots with doses from either a state or the federal program, a company spokesman said.
Both pharmacy chains said they have chosen stores in neighborhoods with greater need. About half of each companies' stores with Covid vaccines are located in medically underserved areas or places that rank high on the CDC's social vulnerability index, which is based on factors like the prevalence of poverty, lack of vehicle access and crowded housing.
Walgreens will also allow people to schedule appointments in person or by phone, so people are not excluded if they don't have internet or a computer, said Rina Shah, Walgreens group vice president of pharmacy operations. CVS has a 1-800 number as its alternative to booking online.
Walgreens struck a partnership with Uber to provide free rides to vaccine appointments to people who live in underserved parts of major cities, such as Atlanta and Chicago. Charitable partners will help identify people who need transportation.
CVS is taking proactive steps to make sure locals can get vaccine appointments at their nearby store, said Chris Cox, the company's senior vice president of pharmacy. He said staff are calling some customers to schedule their appointments, particularly those who are lower income and older.
Along with enlisting pharmacies, the Biden administration will ship doses to community health centers next week that serve millions of Americans who live below the poverty line and are racial minorities.
The vaccination program allows CVS to powerfully demonstrate how it can provide health care in places where it typically is not accessible, Cox said.
"Everything we do is really with the intent of helping people on their path to better health," he said. "What this opportunity really gives us is to demonstrate to our patients and to other stakeholders what we've been saying for several years, which is that community pharmacy has a big role to play in health care."
Many patients see their pharmacists more often than their doctors since they need to pick up high blood pressure pills or other maintenance prescriptions, he said. Those frequent interactions mean that CVS can play a larger role in making sure people take their medications properly or can intervene before potential complications.
As Walgreens gets more supply, Shah said it will expand its hours and offer shots on weekends for people who can't skip a day of work. It will open clinics at community centers, like it does for flu shots.
Shah said its pharmacists can play a key role as they educate and answer questions, so people are eager for the shots rather than apprehensive. But, she said, the company ultimately needs more supply to reach more people in minority communities.
"Our biggest opportunity is getting more vaccine," she said.