Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.
Jason Gallagher, a licensed pharmacist and professor of infectious diseases at Temple University in Philadelphia, Pennsylvania, wanted to help out in the COVID-19 vaccination effort, so he decided to volunteer.
First, he had to take a 20-hour course in vaccination. While he waited for his CPR card to come in the mail, he obtained liability insurance and submitted an FBI criminal background check form, though he later found out that that step wasn’t supposed to be in the application. He then had to get his application documents notarized.
After almost a month, he gave his first COVID-19 shots in Pennsylvania. He’s still waiting to be approved in New Jersey.
Many healthcare workers who try to volunteer as vaccinators run into an ad hoc system just as chaotic as the rollout of the vaccines. Without a streamlined, national system, the rules for eligibility aren’t always easy to find and often vary from state to state. Many would-be vaccinators are told they need to buy malpractice insurance, and many states require background checks.
Both the CARES Act and the PREP Act have eased the path for volunteers, but their impact is muted by lack of communication and understanding of the modifications, such as protection from liability. Even when there is a national volunteer system, such as the Medical Reserve Corps, not all states participate to the same extent. The stakes are high for getting it right: Volunteers will be increasingly crucial to staffing vaccination sites, especially as more Americans become eligible for the shots and mass, stadium-style sites become more prevalent.
“It’s one thing to have the vaccine,” President Joe Biden said in a recent appearance at the National Institutes of Health. “It’s another thing to have vaccinators.”
Congressional Acts Help, but Leave Gaps
In 2005, Congress passed the PREP Act to ensure that drug companies could develop emergency vaccines without fear of excessive legal liability. The secretary of the US Department of Health and Human Services (HHS) may invoke the PREP Act during a health emergency, which, according to the law, provides “immunity from tort liability claims (except willful misconduct) to individuals or organizations involved in the manufacture, distribution, or dispensing of medical countermeasures.”
Former Secretary of HHS Alex Azar invoked the PREP Act in February 2020. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which was enacted in March 2020, also limited liability for healthcare professionals who volunteered during the COVID-19 emergency response.
Amendments to the PREP Act during the coronavirus pandemic have broadened its reach, allowing states to accept healthcare workers with licenses or certifications from other states as volunteers. Another amendment allows recently retired medical professionals to administer vaccines.
The PREP Act provides healthcare workers immunity from liability for administering the COVID-19 vaccine and other countermeasures, but it does not cover general medical care administered to patients, according to an HHS spokesperson.
These laws don’t give broad authority to every professional with medical expertise, such as dentists and veterinarians, to administer the vaccines ― those permissions come from individual states. Although Biden administration officials and Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky have called for more volunteers from among retirees, dentists, veterinarians, and medical students, it’s often up to governors to decide who can vaccinate.
“We need to make sure…that we have commissioned health corps, medical military, retirees, medical students, and nursing students just about to graduate, dentists, and veterinarians in order to be out there to vaccinate the public,” Walensky told The Today Show.
In the meantime, there is little cohesion among states. In New York, podiatrists, dentists, and pharmacy students are giving shots. In Colorado, chiropractors and optometrists are allowed to sign up. An Austin, Texas–based veterinarian network volunteered thousands of employees and 390 sites in 37 states, though it’s unclear whether they’ll be allowed to vaccinate people, because currently, permission for veterinarians varies by state. A survey of state immunization managers shows that the only settings all states plan to tap for volunteers are medical, pharmacy, and nursing schools.
Currently, 20 states allow dentists to vaccinate. But that doesn’t mean the path is smooth for volunteers.
In Cape Cod, Massachusetts, retired periodontist Kathleen Barrett has been trying to find a way to volunteer as a vaccinator for the past 2 months. But after speaking to the American Dental Association, the Massachusetts Dental Society, and the Massachusetts Board of Registration in Dentistry, she was referred to her previous malpractice carrier, which is advising her to purchase malpractice insurance, which costs around $850 a month.
“I’m trying to do my best to help, but I’ve gotten nothing but roadblocks,” she said.
Even for fully licensed, practicing physicians, some localities require volunteers to undergo background checks. In Illinois, physicians from the Chicago Medical Society wrote a letter to Gov. J. B. Pritzker imploring him to waive background checks for licensed healthcare workers to volunteer at mass vaccination sites, the Chicago Tribune reported. A spokeswoman for Prtizker told the newspaper that the Illinois Department of Public Health has urged local health departments to remove unnecessary barriers.
Training requirements appear to vary by state as well. The CDC provides an online training module designed for COVID-19 vaccinators, but states can choose to require their own training instead of or in addition to the CDC’s module.
The Medical Reserve Corps Is an Underutilized Model
The Medical Reserve Corps (MRC), which operates out of HHS’s Office of the Assistant Secretary for Preparedness and Response, was established after 9/11 to coordinate medical professionals who offer help during emergencies. But, unlike the programs its designers meant to emulate, such as the Peace Corps, the MRC hasn’t caught on equally nationwide. That could change if the Biden administration decides to deploy MRC volunteers at the federal level with a coordinated plan that could streamline training and requirements and get people where they could help the most. A spokesperson told Undark that such a plan is not currently in the works, though HHS has financially supported MRC with over $1 million during the pandemic.
More than 450 MRC units from 47 states report volunteer hours in response to COVID-19, although the numbers in each unit vary widely, as does publicity. Many medical professionals and even policymakers haven’t heard of the MRC.
It’s not known how many of these volunteers are vaccinating, but in some states, that’s a priority of the volunteer units. The Virginia MRC, for example, maintains a roster of almost 10,000 volunteers, though that has surged to over 27,000 during the pandemic (by comparison, some states have fewer than 1000). The Virginia MRC works hand in hand with the state health department. The volunteers were poised to help from the beginning of the pandemic and began training vaccinators last February.
“If I had to guess, we probably are using volunteers more than any other state,” said Jennifer Freeland, the state volunteer coordinator for the Virginia Department of Health. “Whenever we were short staffed, our first call was to volunteers. We can bring on trusted volunteers quicker than contractors.”
The Virginia MRC’s list of volunteers now includes 1520 vaccinators, and Freeland anticipates that that could increase to 2500 by the end of the month, leaving the state with a different challenge.
“We have people knocking at the door ― everyone wants to help vaccinate ― but we don’t have enough vaccine for all of them,” Freeland said.
She credits much of the Virginia unit’s success to state support and funding for the MRC.
“Overall, our department of health has really invested in the program, and that investment is proving to be a good one,” she said. “The return on investment is high when you can onboard and mobilize this many volunteers.”
As other states muddle through the volunteer sign-up process, the need for more volunteers may become even more apparent as supplies of vaccine ramp up and more large-scale, centralized clinics are set up, said Claire Hannan, executive director of the Association of Immunization Managers. (The American Medical Association maintains a guide for healthcare professionals who’d like to volunteer during the COVID-19 pandemic.)
“I think states are looking at how to scale up their workforces,” she said. “Those volunteers are going to be needed.”
Sheila Eldred is a freelance health journalist in Minneapolis. Find her on Twitter @MilepostMedia.
Do you have information on how your hospital or health network is responding to PPE shortages, gag orders, or other related issues? Has anyone you know faced disciplinary measures for speaking out? Write to us: [email protected]