Many Older Americans Need Help Scheduling a COVID-19 Vaccine

Since the onset of the COVID-19 pandemic, older adults have been at greater risk of serious illness, hospitalization and death due to the virus. In mid-January, the federal government asked states to expand vaccine eligibility to people ages 65 and older. Although the pace of COVID-19 vaccinations is increasing nationwide, no state has crossed the threshold of vaccinating 50 percent or more of its older population according to a Kaiser Family Foundation (KFF) analysis.

In addition, while a recent COVID-19 vaccine monitoring report shows that many older Americans have been able to navigate the sign-up system successfully, about one in six have been unable to schedule a shot. Overall, some 43 percent of older adults who got vaccinated or attempted to make an appointment say the process is difficult.

Notably, older adults with college degrees are more likely than those who have not graduated from college to say they have received or scheduled their first dose (65 percent compared to 46 percent).

Challenges Faced by Older Adults
Many people age 65 and older face a host of problems getting vaccinated, including not knowing how to schedule appointments or where to get vaccinated, waiting in long lines, or arriving for an appointment only to learn that vaccines are no longer available. Seniors also may be disadvantaged by appointment sign-ups that occur online rather than by telephone, since almost one in five people in this age group do not have internet access at home.

In fact, an estimated one-third of seniors no longer drive cars, and many do not have adult children, grandchildren or relatives who can provide assistance. Underlying inequities in resources, such as access to technology and transportation, may further increase barriers to vaccination for seniors of color.

In Los Angeles, for example, this situation has been compounded by supply shortages and an inconsistent flow of vaccine deliveries. Recently, several large vaccination sites were limited to second doses only and some were forced to close for days at a time due to insufficient supplies. Unfortunately, vaccine distribution systems seem to favor physically healthy, tech-savvy people with reliable transportation above the most vulnerable members of the community.

The introduction of Johnson & Johnson’s COVID-19 vaccine should result in a steady stream of new doses – adding to the supply provided by Moderna and Pfizer-BioNTech – with an estimated delivery of 37 million doses by the end of March. However, officials warn that initial supply of the new vaccine will be highly uneven during the first month.

Addressing the Problem
To address inequities and delays in vaccination distribution systems, the state of California has signed a contract with Blue Shield of California (Blue Shield) to develop a vaccine allocation algorithm with a focus on equitable and efficient distribution. As a third-party administrator, Blue Shield will establish a new centralized system to distribute doses equitably and quickly. Blue Shield will work with public health officials, local health jurisdictions and health care providers to offer vaccination shots in vulnerable neighborhoods and communities – serving individuals who have experienced difficulty accessing major vaccine sites and clinics.

For example, the agreement with Blue Shield states that the travel distance for a healthy person to drive or be transported in a vehicle from their home to a vaccination site should be less than 30 minutes for those living in urban areas (i.e., approximately 95 percent of the state population) and less than 60 minutes for those living in rural areas.

In addition, transportation companies such as Uber and Lyft are partnering with a number of pharmacies, health care systems, Medicaid and Medicare Advantage plans to offer free transportation to vaccination sites to serve the elderly and communities of color. With this option, health care providers may schedule free transportation to vaccine appointments on behalf of those covered by government health programs.

Reaching the Disadvantaged
Blue Shield is also tasked with finding ways to deliver vaccines to people who are homebound or suffering from medical conditions that make it prohibitively difficult for them to visit a clinic or mass distribution site. It will work with the state to determine how vaccines are allocated and develop incentive payments for providers to administer doses quickly to targeted populations.

The state will also set goals for what percentage of vaccines should be reserved for low-income or disadvantaged areas. The elderly, disabled and others in hard-to-reach areas may be able to schedule an appointment at a mobile vaccination site, local pharmacy or community center, and even have the option to receive the vaccination in their home.

Kaiser Permanente is also expected to operate a vaccination program for its 9 million health plan members in California that is focused on reaching individuals in hard-to-reach and disproportionately impacted populations.

Vaccinations Going Forward
California’s new system of delivering, tracking and scheduling COVD-19 vaccines was rolled out in select counties on March 1, at which time the state committed to administering 3 million vaccines per week dependent on supply. This marks an important step toward a centralized delivery system that improves access, equity and accountability throughout the state. It also promises to offer the older population a simple and straightforward way to understand when, where and how they can get vaccinated.


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