Covid has killed 170,000 in nursing homes. Most residents still haven’t gotten their last shot.

“Americans look to you as the nation’s top public health official; “It would make sense if, in addition to other actions, I appealed directly to residents and their family members,” Katie Smith Sloan, president of the industry group LeadingAge, wrote in a Dec. 22 letter to Becerra.

More than 170,000 nursing home residents have died since Covid arrived four years ago. But after aggressive efforts to vaccinate seniors in 2020 and 2021, America’s most vulnerable citizens are now largely on their own.

Sloan gave Becerra a to-do list to help homes: allowing them to place small vaccine orders to fit lagging demand, getting hospitals involved in the vaccination campaign, allowing industry to bill Medicare for administering the shots, and getting the message out that it works.

A day later, at a second meeting, Becerra did not offer new aid, but reiterated federal rules requiring homes to provide vaccines.

“We’ve been chasing all these must-do items for three years in a row — I don’t think it’s had an impact,” one senior administration official, who requested anonymity to discuss the administration’s response, said of the nursing home demands. . This person said the agency would consider the latest requests and continue to work with industry, but was skeptical it would radically change the outcome even if the administration approved it.

“I don’t think this message with all its elements, even if we check every box, will suddenly magically change the vaccination rate,” the official said.

“We know they can do it.”

Nursing home residents, due to their age and underlying conditions, are particularly vulnerable to Covid-19.

When the first coronavirus doses arrived at nursing homes in late 2020 at government-run clinics, nearly every resident chose to be vaccinated — a huge relief, given the homes’ huge death toll up to that point.

“(The administration) had the major pharmacies on board. “They brought clinics into nursing homes, and by and large, residents received their vaccines,” recalls David Grabowski, a professor of health care policy at Harvard Medical School.

But that success faded with the broader vaccination campaign.

There’s no clear answer as to why, but two shifts are likely contributing, according to industry and government leaders.

First, interest in vaccination has declined after they proved unable to stop transmission, as have disagreements over who needs an annual dose – even as there is consensus among experts that older people do.

Second, the administration stopped procuring and managing vaccine distribution starting with the updated vaccine rollout last September.

The move coincided with the administration’s decision to end the public health emergency, which justified the move to shift responsibility to insurance companies, pharmacies, doctors’ offices and other private health care organizations administering other vaccinations.

For nursing homes, this means they have to source the shots and manage how to administer them, creating logistical and reimbursement challenges.

Although government and industry leaders agree that a number of other factors could also play a role, the result is clear: Only 38% of nursing home residents have received the most recent dose — a significant decline from the initial vaccination campaign.

There is wide variation between states. Both North and South Dakota reported that more than 60 percent of nursing home residents have been vaccinated while only 20.1 percent of nursing home residents in Arizona have been vaccinated.

Covid continues to take lives in nursing homes, with nearly 600 residents dying in the first two weeks of 2024. As of January 14, more than 14,700 cases of COVID-19 have been confirmed among nursing home residents since the start of winter – It is much less. Case rate compared to previous years.

People in the administration point to discrepancies between states as reason to believe providers could do more.

In some homes, most residents are vaccinated, in others almost no one is, prompting Becerra to remind nursing home administrators that they are legally obligated to at least offer vaccinations to their residents.

“We know they can do it,” the administration official said. “The best is possible.”

The administration can point to facilities, such as those in the Dakotas, that have vaccinated most of their residents.

“It’s all about that trust,” said Dr. Jeremy Cowles, who oversees Good Samaritan Society, the long-term care provider affiliated with South Dakota-based Sanford Health.

He said years of relationships with patients were strong enough to overcome vaccine skepticism. At some Sanford-owned facilities, he said absorption is more than 90 percent.

‘pulpit bully’

Sloan acknowledged that some homes are doing a better job than others at vaccinating residents — more than half of residents at LeadingAge facilities have gotten the most recent dose — suggesting that facilities can help boost confidence.

But she also said she noticed the administration had made less of an effort to convince Americans to get vaccinated than it had in the past.

“One of the things we talked about with the secretary was really the role that the Department of Health and Human Services in particular could play in using its bully pulpit as the primary public health contact in the country,” Sloan said. “This to me is a huge, huge role.”

Mandy Cohen, director of the Centers for Disease Control and Prevention, told Politico in October that vaccinating nursing home residents was a top priority for her agency given the risks they face.

“In the lead-up to this virus season, and throughout the fall, CDC worked with other federal agencies, state and local health departments, and health care partners to address vaccine access issues and encourage vaccine uptake. “We expect to see improvement,” an agency spokesperson wrote in an email.

But some in the administration also said it was appropriate that the shift from a government-run distribution system to one run by the private sector should also mean a shift away from the government’s pandemic role in promoting vaccination.

“There were some who thought maybe it would be better if the messaging came from the manufacturers and from private entities,” the senior official said, believing the administration’s hard sell was merely reinforcing skepticism about the vaccine in some communities.