Another COVID-19 Challenge: Vaccinating the Homebound

However, one centralized effort is in the works. A group of 13 health insurance plans under America’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield Association (BCBSA) are now coordinating with the White House on ways to reach the most vulnerable, underserved older Americans, including African American and Hispanic communities and people who are homebound. Part of the Biden administration’s Vaccine Community Connectors program, they may use mobile vans to get COVID-19 vaccine doses out to people who are unable to leave their homes, says Tonya Adams, national spokesperson for the program and chief customer experience officer at Regence BlueCross BlueShield. People don’t need to be covered by insurance to receive the vaccine, however. (See their site for more information.)   

And there are local programs making progress. Wake Forest Baptist Health, based in Winston-Salem, North Carolina, started reaching out last month to patients who have difficulty leaving their homes; it so far has administered 50 first doses of either the Pfizer–BioNTech or Moderna vaccine. Both vaccines have been used in the U.S. since December and each requires a second shot a few weeks after the first. The one-dose Johnson & Johnson vaccine is a new, third option.

In Miami Beach, the fire department has distributed more than 5,200 first and second doses to homebound and other vulnerable older residents (in affordable housing, for instance) since January, says city spokesperson Melissa Berthier. She notes that the city already had a list of such residents for hurricane emergencies, and has the advantage of being a compact 7-square-mile island.

Logistical challenges

Distributing the vaccines to people who live close together, of course, is far easier than driving for miles between homes. The Pfizer–BioNTech and Moderna vaccines are relatively delicate. The first must be stored at minus 13 degrees to minus 5 degrees Fahrenheit; Moderna’s vaccine needs to be shipped and stored at minus 4 degrees. That means administrators need special cold storage units.

They also need to deliver the shots fairly quickly, points out Denny Chan, a senior staff attorney at Justice in Aging, a national legal advocacy organization for low-income older adults. Once a vial of the Pfizer–BioNTech vaccine is thawed, for instance, it must be used between 30 minutes and two hours.

“Then you also have to wait for a certain amount of time to see if there are any allergic reactions to the vaccine,” Chan adds. That leaves less time to travel to the next homebound person. In contrast, vaccinating residents in nursing homes or other congregate living facilities is extremely efficient, allowing a median of 78 percent of nursing home residents to have received at least the first dose by early February, according to the Centers for Disease Control and Prevention (CDC).

“There’s a whole level of coordination that has to be taken into account,” says Karen Anna Abrashkin, M.D., medical director of Northwell Health’s House Calls program, which is based in New Hyde Park, New York, and serves about 1,500 patients in the region. The program plans to start home vaccinations soon, using “mapping software that clusters patients to allow for enough time from the vial puncture to when the last dose is drawn.”

Another roadblock to more efficient home vaccinations: strict eligibility rules. It would make sense for the people visiting homes to vaccinate both the older person and his or her caregiver, but that’s often not possible under state rules. “We’re seeing that home health agencies are more reluctant to do the vaccine administration for homebound individuals, knowing that that one trip is only going to result in one shot being administered,” says Chan, a member of California’s Community Vaccine Advisory Committee, which provides feedback on the state’s COVID-19 vaccine rollout.

The good news

The U.S. now has a vaccine in its arsenal that’s easier to store and administer. The Johnson & Johnson vaccine received emergency use authorization (EUA) for adults 18 and older from the U.S. Food and Drug Administration (FDA) last weekend, and doses have begun shipping. It’s a one-shot vaccine, making it less complicated than the two currently used vaccines, which require a second shot three or four weeks after the first.   

The J&J vaccine also has less stringent storage requirements: It can be shipped and maintained at standard refrigerator temperatures of 36 to 46 degrees Fahrenheit.

And it’s just as good at preventing extreme outcomes from COVID-19: The data from phase 3 clinical trials show that all three of the vaccines are 100 percent effective in preventing hospitalization and death from COVID-19.

Adams is among the many health care experts and providers who say the J&J vaccine is likely to be a game-changer for vaccinating the homebound, once its distribution becomes more widespread: “It will make all of these efforts easier,” she says. “It’s not that you can’t do it now, but it will take away some of that complexity.”

Christina Ianzito is a Washington, D.C.-based journalist who joined AARP in 2010. She's the travel and books editor for aarp.org and AARP The Magazine, and also edits and writes health, entertainment and other stories for aarp.org. She received a 2020 Lowell Thomas Award for travel writing.