Tester leads hearing on VA vaccine roll-out

The U.S. Senate Committee on Veterans Affairs, led by it’s recently appointed chair Jon Tester, D-Mont., held a hearing Wednesday to take stock of the U.S. Department of Veterans Affairs’s vaccine roll-out and address concerns held by members of the committee.

Tester said, based on everything he’s seen, the VA is doing an admirable job getting the vaccine to veterans efficiently and quickly, and complimented VA Acting Under Secretary for Health Dr. Richard Stone, who was at the hearing, for his work and that of his department, which has surpassed that of the private sector.

Tester said the department has immunized 2.3 million veterans, but the 17 million that remain indicate there there is a long way to go yet, and he believes improvements in communication between the VA and veterans can still be made, particularly in rural areas of the U.S. which have much higher refusal rates.

Ranking Member Sen. Jerry Moran, R-Kan., also praised the VA’s work, in particular that of Veterans Integrated Service Network 15 Director Dr. William Patterson, but said despite having regular calls with the VA members of the committee are learning things through the news media and individual veterans that need to be cleared up and should have been mentioned to them earlier.

In particular, he expressed concern about the use of algorithms to determine vaccine eligibility prioritization and he said he’s heard that veterans that should have priority are being put lower in the order than they should by the algorithm.

Stone thanked members of the committee for their work and praised his staff for their bravery at all levels, but especially those on the front lines.

However, he said, he feels a need to acknowledge the grim milestone the U.S. passed earlier this week, with half a million deaths.

He said 10,000 of those people have been veterans and well more than 100 have been VA employees.

“We collectively mourn all of those that have been lost and continue our pledge to save every possible life that comes to the VA for care,” he said.

Stone said distribution of the vaccine has been a complex process and he continues to ask veterans to use the Keep Me Informed online tool, which can be found at https://www.va.gov/health-care/covid-19-vaccine/stay-informed, to stay up-to-date.

He also encouraged veterans to enroll in the VA so they can get the vaccine as soon as possible.

Stone also thanked the committee for supporting the CARES Act, and said the last of the funds it provided will be spent by the end of this fiscal year.

“Those funds have facilitated the agility of the VA has shown during this event,” he said.

He also praised the Biden Administration’s American Rescue Plan which he said will sustain the continuation of the project and will ensure that they can respond to delayed and deferred patient care needs in late 2021 and early 2022.

Allocation

Multiple senators on the committee, including Tester, asked Stone about the VA’s allocation and what they can handle based on their current operations.

Stone said the VA is getting about 125,000 doses per week, but that number is increasing, and the VA can handle a weekly allocation of 300,000 to 600,000.

Tester said he’s been working closely with Moran to pressure the Biden Administration into getting the VA more vaccine, and Stone said he got a call just before the hearing from the administration saying that next week the VA would have an allocation of more than 500,000 doses, and Tester and Moran said that is great to hear.

They asked Stone how allocation to local regions is determined and he said discretion is given to local VA leaders to take variables like workforce and refrigeration capacity into account, and VA Preventative Medicine Chief Consultant Dr. Jane Kim said these local leaders are using a pro rata approach based on the guidance of the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention’s guidance for prioritization.

Kim said the VA updated the data on the veterans they serve before distribution began to make sure they have accurate numbers on how many people fit into each prioritization category.

Patterson said regions do have minimum allocations that are usually surpassed based on how much vaccine is available.

Veterans Integrated Service Network 15 Director Dr. Ralph Gigliotti said these regions, when scheduling veterans for vaccination, take into account how much lead time they need and those who can show up on short notice are put on lists so they can be called in the event that there is vaccine that would otherwise go to waste.

Rural and minority Veterans

Tester said his priority is to bolster the vaccine supply chains and make sure all veterans have access regardless of where they live, a goal he said he he shares with Moran.

“The VA has piloted a vaccine fly-in program for rural areas such as Havre and Kalispell, and to communities in Alaska, which I think is an innovative way to reach rural vets,” he said. ”But we know there are still barriers to getting our rural vets vaccinated in Montana and across the country.”

Tester and many other senators brought up the fact that vaccination refusal and hesitancy is far higher in rural areas and that needs to be addressed.

“There’s a lot of hesitancy in rural America and we’ve gotta find a way to break that down,” Tester said.

Stone said the primary way the VA has been attempting to address refusal and hesitancy is by communicating with primary care providers and making sure they are informed about the efficacy and safety of the vaccine.

He said a person’s care provider, whether that is a doctor or nurse, is going to be the person they listen to and trust the most.

Sen. Tommy Tuberville, R-Ala., said it might be a good idea for the VA to reach out to other community members and ask them to do public service announcements for the vaccine in rural areas.

Stone said the VA would welcome anyone willing to do something like that.

Tester asked about vaccine hesitancy among VA employees and whether or not Stone had the authority to make the vaccine mandatory for employment.

“Sir, I have that authority, but I’m not going to use it,” Stone said.

He said the data he’s seen shows that VA employees are overwhelmingly getting the vaccine, far more than in the commercial sector, and he doesn’t see the need to make it mandatory.

Stone said the data on hesitancy is not as clear as it could be, but it appears to be declining nationwide.

Patterson also mentioned that the VA has been working with local VFWs and American Legion Chapters to reach veterans who may not have internet access and need more information on the vaccine.

Senator Joe Manchin, D-W.Va., asked if the VA was taking into account the fact that the Pfizer vaccine is much more difficult to properly refrigerate when dealing with rural communities, and whether vaccine loss has been a serious problem.

Stone said the VA does take refrigeration capacity into account when distributing to rural areas, and which vaccine loss is not unheard of, it has been kept to a minimum.

Kim said the Johnson & Johnson vaccine currently being considered for emergency use authorization by the Federal Food and Drug Administration is a one-dose vaccine that is easy to store, but there are yet unknown details about it that make predictions about its use difficult.

She said while this new vaccine is not quite as effective as those from Pfizer and Moderna, it is still shown to prevent the worst outcomes from COVID-19, and seems like it will be useful for mass-vaccination clinic, which she said are becoming increasingly vital for distribution.

“We see in the data that the vaccine does effectively prevent serious illness and death from the disease, which is ultimately the goal,” she said.

Sen. Patt Murray, D-Wash., brought up the fact that communities of color are statistically more likely to be skeptical of vaccines and other similar mass procedures and asked if that was being addressed, which she said is especially important given how they are ate a higher risk of death from the disease.

Stone said the racial disparity in trust is an unfortunate result of past experiments by national health organizations on these communities.

Thankfully, he said, the tendency for skepticism among these communities has not been a major issue so far in vaccine uptake, which he credits to the work of his agency in reaching out and building trust with these communities.

Murray also brought up the issue of minority access to medical facilities, but Patterson said this isn’t as much of an issue as it would be for non-VA facilities.

He said his agency’s facilities tend to reside in minority communities that are otherwise health care deserts, so access has not been as much of an issue as it would otherwise be.

Sen. Mazie K. Hirono, D-Hawaii, said she’s heard the vaccine rollout in American Samoa and Guam has been very slow and said she hopes the VA is addressing the unique access problems those areas face.

Stone said this has been a very frustrating problem, but they are working with local public health in those regions to address it as best they can.

Hirono also asked about veterans not actively enrolled in the VA system, and Stone said he absolutely wants to get those people the vaccine as soon as possible but for now the VA is only guaranteed enough vaccine for their 6 million active users, so they have to come first.

Additional funding

Moran and Sen. John Boozman, R-Ark., asked Stone specifically about the American Rescue Plan and the fact that it provides the VA with much more funding and why that was when the CARES Act is covering vaccine distribution.

Stone said the CARES Act was required for immediate action with getting the vaccine out, but their need for more funds is based on the toll that the pandemic has taken on the U.S. veteran population, one that has only recently become apparent in it’s incredible scope.

He said deferred and delayed care is something the VA will need to address in late 2021 and early 2022.

For example, Stone said, surgeries at the VA are down by 12,000 a month because people just don’t want to leave their homes during a pandemic.

Not only is that delayed demand, he said, these operations will be more difficult because they’ve been delayed.

Stone said this backlog of needed care was not anticipated during the creation of the CARES Act.

Tester said he knows exactly what Stone mean and said his brother has chronic obstructive pulmonary disease, and he hasn’t seen a doctor in a year.

“He just got his second shot,” Tester said, “and he is now setting up doctor appointment after doctor appointment after doctor appointment. There is a lot of pent-up demand out there.”

Stone said the economic effects of the pandemic have seen a lot of veterans lose their health insurance as well, which will make things more difficult.

He said while the costs of this backlog, which also happened during the Spanish Flu Pandemic 100 years ago, are significant, they will not be permanent.

“When I was in U.S. Department of Defense during wartime we did what we call contingency funding, and that’s how I view the American Rescue Plan and the CARES Act,” he said.

Mental health and PTSD

Tuberville brought up the fact that his state has a lot of young veterans suffering from post-traumatic stress disorder and they have seen a rise in suicide since the pandemic began. He asked if anything could be done to get them higher on the priority list.

Stone said there’s no evidence to suggest that PTSD increases the risk of poorer outcomes of COVID-19, but the VA has and is ramping up its remote mental health care programs to try to address this problem in conjunction with their efforts to distribute the vaccine.

Spouse eligibility

Moran and others asked about the eligibility of spouses for getting the vaccine through the VA, but Stone said unless they are part of the VA’s stipend program the department is not authorized to give them the vaccine, but they’re working with the states to solve that problem.

Tester said his staff and Moran’s staff would get together to see what kind of language is needed to provide temporary authority to the VA to get the vaccine to military spouses and primary care givers.