CVS & Walgreens Blamed For Slow Vaccine Rollout In Nursing Homes

CVS on Monday touted its nationwide progress vaccinating residents and workers in long-term care facilities against COVID-19. The drugstore chain announced it has administered its entire batch — some 2 million shots — of first doses in the nearly 8,000 nursing homes working with CVS.

That milestone is unlikely to allay complaints that CVS and Walgreens, the other major pharmacy chain tapped by the federal government to inoculate vulnerable populations in nursing homes, assisted living centers and other health providers, are falling short. Critics say the vaccine rollout to long-term care residents has been ill-planned and mismanaged, raising the death toll.

"There are outbreaks right now in long-term care facilities," said Dr. Karl Steinberg, who is the chief medical officer of Mariner Health Central, which runs 20 nursing, assisted living and rehab facilities in California. "I have no doubt that people are dying who with a prompt rollout of the vaccine didn't have to."

Both CVS and Walgreens appear to be at least a month behind schedule. In mid-December, Alex Azar, formerly the secretary of health and human services in the Trump administration, told CBS News that all nursing home residents could receive their first vaccine dose by Christmas.

Neither CVS nor Walgreen ever publicly committed to Azar's rapid deadline. But in early December, CVS CEO Larry Merlo promised a quick rollout. "We're ready to go," Merlo said in a virtual meeting with investors and analysts. "Once the vaccine hits our facilities, we expect to be in those long-term care facilities within 48 hours later beginning to provide vaccinations in the arms of what is our most vulnerable population."

Both CVS and Walgreens declined to comment for this story. In its announcement on Monday, CVS called its inoculation effort "on schedule based on program parameters." Walgreens, which has a similar but smaller role in the effort, said last week it expected to finish administering its first doses in nursing homes this week. 

Despite Azar's optimistic timeline, experts have expressed concern with the government's plan, including its heavy reliance on CVS and Walgreens. Other signs the rollout is lagging.

1. West Virginia, the only state in the country to opt out of the federal government's partnership with CVS and Walgreens, is expected to finish vaccinating people in long-term care facilities — both first and second doses — this week. By contrast, CVS and Walgreens appear to be several weeks away from giving both doses.
2. A number of states, including Michigan and Mississippi, have asked the federal government to allow them to start working with other pharmacies and suppliers to nursing homes in order to speed vaccinations.
3. When the program was announced in October, the U.S. said CVS and Walgreens would be responsible for vaccinating the nation's more than 15,000 nursing homes as well as tens of thousands of assisted living and rehab centers. But CVS' announcement on Monday only covers nursing homes. 

For assisted living facilities, CVS says it has completed first doses in just 11 states. Vaccination efforts in other states are behind. In Arizona, the company has completed first doses in 202 assisted living facilities out of the more than 800 that signed up with the pharmacy.

In all, of the nearly 38,000 assisted living or group homes signed up to vaccinated by CVS across the country, first doses were to have been completed in just over 18,000, or 48%, of those, by the end of the day January 25, according to CVS' own data.

"It was obvious to me that CVS and Walgreens would fail, and now they have," said Michael Wasserstein, a geriatric care specialist and a past president of the California Association of Long Term Care Medicine, which is urging the government to revamp its approach to vaccinating older Americans. "We should have had all the nursing care homes vaccinated by now. I don't accept that this was inevitable."

Help wanted

The biggest problem, according to experts: staffing. CVS and Walgreens, with nearly 20,000 stores combined, dominate the retail drugstore businesses in the U.S. But they are relatively small players in distributing drugs to group homes. Prior to the coronavirus, the two companies had contracts with only about a quarter of all nursing homes — the other 75% were served by smaller, often-regional specialists who supplied the sites with medications. In October, CVS announced that it would need to hire as many as 15,000 pharmacists to effectively manage its COVID-19 vaccination effort.

"It's been slow," said Chad Worz, head of the American Society of Consultant Pharmacists (ASCP). "I don't think CVS and Walgreens were prepared from a labor perspective."

Another problem has been the use of detailed consent forms, which for many older or ailing nursing home residents meant finding guardians or family members to sign them. That took time, especially in facilities that CVS and Walgreens had never worked with before, while discouraging people from getting a shot who might otherwise have gotten the vaccine if the process seemed less bureaucratic and daunting.

"CVS and Walgreens required ridiculous consent forms, with all types of stuff on them, including heart conditions and diabetes," said Mariner Health's Steinberg. "Some patients and staff looked at that form and said, 'Oh gosh, I guess I shouldn't get it.'"

A management shuffle at CVS may also be playing a role. As the company was rolling out its vaccination effort, it was also undergoing a major change in its top ranks. Long-time CEO Merlo is scheduled to step down on February 1. The company's new CEO, Karen Lynch, comes from insurer Aetna, which CVS bought in 2018. The management change was announced in November.

"Pretty orderly"

In its announcement on Monday, CVS blamed vaccination delays on a mixture of scheduling issues and logistics. The pharmacy chain said vaccinations at a number of assisted living facilities needed to be rescheduled "due to a lack of responsiveness." 

In other instances, CVS said it was asked to delay vaccinations by facility administrators because of COVID-19 outbreaks. The company also said it took on some assisted living facilities that did not initially meet its requirements because they were located too far from an existing CVS Pharmacy. Those facilities are taking longer to vaccinate as well.

Other experts say CVS and Walgreens deserve more credit for their unprecedented assignment. Peter Van Runkle, head of the Ohio Health Care Association, which represents the nursing care industry in the state, said the government's partnership with the chains is working.

"There are always going to be some issues when you undertake an effort as large as this," Van Runkle said. "Whatever the issues that have been with it, overall the program has been pretty orderly and worked well."

In December, incoming CVS CEO Lynch told investors in a virtual conference that the company's COVID-19 vaccination effort could provide a major boost to its long-struggling long-term care pharmacy division, which Merlo had called a disappointment earlier in 2020. 

"You oftentimes need to go see someone around [their] physical [space]," Lynch said. "We have those capabilities and these are good demonstrations of the capabilities that we have that really does position us for the future."

Here comes Walmart

Now states and assisted living facilities are racing to add additional pharmacies into their COVID-19 vaccination plans, which some see as a sign that many are unhappy with the job that CVS and Walgreens have done.

Walmart last week announced that it will begin offering vaccinations to authorized groups in seven states around the country, including in Texas, where earlier this month Governor Greg Abbott told CVS and Walgreens they needed to pick up the pace of nursing home vaccinations.

According to CDC data as of January 10, just over 107,000 residents of nursing homes have died from COVID-19, including about 20,000 people in the prior four weeks.

"The reality at this point is that we need to get these people vaccinated," said ASCP's Worz. "What that means is getting more vaccines into the hands of more pharmacists. Relying on CVS and Walgreens has cost us time, and if someone wants to say that more time has lead to more lives lost, then I think that is fair."