COVID-19 vaccines in doctor’s offices?

The next step for COVID-19 vaccinations may be doctor’s offices, experts say, though there are significant challenges that have so far prevented it from becoming reality.

For Tom Balcezak, Yale New Haven Health’s chief medical officer, the question is: “How do we lower the barriers” to vaccination?

“I think the next phase is going to have to be in physician offices,” he said.

The state announced Tuesday that 11 more patients had been hospitalized for a COVID infection, with 275 additional cases identified in the previous 24 hours and 2.85 percent of COVID tests coming back positive.

The increasing number of cases have prompted more Connecticut cities to enact mask mandates in indoor public places. Norwalk, Bridgeport, Stamford, New Haven and Hartford will now all require masks indoors.

The rate of COVID vaccinations in Connecticut has stalled over the last month. The week of April 10, there were more than 315,000 COVID vaccinations, compared with the month of July when there were an average of 35,236 vaccinations per week, according to state data.

The need is real, Balcezak said. With the delta variant spreading through the population, vaccines continue to be “our best tool” for fighting the virus, he said.

“The vaccine is incredibly useful, especially at preventing severe disease and death,” Balcezak said. “The unvaccinated are at much, much higher risk.”

One solution to that stagnation, experts say, is getting COVID-19 vaccinations into the hands of local doctors.

“It’s something that we would love to have happen,” said Michael Parry, chair of infectious diseases at Stamford Health.

Parry said Stamford Health is taking an initial step with a pilot

program, which will offer COVID vaccines at a pediatrician’s office. Parry said vaccines are “best administered by the physician that knows the patient.”

“On the pediatric side, that relationship is going to be very important in getting the kids vaccinated,” he said.

Last month, the Fairfield region of Hartford HealthCare began offering COVID-19 vaccination at five urgent care clinics, in Monroe, Trumbull, Shelton, Stratford and Fairfield.

This offers more accessibility than the mega-sites that were the primary location for vaccines when they first became available, said Dr. Syed Z. Hussain, medical director of urgent care, occupational medicine and employee health for Hartford HealthCare’s Fairfield region.

“It’s easy access,” he said. “This is in your neighborhood. All you have to do is call and come and get the vaccine.”

David Emmel, an ophthalmologist and legislative chairman for the Connecticut State Medical Society, said in addition to easing access, people have a stronger trust in their own physicians.

“A big impediment to increasing the vaccination rate for COVID-19 has been the misinformation out there,” he said. “There’s a lot of evidence that patients do trust their physicians.”

“The purchase of a few refrigerators would be small change and a good investment if it went toward strengthening the medical home and the trust that underpins the patient-physician relationship,” Emmel said. “That is the only force that can truly overcome the fear and misinformation that keeps so many vaccine hesitant.”

There are, however, technical and logistical challenges to that goal, most notably the cold temperatures at which the vaccines must be stored.

“Most physician offices don’t have freezers,” Parry said. “The Pfizer vaccine has required ultra-cold freezing, which only hospitals have.”

The vaccines are delivered in large amounts, 500 doses to a tray, which a smaller doctor’s office couldn’t possibly use.

Then there are the tracking requirements.

“The other thing that has limited flexibility is that the tracking system is very complicated,” Parry said. Providers are required to “report every vaccination administered to the state.”

Every vaccine must be tracked and reported, the sites that administer them must be accredited and the temperatures of the freezers storing the vaccines must be checked, requirements that local, family doctors could not meet, experts said.

Emmel said larger practices might better manage those issues.

“Small practices are being consolidated every day,” he said. “The logistics could be solved if the state were willing to give it a try.”

The vaccines are still being administered under an emergency use authorization from the U.S. Food and Drug Administration, and Parry said many of those challenges will be resolved if and when the vaccines are fully authorized.

“The conditions of EUA include the tracking, the monitoring of the storage, etcetera, etcetera,” he said. “Once you've got a vaccine that is FDA approved, the monitoring is much less stringent.”

That full authorization may arrive sooner rather than later. The FDA expects Pfizer’s vaccine will be approved by Labor Day, The New York Times reported this month.

“We’re looking forward to the approval. That would allow the manufacturer to give more flexibility in packaging,” Parry said. “What we really need in doctor’s offices are single-dose vials.”

Hussain said “the issues we are seeing right now is that the younger population, such as 18- to 25-yearolds, is being hit hard by the delta variant.” However, Parry saidthat age group does not often go to a doctor and might need “a separate strategy.”

“Coming down the pike will be the 5 to 12 (year old) group,” Parry said. “That’s why our focus has been setting up the pediatrician’s office as the pilot program.”

Eventually, Parry said COVID vaccines will be administered along with other childhood immunizations, like the measles, mumps and rubella (MMR), diphtheria, tetanus and pertussis (DTAP) vaccines.

“I think we’re all going to get a flu shot and a COVID shot every fall,” he said.

Hearst Connecticut Media Group staff writer Amanda Cuda contributed to this report.