Different COVID-19 vaccine allocation rules across the United States have complicated dialysis facility efforts to immunize their patients against the novel coronavirus that causes the disease, according to interviews with officials from major dialysis chains.

As a result, dialysis providers are trying to persuade governments at various levels to make direct vaccine allocation to dialysis centers, which would make it easier for patients to receive the vaccine.

“Vaccine availability in the community is the single largest challenge we face in getting our patients vaccinated,” said Jeff Giullian, MD, chief medical officer for DaVita Kidney Care, a major US provider of dialysis care.

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He noted that vaccine availability varies by city, state, and region. “We are working with state and local health departments in every state where we operate,” Dr Giullian said.

In addition, he said DaVita and other providers are working directly with the Centers for Disease Control and Prevention with the goal of getting direct allocation to dialysis facilities across the entire country.

Getting Vaccinated Made Easier

With direct access, “our patients can receive the vaccine in dialysis centers and avoid navigating complicated scheduling systems or traveling to a mass vaccination site,” Dr Giullian said. “With such an allocation, we are confident that we could quickly get the percent of patients vaccinated up dramatically.” 

He added, “If patients need to go to a third-party site to get vaccinated, we have found that additional hurdle to be enough to dissuade them from getting the vaccine. Where we have received vaccine allotments directly from states, we have had success vaccinating our patients, which is why we are pursuing a direct allotment from the federal government.”

“Utilizing dialysis clinics as distribution points is an effective way of vaccinating hard-to-reach and high-risk populations,” said Jeffrey L. Hymes, MD, executive vice president, global head of clinical affairs, and chief medical officer for Fresenius Kidney Care in North America, another major US dialysis provider.

“Since our centers already regularly deliver influenza, hepatitis B, and pneumococcal vaccines, we are well equipped to administer the [COVID-19] vaccines to our frontline care

teams and patients nationwide,” Dr Hymes stated.

Dialysis Patients Should Receive Priority

Patients on dialysis should receive priority in light of studies showing that individuals with kidney disease are far more likely than the general population to require hospitalization if they contract COVID-19, even when compared with individuals older than 65 years, Dr Hymes said.

Of 554,038 patients who were undergoing dialysis in the United States at the end of 2018, 485,052 (87.5%) were undergoing in-center hemodialysis, according to the US Renal Data System 2020 Annual Data Report.

As the United States continues to modify and expand vaccine distribution, “we hope that government officials will rely on the dialysis community to get more of our vulnerable patient population vaccinated against this deadly virus,” Dr Hymes said. “The sooner the existing resources of dialysis centers are put to work, the sooner we can put this pandemic behind us. We have advocated for a national strategy that prioritizes patients with kidney failure. Without a national strategy, we must advocate separately in every state as every health department has established different rules for prioritization and distribution.”

“As vaccines continue to be allocated on a state-by-state basis, we have been advocating with state and local health departments to allow us to directly vaccinate our frontline healthcare workers and patients,” Kathleen Belmonte, MS, RN, senior vice president of nursing and clinical services for Fresenius Kidney Care.

Some states have provided direct vaccine allocations to Fresenius dialysis clinics, Belmonte said. These include Louisiana, Massachusetts, Minnesota, and Maine. These direct allocations have enabled Fresenius to rapidly deploy vaccinations. In Louisiana, for example, Fresenius administered more than 5000 doses in just a few weeks, and is wrapping up second doses in that state, she said.

In states that have not provided Fresenius with the vaccine, many employees have proactively sought and received the vaccine through local government vaccination programs, she said.

In addition to the doses administered in Louisiana, Fresenius staff have administered around 1300 doses to frontline caregivers and patients in Massachusetts, 1300 doses in Maine, and 2300 in Minnesota.

Vaccine Hesitancy

With regard to how receptive dialysis patients are to getting vaccinated, Belmonte observed, “We have found that vaccine hesitancy from our patients is no different than the general population. With patients and employees accessing information in different ways, we want them to have a central place they can rely on to stay informed and receive clear, trustworthy guidance surrounding the benefits of vaccination versus the potential consequences of not being vaccinated.”

With regard to patient acceptance of the vaccine, Dr Giullian related: “Where vaccines are available, we have seen great response from patients. Many of our patients welcome the opportunity to get a COVID vaccine to help protect their health and the health of their loved ones. For those who are hesitant or decline the vaccine, we continue to educate them.”