By KRISTINE de LEON/The Oregonian/OregonLive
The latest COVID-19 vaccines are only available to Oregonians with a prescription for the time being, but the state’s doctors are hesitant to order the inoculations.
The U.S. Food and Drug Administration cleared the updated COVID-19 shots for seniors and younger Americans with certain health conditions — excluding healthy children and young adults — but the Centers for Disease Control and Prevention’s vaccine advisory committee has not yet issued recommendations on who should receive them.
Until the committee issues its recommendation, state policy bars pharmacists from giving the shots to anyone without a prescription, even to those for whom the drug is approved.
So go see a doctor, then? It might not be so simple.
Doctors, too, are hesitant to prescribe or administer the new COVID-19 vaccine without the CDC’s official recommendation on the shot.
Courtni Dresser, the Oregon Medical Association’s vice president of government relations, said the doctors’ hesitation to prescribe the vaccine “comes from a place of caution and concern” due to the lack of clear guidance from the federal government and from the state.
Dresser said physicians are concerned about liability and insurance coverage issues when prescribing it for those eligible, as well as for what would be considered off-label use to those who don’t fit under the U.S. Food and Drug Administration’s narrower approval.
“The lack of guidance from the CDC has created an unnecessary mess,” Dresser said. “For one, this is the first time that doctors are having to prescribe the vaccine. … For those who aren’t eligible for the shot under the FDA’s criteria, it’s even harder for physicians to make the call on whether to prescribe it.”
The CDC’s guidance was delayed this year after Health and Human Services Secretary Robert F. Kennedy Jr. dismissed the entire advisory committee, and replacements appointed by Kennedy — among them vaccine skeptics and people who have spread misinformation about vaccines — have yet to make recommendations on the new COVID-19 formulations.
In the absence of clear federal guidance, Oregon has joined California, Washington and Hawaii in forming a West Coast Health Alliance to issue its own recommendations. But Oregon health officials have yet to issue state-level guidance.
Physicians at Providence Health & Services, one of the region’s largest health providers, have turned away some patients seeking COVID-19 vaccinations, several of the patients told The Oregonian/OregonLive.
Asked whether its physicians were prescribing the updated COVID-19 vaccines, Providence Health & Services Oregon said in an email that it is “carefully evaluating revised guidance from the FDA on the updated COVID-19 vaccines and is awaiting further recommendations from the CDC and state public health authorities to understand how this may or may not affect our family of organizations.”
Oregon Health & Science University also has told patients it is not prescribing vaccines.
Jonathan Modie, a spokesperson for the Oregon Health Authority, said his agency, the state Board of Pharmacy, the governor’s office and the Oregon Department of Justice are reviewing “existing statutes and rules to determine next steps needed to support continued access to vaccines throughout the state, including at pharmacies.”
Modie said the state has only limited control over vaccine eligibility. He said the health authority can set eligibility for its own vaccine programs, but state-supplied doses make up a small fraction of what’s given in Oregon. He said most people get vaccines that are bought by pharmacies, clinics or hospitals directly.
Modie said doctors and other clinicians already have the authority to recommend and give the new COVID-19 vaccine to their patients as they see fit, as long as it’s within their professional scope.
Modie said the state supports COVID-19 vaccine recommendations from the American Academy of Pediatrics for children and the American College of Obstetricians and Gynecologists for pregnant people. He said Oregon recommends COVID-19 vaccination for adults aged 18 to 64 who are at higher risk or live in group settings, and supports making the shots available to all adults in that age group who want it.
He said Oregon expects to reach agreement with other West Coast Health Alliance states soon on recommendations for COVID-19 and other respiratory virus vaccines.
Meanwhile, providers can vaccinate anyone 6 months or older using an FDA-approved COVID-19 vaccine formulation, Modie said, adding that the state health authority “recommends health care and vaccine providers discuss this issue with their own risk management or counsel.”
He said prescribing “off-label” vaccines is a common, lawful practice in the U.S., as long as it is within a provider’s scope. That means even if a patient doesn’t fit the FDA’s narrow criteria, their doctor may still be able to give them the shot.
Dresser said the state medical association is waiting for more guidance from Oregon officials on whether physicians prescribing or administering the vaccine will be legally protected and reimbursed by insurers for doing so.
“There’s also a risk for physicians. They need clear direction from the state on who they can prescribe and give the vaccine to, and whether there will be protection and coverage,” she said. “Oregon hasn’t done that, and it’s frustrating for everybody, including physicians and their patients.”
Dresser said Oregon should follow its northern neighbor, which signed a standing order into effect last week allowing anyone in the state 6 months or older to receive the vaccine without a prescription through pharmacists or nurses.
Washington State Department of Health’s standing order provides legal protection for providers administering the COVID-19 vaccine and allows residents to get vaccinated without first needing to consult a doctor.
Other states have taken measures to expand access to the new COVID-19 vaccines. Colorado, Minnesota and New York have issued standing orders to allow pharmacists to give COVID-19 shots without a prescription. Pennsylvania’s board of pharmacy voted to allow pharmacists to follow recommendations from trusted medical organizations without requiring a doctor’s prescription.
— Kristine de Leon is a reporter for The Oregonian/OregonLive focusing on consumer health and data enterprise stories. Contact her at kdeleon@oregonian.com.
Maybe approval or disapproval of vaccines could be done by the West Coast Alliance? If not this year, then by next year?
Providers at the Samaritan Clinic in Waldport called in prescriptions for Bill and me to Newport Walgreens this week.