key: cord-1018715-296wonne
authors: Waxman, Michael J.; Moschella, Phillip; Duber, Herbert C.; Martin, Daniel R.; Benzoni, Thomas; Rothman, Richard E.; Schechter‐Perkins, Elissa M.
title: Emergency department–based COVID‐19 vaccination: Where do we stand?
date: 2021-06-13
journal: Acad Emerg Med
DOI: 10.1111/acem.14261
sha: ab91ebc8662f2264ca964dff325ed9258e72c261
doc_id: 1018715
cord_uid: 296wonne

Cautious optimism suggests the COVID-19 pandemic in the United States (U.S.) has reached a turning point. Cases have declined precipitously from their heights in the early winter months and vaccine distribution and administration has moved ahead at an accelerated pace. As of late-March, more than 140 million doses of COVID-19 vaccine had been administered in the U.S., with more than 27% of the population receiving at least one dose.1 Nevertheless, challenges with COVID-19 remain. Rates are increasing in select parts of the country, as non-pharmaceutical interventions such as mask mandates and capacity limits are relaxed; more transmissible variants now represent a greater proportion of new cases; and, vaccine hesitancy persists in many sectors of the population. With this shifting landscape, it is imperative that the U.S. continue to rapidly vaccinate as many individuals as possible.

As the COVID-19 pandemic progresses, genetic variants are emerging raising concern for increased infectivity and the potential of eluding vaccine-induced immunogenicity. The B.1.351 and B.1.1.7 variants have caused particular concern, as they appear to be more contagious than wild-type SARS-CoV-2. The extent to which each vaccine is efficacious against each variant is still being studied.

While some studies suggest that the vaccines may produce reduced neutralizing antibodies against certain variants (e.g., B. Engaging vaccine-hesitant and difficult-to-reach populations may represent one of the major public health challenges in U.S. history. EDs are well poised to play an essential role in meeting this next phase of the pandemic response. As state and local public health agencies have rapidly implemented COVID-19 vaccinations across many settings, the ED will not likely play a large role as a primary vaccine location for those actively seeking vaccination. Instead, as we transition from vaccine scarcity to sufficient supply, the ED has a unique opportunity and window to engage vaccine-hesitant and difficult-to-reach individuals. These populations include individuals who have less access to primary care services, a higher degree of social needs, and those who are more vulnerable to becoming infected with or having complications from COVID-19. Unvaccinated populations may also include a cohort that is skeptical of medical care but willing to trust ED providers.

There will be challenges with ED-based COVID-19 vaccination.

EDs must find ways to identify appropriate patients; streamline the vaccination process; engage vaccine-hesitant and difficult-toreach populations; communicate vaccinations with state or regional vaccine databases, as appropriate; and arrange for follow-up vaccination, when needed. With ingenuity and lessons learned from successful implementation of prior ED-based preventive interventions (e.g., HIV screening) these barriers can be overcome.

EDs across the country have stepped up in unprecedented ways throughout the COVID-19 pandemic. Physicians, advanced practice practitioners, nurses, and staff have demonstrated incredible resilience accompanied by a sense of duty and purpose to stem the tide of the pandemic. Our response could be amplified by offering COVID-19 vaccinations to ED patients, thereby supporting a push to end the pandemic. Given our prior experience and expertise addressing public health issues, our unique patient population, and our volume of patient encounters, EDs now have an opportunity and obligation to participate in the U.S. COVID-19 vaccination campaign.

How Is The COVID-19 Vaccination Campaign Going In Your State? NPR website

Uncovering HIV infection in the emergency department: a broader perspective

Emergency department screening and interventions for substance use disorders

Efficacy of a pediatric emergency department-based influenza vaccination program

COVID-19 Vaccine Emergency Use Authorization (EUA) Fact Sheets for Recipients and Caregivers. CDC website

Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine

Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine

Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine

FDA Briefing Document, Janssen Ad26.COV2.S Vaccine for the Prevention of COVID-19. Silver Spring, MD: Food and Drug Administration

COVID-19 vaccines vs variants-determining how much immunity is enough

Emergency department-based COVID-19 vaccination: Where do we stand?

The authors have no potential conflicts to disclose.

All authors contributed to the ideas and drafting of the manuscript.