Retail pharmacies are stepping in to help speed up Covid-19 vaccinations much earlier than anticipated after calls for states to take more advantage of their networks and experience.
Independent and chain drug stores weren't supposed to take a large role in distributing the vaccines until later stages, when doses will be much more widely available. But the halting rollout so far has sent governors scrambling for alternatives to hospital systems and local health departments, which have been handling most vaccinations so far.
New York this week is expanding distribution to hundreds of pharmacies throughout the state so health care workers or people ages 75 and older have more options to get vaccinated.
"They know how to do this," Gov. Andrew Cuomo, a Democrat, said at a briefing Friday. He said 1,200 pharmacies had committed to help speed distribution, in addition to other health care providers.
Louisiana made a similar announcement Monday, and some of the biggest chains in the country are widening their distribution to help with states' Phase 1 plans.
Rite Aid said Monday that it had agreements to immunize Phase 1 groups in Delaware, New Jersey, New York City and Philadelphia. In Florida, pharmacies inside some Publix Super Markets began administering vaccinations Friday.
"The list is growing as additional jurisdictions reach out for assistance," Jim Peters, Rite Aid's chief operating officer, said in a statement.
Another major chain, Kroger, said it was vaccinating health care workers in selected parts of five states, including California and Texas, and other chains and states said they were in discussions to do more.
The states generally aren't widening who's eligible to be vaccinated — just adding to their lists of distribution points.
Experts said it's an important step in ramping up distribution, one that makes sense given the millions of flu shots pharmacists administer every year.
"I go to CVS every year to get my flu shot down the street. I would do the same for Covid," said Joe Grogan, who worked on the early coronavirus federal response as director of the Domestic Policy Council in the Trump White House. He left in May.
"I don't understand the rationale for holding back the pharmacies and why they haven't already been activated," Grogan said.
Covid-19 vaccinations have been slow nationwide in part because of problems at the final step, where the burden of injecting doses has often fallen to overburdened county health officials. Appointment websites have crashed, offices have closed for weekends and holidays, and confusion about the process has been common.
The Centers for Disease Control and Prevention reports that only about a third of the vaccine doses the federal government has distributed to the states have actually been administered into arms.
CVS and Walgreens, the two largest pharmacy chains in the U.S., began offering Pfizer and BioNTech's vaccine to nursing home residents and staff members last month in a partnership with the federal government. That didn't involve retail locations for other high-priority groups.
Getting involved in vaccine distribution is an important business opportunity for pharmacies to prove their relevance to consumers.
"They, as an industry, have all been trying to figure out 'What do we need to do to pivot our strategy so that we don't become the next RadioShack?'" Brian Tanquilut, a health care services research analyst for financial services company Jefferies, told CNBC, referring to the retail electronics giant that is now a shell of its former self.
And lobbyists haven't been shy about touting pharmacies' huge footprint, saying their companies could administer 100 million doses a month if given the chance and if adequate supply were available. Chris Krese, a spokesperson for the National Association of Chain Drug Stores, said that the number was "based on very conservative assumptions" about staffing and that it could well be higher.
The association is "conveying to all levels of government the recommendations for how to help ensure the efficient and equitable administration of safe and effective COVID vaccines," Krese said in an email.
Non-chain pharmacies said they're also in conversations with federal officials. "For a Covid-19 vaccine rollout plan to be successful, independent pharmacies must be included and be a part of the solution," said Andie Pivarunas, a spokesperson for the National Community Pharmacists Association.
But pharmacies and other health care providers can't do much without the go-ahead from governors.
"We are just an agent for the states," Walgreens CEO Stefano Pessina told The Wall Street Journal last week. "We are vaccinating at a pace that is a fraction of the pace that we could be doing. We could do much more as a pharmacy chain if we had a certain degree of freedom."
CVS has no vaccine doses available at retail locations, but it is "in discussions with several states to make a limited number of doses available in the coming weeks in advance of the broader rollout," spokesperson T.J. Crawford said in an email.
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The two major pharmacies, along with 17 other pharmacy networks, weren't scheduled to begin opening up vaccinations to the general population in their stores until phases 2 and 3. New York, Florida and other states using pharmacies now are still in Phase 1.
Some hope the federal government goes further after President-elect Joe Biden is sworn in next week.
"As the Biden team expands the supply of Covid vaccine, the challenge will continue to be standing up delivery sites fast; that can handle the volume," Scott Gottlieb, a former commissioner of the Food and Drug Administration, tweeted Friday.
"The channel that's able to quickly absorb massive volume are the pharmacies," he said. "We need to get pharmacists fully in the game."
In New York, Cuomo said, 5,000 pharmacy locations will ultimately be involved in vaccinations. The state is maintaining lists by region on a new website, and he said he hopes distribution will soon cease to be a problem.
"We're now going to have the opposite problem," Cuomo said. "I'm hoping for increased supply."