I had a COVID-19 vaccine last week. I’m traveling in 10 days and wanted to make sure I don’t get sick when I’m traveling. Better safe than sorry – better jabbed than stuck in a hotel room for five extra days, unable to go out. Or hospitalized.
The COVID-19 vaccine was easy to get and painless. I had to go online and register at a retail pharmacy – which was a pain, because I had to give them the same information everyone wants about myself and my medical history — but that is now routine before any vaccine these days, rules being rules. But I got an appointment at exactly the time I wanted it, and the nice pharmacist did a fine job giving me the shot. I even got to choose which manufacturer’s vaccine I wanted, even though no one took me through the differences between them. (There isn’t much.) I could have had a flu shot at the same time, and was offered other vaccines — the shingles and RSV vaccine — which suggests that the pharmacy is in the business of selling vaccines, itself no surprise, given where health care in the US is at the moment – it’s a business, not a system, remember.
The bad news is exactly that — no one was telling me the pluses and minuses of these vaccines and their timing, discussing their risks and benefits, or helping me understand what I actually needed and when. That matters for the flu vaccine, for example, which lasts only about three months in people my age, and means I should get a flu vaccine in mid-November, not now, because our flu outbreak usually happens in late February and March.
So what’s crazy is this: we have a moment of starvation in the midst of plenty, from a public health perspective. We have lots of vaccines and great vaccine availability. But we have a time when all sorts of people are saying all sorts of things about vaccines, which is confusing to many of us. The starvation is the dearth of primary care relationships, so there is no one who can help regular people figure out what they need and when. We have someone good at selling vaccines, but no one you trust to tell you what you need, when and why.
So some people, who have insurance that covers vaccines, may get vaccines that make the seller’s money. Other people who aren’t paying attention may not get what they need when they need it. People without insurance are much less likely to be vaccinated at all. But pharmacies and vaccine manufacturers are likely to make out well.
None of this helps us build a health care system that is for people, not for profit, that helps all of us stay healthy, and is affordable, personal, rational, and just.
That’s crazy.
You can find Michael Fine’s commentaries and short stories on https://michaelfinemd.substack.com and on http://www.michaelfinemd.com