When it comes to getting its patients vaccinated, the Department of Veterans Affairs health care system has in many ways been out ahead of its counterparts responsible for inoculating the general population.
In several regions, the VA already has opened vaccinations to all its enrollees, regardless of age or health status.
But now Congress has given it a bigger vaccination challenge.
A new law called the Save Lives Act says the VA can now vaccinate all veterans and their spouses and caregivers - not just those enrolled in its health care system.
That's a huge jump, even for a system as large as the VA.
"We've been targeting our efforts to date at the roughly 6.4 million vets who rely on us for all of their care," VA Secretary Denis McDonough testified during a recent hearing of the House Committee on Veterans Affairs. "As you step up the additional categories that you all have now enacted, you get up around 24 million. It's kind of a four-x growth."So, four times more veterans than the VA was previously responsible for. Plus potentially millions of vets' spouses and caregivers. Many of the people being added to the eligible list differ from those the VA had been responsible for vaccinating.
One of its most successful local medical systems at getting vets vaccinated has been the one anchored by VA Medical Center in Durham, N.C. It has moved so quickly that it was able to open appointments to its enrolled vets of all ages, regardless of their health status, weeks ahead of the state's general population.
On a recent day, the Medical Center was holding a makeshift vaccination clinic inside a repurposed dining area.
Among those in the short line was 32-year-old Army vet Dante Hester, whose age group was the final one to open. Hester hopes he'll be able to visit family members in Germany sooner once he's vaccinated.
"I actually received notice on a text message and also received an email from the VA," Hester said. "My initial reaction was just joy."
Dr. Christopher Hostler, chief of public health and epidemiology for the Durham VA system, said the VA's ties to its enrolled patients has made the vaccination process quicker and smoother.
"We already have a dedicated network with all these patients; we know who our patients are," he said. "And so we're able to schedule directly through text message."
But the VA doesn't know in the same ways vets who aren't enrolled. So getting them in for vaccinations will require different forms of outreach.
"We're going to use every channel we have," McDonough told the members of Congress. "We're going to use U.S. mail, we're going to use standard email, we're going to use our social media platforms."
McDonough also said a new tool called VEText "has worked exceedingly well." VEText is an automated texting system that the VA uses for things like scheduling appointments.
The VA has already opened vaccinations to all veterans in a few pilot programs around the country. From those, it's beginning to gather information on how best to register those patients not enrolled in the VA system and figuring out what outreach methods will be effective.
It's also monitoring how to manage its vaccine allocation for the additional vets. Getting enough vaccine to expand the eligibility pool is a crucial issue, said Dr. Jane Kim, who leads the VA's national COVID-19 vaccination project team.
"We do want to make sure that whatever vaccine supply we have does get offered to our veterans receiving care with us first, and as we have increased supply to offer to the expanded populations that are in the Save Lives Act," she said.
The VA gets its vaccine supply directly from the U.S. Department of Health and Human Services. A spokesman for that agency said it will increase the allocation of vaccine to the VA, but is still working out the details of how much and when.
Dr. Kim says the VA wants to be careful with managing expectations until it has more supply and is sure it's ready in other ways.
"When we do have capacity, that's when we would want to make sure to reach out," she said. "We heard loud and clear from our veterans prior to having any COVID vaccination: 'Make sure you don't over promise.'"
VA officials said its unclear how many of the veterans who fall under the new law will actually seek appointments. Many will have already gotten vaccinated elsewhere or will refuse to be vaccinated.
It also isn't able to say yet when each local VA system will open appointments to the new group. For now, it's asking vets, caregivers, and spouses to register on the its COVID-19 vaccine web page so it can reach them.
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting.
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