First coronavirus vaccine shipments set to arrive in states Monday
On Monday, 145 facilities, mostly large hospital systems, will get doses, followed by 425 on Tuesday and 66 on Wednesday.
By
Frances Stead Sellers,
Ariana Eunjung Cha,
Lena H. Sun and
Isaac Stanley-Becker
December 12, 2020
Hospitals that have spent months preparing to receive and administer a vaccine against a virus that has killed more than 295,000 people in the United States will begin receiving shipments of the shots on Monday, U.S. officials said Saturday morning, comparing the start of distribution to the Allied invasion of Normandy in June 1944.
“You have heard me refer to today as D-Day,” said Gen. Gustave Perna, the chief operating officer of Operation Warp Speed, the public-private partnership speeding the development of vaccines and therapeutics. “Some people assumed that I meant the day of distribution. In fact, D-Day, in military, designates the day the mission begins. D-Day was a pivotal turning point in World War II. It was the beginning of the end. D-Day was the beginning of the end, and that’s where we are today.”
Hospitals desperate to turn the tide of a worsening pandemic will begin receiving vaccine on Monday, marking the beginning of one of the most complicated logistical missions in U.S. history. The vaccine, manufactured by Pfizer and BioNTech, is being sent with heavy security and must be stored at ultracold temperatures.
Hospitals had been in the dark about when they would receive the vaccine, which was approved late Friday. Operation Warp Speed, the Trump administration’s initiative to speed development of vaccines and therapeutics, had repeatedly declined to disclose the number of doses the federal government is sending to each state or jurisdiction until Saturday morning.
“Until now, we’ve only had hints of when it would arrive,” said Lauren Sauer, director of operations at the Johns Hopkins Office of Critical Event Preparedness and Response, which has hospitals in the District, Florida and Maryland, said Saturday.
According to recommendations from the Centers for Disease Control and Prevention, the nation’s 21 million health care workers and three million residents of long-term care facilities should receive the vaccine first. A CDC vaccine advisory committee is expected to issue guidance Saturday stating that the vaccine should be administered to people 16 and older, paving the way for immunizations to begin with those priority groups.
States have been granted leeway to interpret the guidelines, leaving hospital administrators to decide who should receive the first doses and how to administer them. At some institutions, ICU staff will receive priority; others include those who work in housekeeping or with cancer patients or newborns. Hospitals grappled with whether to include those working with covid patients in full protective gear ahead of masked staff interacting with people who may be asymptomatic carriers.
The vaccines are arriving as hospitals are overwhelmed with covid patients. As of Friday more than 108,000 were hospitalized nationwide, according to Washington Post data.
At many health care institutions, surveys are quietly being sent out, lotteries launched and invitations issued to one of the most highly anticipated events of 2020: the opportunity to get in line for a shot. At the same time, institutions are trying to combat hesitancy among staff concerned about a brand-new vaccine.
On Thursday, Temple Health in Philadelphia emailed 3,000 invitations to employees deemed at “high risk” of infection. Within minutes, housekeepers and anestheologists began sending in their RSVPs. And within 24 hours, every one of the 252 slots at the main campus’s vaccination site was taken.
That uptake seemed likely to assuage chief medical officer Tony S. Reed’s fears that vaccine hesitancy will keep people from signing up, wasting precious vaccine. Among the first takers, who will likely start receiving shots Wednesday, will be people working on covid-19 floors, in the emergency room and at the Fox Chase Cancer Center, where the goal is reducing risk to patients who have little ability to fight off infection.
The goal is simple, Reed said: “To do the most good for the most people.”
With a second vaccine from Moderna expected to follow suit shortly, as many as 40 million doses could be delivered by the end of the year — enough to vaccinate the CDC’s first priority group.
The Pfizer-BioNTech vaccine, which must be stored in ultracold freezers, presents another logistical challenge. Hospital officials this week watched a company video walking through each daunting step of distribution: trays containing 195 vials of vaccine can be at room temperature for no more than five minutes while being transferred from frozen storage to an ultracold freezer or three minutes for transfer between low temperatures and thawing. The vaccine must remain in frozen storage for at least two hours if it is put back in an ultracold freezer after room temperature exposure.
In Philadelphia, all of the city’s the hospitals will be receiving vaccine, either directly from the federal distributor or from the city health department’s ultracold storage.
“We know we’re in a unique situation in that our city is small enough that we can feasibly distribute from our facility,” said James Garrow, the department’s director of communications, “provided [the hospitals] can administer them quick enough.”
The multi-facility Cleveland Clinic has set up a “refrigeration farm” with rows of gleaming white freezers capable of keeping the vaccine at Antarctic temperatures. The yawning atrium at the University of Florida Health Jacksonville hospital is being turned into a vaccination site. And other hospitals are preparing to receive the ancillary supplies needed for the finicky Pfizer vaccine.
On Thursday, a package needed to administer the Pfizer vaccine suddenly showed up at the University of Pittsburgh Medical Center’s Presbyterian Hospital, including vaccination record cards, masks, visors, information sheets, syringes and the diluent that needs to be mixed with every dose before it is injected.
Other hospital systems are devising their own approaches. In Detroit, close to Pfizer’s Kalamazoo, Mich., plant that will ship out vaccine, the Henry Ford Health System will put health care workers such as anesthesiologists who are at high risk for exposure first in line, said Henry Ford spokesman David Olejarz.
But much depends on the supply of vaccine.
Dora Anne Mills, who is overseeing the vaccine rollout for Maine Health, which operates 10 hospitals, said they may get around 970 doses in this first round for the entire hospital system — covering a fraction of the 17,000 patient-facing employees the system would like to vaccinate as soon as possible.
“We are all facing the same dilemma. How do we stabilize the hospital systems at a time when we have so many doctors and nurses out because of covid exposure?” she said.
The hospital has been holding Zoom sessions to explain the vaccine to staff and convince them that it is safe to take. Mills said she is fine with her two adult children receiving the vaccine; she was not over the summer, but is now convinced of its safety and efficacy.
At Salt Lake City-based Intermountain Healthcare, a 23-hospital system that serves Utah, Idaho and Nevada, officials have asked those in the first group to receive the vaccine to sign up at the end of their week of shifts in case they have mild-to-moderate side effects in the days after they get the vaccine.
In Minnesota, which has reported one of the nation’s highest per capita rates of infection, state health officials have meticulously planned for months the rollout of the vaccine. The Minnesota Department of Health designated 25 main distribution hubs around the state which will deliver the vaccine to 118 smaller facilities, including in rural areas.
Gov. Tim Walz (D) said the state had embarked on several “dry runs” in recent weeks, trying to game out “every possible scenario” in the distribution process using a box sent by Pfizer containing “everything but the vaccine.”
But as obsessively as the state has planned, Walz acknowledged lingering concerns, including access to dry ice, which Walz said could pit the state and health care industry against Upper Midwest cheese and dairy producers which use dry ice to ship cheese curds.
In Florida, Gov. Ron DeSantis said this week that the state expects to get 180,000 doses of the Pfizer-BioNTech vaccine in the first release. Of those, 100,000 doses will go to five hospitals that can store the finicky vaccine.
The rest of the doses will go to nursing homes and long-term care facilities, and will be administered to both patients and staff, the governor said.
“It’s a very fluid situation, things are changing. But the plan is to get it on or before December 15,” said John Couris, president and CEO of Tampa General Hospital.
Couris noted some hesitancy among staff and will plan for that.
“If we say you must take the vaccine, if you don’t, what are we going to do? Terminate them?”
At the UF Health Jacksonville hospital the atrium will allow for social distancing, and also has space so those who get vaccinated can be monitored for 15 minutes after receiving the shot. The space is large enough to accommodate 500 to 1,000 people a day, said Leon Haley Jr., CEO of UF Health Jacksonville and Dean of the University of Florida’s College of Medicine in Jacksonville.
Haley said he doesn’t know how many doses to expect. He will be videotaped getting one of the first doses of the vaccine as a PSA for other staff.
“We definitely have some people that are very enthusiastic, they can’t wait to be in first,” Haley said. “But we have a couple of people that are still on the bubble.
Riverside Health System, based in Newport News, Va., will receive 975 doses for five hospitals. It expects to start vaccinating personnel at highest risk for covid exposure Wednesday, including doctors, nurses and housekeeping staff, said Cindy Williams, Riverside’s chief pharmacy officer.
Like many hospital systems, Riverside’s loading dock only operates Monday through Friday. If the vaccine is shipped Sunday, the hospital would receive it Monday. Ancillary supply kits of needles and syringes are being sent separately.
“There are so many moving pieces,” Williams said.
The system is used to administering flu shots, but must change its clinic layout for the coronavirus vaccine to allow for social distancing and recipients to be monitored for 30 minutes post-jab.
The health system had previously surveyed employees before news about the efficacy of the two vaccines and found about a third of respondents were willing to get a shot. But a more recent survey this week found that about 60 percent were interested in getting the vaccine, Williams said.
At the University of Pittsburgh Medical Center, a team of in-house experts is reviewing the vaccine data, to double-check the FDA’s decision before vaccinations are given to health care staff.
“We have convened our group of experts to independently review the data on these vaccines,” Graham Snyder, medical director for infection prevention and hospital epidemiology, said at a briefing this week. “I want our experts … to tell us that the vaccines are safe and effective to use in our communities.”
Sauer of Hopkins said she is concerned about the emotional burdens being placed on already exhausted health care workers as they are turned into role models. They will be asked about their experience and whether they did or did not take the vaccine, she said, possibly for personal health reasons.
“We are asking them to take a brand new vaccine and then in addition to be advocates for patients, friends, family members,” Sauer said.
“That is a lot to ask during a pandemic.”
Andrew Becker in Salt Lake City, Lori Rozsa in West Palm Beach, Fla., Kayla Ruble in Detroit and Cid Standifer in Cleveland contributed reporting.
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