Area hospitals adjusting to vaccine rollout challenges
Five days after Regional One Health started disseminating the first doses of the Pfizer COVID-19 vaccine, the hospital ran into a problem: More doses had been thawed than there were people to receive them.
With a strict timeline for distribution once the vaccine thaws, the hospital sent out an email on Dec. 21 inviting physicians outside the hospital and hospital volunteers to get the vaccine.
“Any vaccine unused by 12 p.m. on December 22 would have been discarded — unused — as required by federal regulations,” hospital spokesperson Angie Golding said in an email. “While continuing to vaccinate priority groups, we opened up availability to a broader group of employees and volunteers to ensure that all thawed vaccine was used.”
Members of the ONE Club, hospital volunteers whose members — including the wife of the hospital CEO — also donate to and fundraise for the hospital were among the volunteers invited to receive the vaccine doses.
It’s unclear exactly how many members of the group and how many medical workers outside Regional One
received the vaccine. Golding said no doses were wasted.
Volunteer activity has decreased at the hospital during the pandemic but is expected to increase, “especially in critical areas,” Golding said, one of the reasons the hospital wanted to vaccinate volunteers. According to the organization’s website, ONE Club members rock babies in the Neonatal Intensive Care Unit, supply the labor and delivery rooms with toys and books, host fundraising dinners and the hospital foundation’s annual gala and organize hospital tours, among other things.
Since vaccinations began Dec. 17, Regional One Health has administered about 1,900 doses to doctors, other providers, staff and volunteers. That accounts for more than 85% of the initial vaccine supply the hospital received, Golding said.
“To date, all 1a1 and 1a2 employees and providers who wished to be vaccinated have received the vaccine,” she said. “We will continue to offer the vaccine to our staff and other community 1a1 and 1a2 healthcare workers until our supply is depleted.”
Regional One is a local example of an issue playing out across the state and country. In Jackson, public health authorities unexpectedly received 200 doses of the Moderna vaccine on Dec. 30 from another agency unable to use the supply. With less than six hours to use the doses, authorities in Madison County vaccinated politicians, relatives of hospital executives, an executive with The Jackson Symphony, a florist and a retired lawyer.
A California hospital experienced a freezer malfunction forcing distribution of more than 800 doses in a span of two hours after the malfunction was identified. Vaccinations were given to county workers, sheriff ’s deputies, jail staff and inmates and city employees, as well as members of the general public.
In some places, there have also been allegations vaccines have intentionally been given to those outside priority groups even when they were not at risk of going to waste. Florida Sen. Rick Scott called for an investigation after reports a nursing home and assisted-living facility offered vaccines meant for residents to donors and board members.
Limited guidance for vaccine emergencies
Which vaccine being used plays a factor in how quickly it needs to be used in a crisis situation. The Moderna vaccine requires freezing for shipping and long-term storage but can remain stable at refrigerated temperatures for up to 30 days, giving vaccinating agencies more flexibility than with the Pfizer vaccine.
Locally, Shelby County Health Department and smaller hospitals within the Baptist system received the Moderna vaccine. Methodist hospitals, larger Baptist hospitals, Regional One, Saint Francis and the Memphis Veterans Affairs Medical Center received the Pfizer vaccine.
But all these instances give rise to questions about the logistics of largescale vaccine distribution and the measures — or lack thereof — put in place by those distributing it. A nationwide vaccine rollout on this scale has never been attempted, and in the early stages, when supply is constricted, each dose is precious.
These early weeks and months are a high-stakes test run for the larger vaccination efforts to come.
“Over time, there will be ample supply. I’m confident of that,” said Dr. Manoj Jain, an infectious disease expert and Memphis and Shelby County Joint COVID-19 Task Force member. “It’s not going to be everything next month. But there’s going to be two parts to the supply (and) demand curve. Right now, there is a huge demand but low supply. In a few months, there will be a huge supply, but there will be low demand.”
These situations also beg questions about how to ensure equitable distribution of the vaccine to those most vulnerable to the virus, including the elderly, people of color, people with serious comorbidities and those living in poverty, who are more likely to work in industries that put them at high risk of infection and have limited access to healthcare.
A framework for equitable distribution developed by the National Academy of Medicine acknowledged the need to be flexible with vaccination plans and adapt to unforeseen obstacles but noted addressing racial and economic equity with distribution would not just be an issue in the first phase but would endure throughout the vaccination efforts, which will take months, if not years. Recommendations from other national organizations largely read the same.
However, guidelines about what to do in a crisis situation when doses are on the verge of becoming unusable seem nonexistent, largely leaving indi
vidual organizations to decide how those situations will be handled on a case-by-case basis as situations arise.
Online reservations, call trees
Kevin Freeman, chief of pharmacy services at the VA, said the center started preparing several weeks before receiving the vaccine, doing dry runs of moving the vaccine from the transport vehicle to the freezers as well as the procedures around getting the vaccine from the freezer into a syringe, covering scenarios where the vaccine could be compromised.
“The real preparation part of this is to make sure that we waste no doses. So we have folks, employees scheduled, but we also have a backup in case someone calls in that day or we have an issue from that standpoint,” he said.
The medical center started vaccinating employees on Dec. 17 and vaccinated the first patient, Randy L. Johnson Sr., a Marine Corps veteran who served in Vietnam, on Dec. 22. Freeman said the pharmacy works under a fairly strict timeline for vaccine preparation.
“It takes about 30 minutes for it to thaw, so we prepare for how many doses we’re going to give that particular day,” he said of the Pfizer vaccine. “Then we start reconstituting it. The reconstitution process takes about 15 to 20 minutes. And then we start pulling it up into individual doses.”
The VA pharmacy went through that process twice daily, once for the vaccinations scheduled in the morning and once for the afternoon appointments. Once in the syringe, the vaccine must be used in about six hours, Freeman said.
Methodist hospitals also have a call list in the eventuality someone scheduled to get the vaccine cannot or does not show up for their appointment, which is scheduled online, said Nikki Polis, chief nurse executive for the hospital system.
“We have a reservation process in place to ensure that we know how many doses to thaw and we have a call tree in the event that perhaps we have an extra dose that we can use to make sure we have the vaccination in the arm and we waste no doses,” she said.
As of Thursday, Methodist has vaccinated more than 6,700 people with no incident and the system has not had any issues with vaccine supply or the supplies needed to administer the vaccine, Polis said.
For Shelby County Health Department, the start of vaccinations has not been seamless. However, the health department has not faced an instance where it had to throw away any of its Moderna vaccine doses, said David Sweat, department deputy director and chief epidemiologist.
“We have not had to dispose of any. They were either used on-site or if there were vials remaining, at the end of the day they went back to the pharmacy for redeployment the next day,” he said. “We have not wasted or lost any vaccine doses.”
Saint Francis and Baptist hospitals did not provide details about measures being taken to prevent wasted doses.
Congregate care settings
Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, said in a statement constantly-rising case numbers in long-term care facilities across the country necessitated swift delivery of the vaccine to workers and residents. But, he said, “we must also be thoughtful and targeted in our approach.”
“As with any effort of this scale, there will be issues, and vaccine hesitancy is our primary focus at this moment. Uptake among residents and staff is varying widely, but in general, staff seem to be mirroring the general public’s reaction: excitement mixed with hesitation about the vaccines’ development and safety,” he said. “Pardon the pun, but we get more than one shot at this. We remain hopeful that uptake for the vac--cine will improve as this pharmacy partnership program continues to unfold.”
Parkinson said vaccinating millions of congregate care facility residents and staff was a massive undertaking but he was not yet aware of widespread delays. More than 400 nursing homes and longterm care facilities in Tennessee are relying on CVS to administer COVID-19 vaccines.
In Shelby County, the health department had predominantly been vaccinating first responders and workers and residents at congregate-care facilities until its supply of the Moderna vaccine was exhausted, director Alisa Haushalter said Wednesday. The department expects to resume vaccinations Jan. 12.
‘We all need to do better’
When the county does receive additional shipments of the vaccine, appointments will be made through online registration system Signupgenius. Previously, appointments at the two drivethru vaccination sites were scheduled via Eventbrite — which has been discontinued — or a hotline. The state has said it will launch an online portal to give more structure and uniformity to the process.
With so many moving parts, successful widespread vaccination is not completely in control of the hospital, health department or the state.
“There are many links in this chain,” said Dr. Steve Threlkeld, co-chair of the infection control program at Baptist Memorial Hospital-memphis. “It’s almost like a Christmas light (strand). If you have a problem in one of the areas, it interrupts the whole chain.”
Tennessee is one of the top five states for the fastest distribution of delivered COVID-19 vaccinations, according to the Centers for Disease Control and Prevention. As of Jan. 5, the state had used more than half the vaccine doses received.
State health department data from Jan. 4 showed more than 169,000 Tennesseans had been vaccinated, including about 12,000 people in Shelby County, something that is “very good news, no question,” Threlkeld said.
“But we all need to do better,” he said, adding that Tennessee was still experiencing one of the worst surges in the country. “It’s good to grade on a curve but the whole class can fail. We need to go fast to be sure.”
Threlkeld said it was encouraging to see Tennessee doing better than many other states but said there would be more work to do until the day everyone who wanted the vaccine had received it.
Commercial Appeal reporters Sam Hardiman and Sarah Macaraeg contributed to this story.
Corinne Kennedy covers economic development, soccer and COVID-19’S impact on hospitals for The Commercial Appeal. She can be reached via email at Corinne.kennedy@commercialappeal.com or at 901-297-3245.