10 Clinical
Pharmacy Practice News • January 2021
Covid-19 Pandemic
Leading the First Phase of COVID-19 Vaccine Rollout A
s expected, pharmacists have been on the front lines of the COVID-19 vaccination rollout, administering the Pfizer/BioNTech and Moderna vaccines to thousands of health care workers and other at-risk people nationwide. But it hasn’t been easy. The early days have been marked by vaccine deliveries falling far short of projections, refrigeration breakdowns and other cold chain challenges, and in several states, vaccination gaps that have led officials to threaten hospitals with fines and reductions in future vaccine allotments. Yet through it all, pharmacy directors say they have been able to avoid breakdowns in vaccine delivery, thanks in part to careful planning and scheduling processes that had to be continually revised on the fly as guidance from federal and state agencies changed almost daily. “The process around handling these vaccines, particularly [from] Pfizer, has to be like clockwork, and our members have practiced for that, even rehearsing the process of removing the Pfizer vaccine from the thermal shipper and placing it in the ultracold freezers,” said Anna Legreid Dopp, PharmD, the senior director of clinical guidelines and quality improvement for ASHP. “But we knew that there would be some bumps and some learning opportunities in the first weeks of vaccine distribution. For example, there were cases where some vaccine came in even colder than the allotted temperature range, which was something unexpected. We had been more concerned about warmer temperature excursions rather than colder, but this incident alerted us to the potential for lower temperature excursions as well.” Legreid Dopp said ASHP has received multiple reports from member institutions about getting fewer allotments of vaccines than they were told to expect. “It’s likely a combination of raw material shortage impacting supply amounts, as well as the federal government holding back some doses,” she said. “We have also heard of some instances where vaccines have had to be replaced due to temperature variations in shipping.” Delivery shortfalls may not be the only hindrance to more widespread vaccinations; some hospitals are struggling to administer even on-hand vaccines quickly. In New York, for example, state officials reported that the city’s public health hospitals had received about 38,000 doses, but as of Jan. 3, had vaccinated only 12,000 eligible employees. While state health officials attributed the gap to “logistical challenges,” Gov. Mario Cuomo said the culprit also was some health systems’ “lack of urgency” regarding COVID-19 vaccinations. He threatened to fine
Jim Jorgenson, RPH, the CEO of pharmacy consultancy Visante, echoed Legreid Dopp’s comments. “Hospitals are stretched to the Nth degree already, and you’re going to fine them for not giving the vaccine fast enough when they’ve been at ground zero?” he said. “The federal government has left it up to the states to organize this process. And the hospitals are at the mercy of their states. The last people in the world we should be blaming are hospitals.” As the following profiles show, health systems are navigating these vaccinations challenges with a variety of operational strategies.
but two are very small and can only service their own location. Six others, in Sioux Falls; Bismarck and Fargo; and Moorhead, Worthington and Bemidji, Minn., have enough capacity to continue to serve as hubs. “Our location in Moorhead is not providing vaccine supply to other hospitals in that west central region at present, but the state wanted us to keep that freezer available for subsequent tiers of front-line health care staff that may be more clinic based, as well as when we get to distribution for the public. It gives us more options.” Breidenbach said Sanford had received fewer doses of vaccine during the later weeks of distribution, as the states began gearing up for their partnerships with pharmacies, including CVS Health and Walgreens, to vaccinate long-term care residents, which Sanford is not directly involved in. As of Dec. 28, the system had administered more than 11,000 vaccines. “Overall, it’s gone very well. The lack of a steady supply has caused us to have to tweak our vaccination clinics a little bit, because we’re always watching how many doses we have received and how many we have given, how many we think we’re getting, and then how many we know we’re getting once we get shipping confirmation. It’s always a moving target, and that’s been the biggest challenge.”
South Dakota: Monument Health Rebecca Doerr, PharmD, a clinical pharmacist at Monument Health, in Rapid City, S.D., shows her vaccination card after receiving the vaccine as a front-line health care worker.
hospitals up to $100,000—and redirect future vaccines to other facilities—if they failed to close the gap quickly. Legreid Dopp pushed back strongly against Cuomo’s criticisms. “Our hospitals are trailblazers. They have been giving 110% to this effort, but the capacity and resilience of our ... health care workforce is stretched thin,” she said. “They’ve been overwhelmed with treating critically ill COVID patients for almost a year now. They’ve been receiving information at the last minute about how many vaccines they will get and when.” Legreid Dopp added that when it comes to the Moderna vaccine, some of the problems have stemmed from a communications loop that initially shut hospitals out, with McKesson serving as the centralized distributor to state departments of health. “We have some hospitals that have been able to form good, consistent, transparent communications with their departments of health, and in other states that has not happened,” she said. “Where there is that disconnect, hospitals are flying blind. We’ve been told that starting next week, hospitals will be included directly in that communications chain.”
South Dakota: Sanford Health Sanford Health, the nation’s largest rural nonprofit health system, was among the first systems to receive doses of the Pfizer vaccine on Dec. 14, with 3,900 doses delivered to its hub in Sioux Falls, S.D., and 3,400 doses to its locations in Fargo and Bismarck, N.D. Frontline health care workers began receiving the vaccine the same day. “During that first week, 3,100 of the doses received at our hub in Sioux Falls were given to the top tier of front-line health care workers in the region,” said Jesse Breidenbach, PharmD, the senior director of pharmacy. “The remaining 800 doses were redistributed to other Sanford sites in the region and also to independent area hospitals, based on a plan we worked out with the state. The doses delivered to Bismarck and Fargo were all for our toptier, front-line health care workers. “We have continued to receive allocations of vaccines from both Pfizer and Moderna,” Breidenbach added. “Some states are trying to focus the Moderna vaccine more in rural areas because of its easier handling and distribution.” Sanford has eight ultracold freezers,
Serving western South Dakota and eastern Wyoming, the Monument Health system received its first shipment of the Pfizer vaccine on Dec. 14, the same day as its neighboring system, Sanford. “South Dakota is a very rural state, so the health department has relied on us, Sanford, and Avera Health, the other large system serving the state, to do a lot in the first couple of phases of vaccine distribution,” said Dana Darger, RPh, the director of pharmacy at Rapid City Hospital, part of the Monument system. “Most of the vaccine doses in South Dakota are being shipped through one of our three organizations and delivered out from there.” Rapid City Hospital received a single flat of 975 doses of the Pfizer vaccine with that first shipment, which it stored in the only ultracold freezer it currently has—a bone freezer, used for preserving
human bone for allografts in orthopedic surgery, housed in the surgical department—and finished administering that same week. Darger said that on his facility’s first day of vaccinations, “we did our first five doses—one doctor and four nurses—for the media, which did a good job of covering the event for us. It felt like one of those monumental days, like the first step on the moon. If we can get the community to see that the doctors, nurses, pharmacists
