With Moderna and Pfizer having both requested emergency Food and Drug Administration authorization for their COVID-19 vaccine candidates, it’s only a matter of time until hospitals across the state of Maryland begin distributing them.
The Maryland Department of Health has been collaborating with health care systems to develop a plan for vaccine distribution, with the MDH ultimately responsible for deciding who will be vaccinated first and where doses of the vaccine will be allocated — all of which is outlined in a draft of Maryland’s vaccine distribution plan that was submitted to the Center for Disease Control in October.
But the COVID-19 vaccine poses numerous obstacles for hospitals as well, including figuring out which staff members will administer the shots and how the vaccines, some which need to be kept at extremely low temperatures, will be stored. Here’s what Maryland’s hospitals are doing to prepare for the vaccine rollout.
Staffing and personnel
Staffing at hospitals is currently a major issue as Maryland experiences an intense fall surge of COVID-19 cases, with Gov. Larry Hogan stating on Tuesday that Maryland was in need of up to 3,000 additional health care workers. This adds an extra layer of difficulty to the distribution process, as health care workers will need to be pulled from their regular positions to administer vaccines and train other workers.
MedStar Health, based in Columbia, is drawing from the same basic processes as they would for a flu clinic, said Christina Hughes, director of MedStar’s health care system preparedness.
“We tend to look into existing processes that we have in place. Thinking about the way in which we might run a flu vaccine clinic … we have participation from occupational health, from peer nurse vaccinators, those sorts of things,” she said.
Lisa Polinsky, health assistant vice president of pharmacy services of LifeBridge Health, said that pulling workers from their regular duties to administer vaccines will be challenging. “You can’t really pull nursing away from the bedside to do that,” she said. Like MedStar, LifeBridge is also considering having occupational health workers give the vaccines.
Additionally, health care workers are among the first people to whom the COVID-19 vaccine will be administered, meaning that if the vaccine causes side effects, the Baltimore-based health care system will have to be prepared for recipients to take a day off to recover, Polinsky explained.
“We’re considering … how [we would] do that with a surge occurring at the same time,” she said.
According to Hughes, the Pfizer vaccine is expected to be delivered to hospitals in self-contained ultra-cold storage units. Still, she said, MedStar purchased several freezers as a “strong preparedness measure,” adding to a small handful of ultra-cold freezers that the hospital system already had, which are traditionally used for research and other hospital programs.
Installing the freezers comes with additional challenges; some have specific power requirements and can only be installed where those requirements can be met. Most importantly, though, the freezers must be stored in secure, monitored locations, Hughes said.
Because other viable vaccines do not need to be stored in such extreme temperatures, storage is only a major consideration in preparing to receive the Pfizer vaccine, said Gary Tuggle, deputy COVID-19 incident commander for the University of Maryland Medical System, which also purchased ultra-cold freezers. The Moderna vaccine does have to be frozen, but at a temperature closer to that of a regular kitchen freezer.
“We are confident that we can accommodate the other vaccines without going out and purchasing additional units,” Tuggle said.
Administration of the vaccine
Communication is going to be a key part of successfully administering vaccines to the public. COVID-19 vaccines require a wait period between their first and second doses. To ensure that everyone who receives their first dose of the vaccine also receives their second, LifeBridge is considering implementing a text or email system to remind patients to return for their second shot, Polinsky said.
Additionally, because the vaccine is going to be distributed largely to older people and other at-risk populations following front-line health care workers, another part of the distribution process will be communicating who is able to receive the vaccine at a given time.
MedStar will likely partner with the MDH for those efforts. “We will certainly be working in tandem with them and in concert with them to be sure our message is consistent,” Hughes said.
Polinsky anticipates LifeBridge using multiple channels — from direct phone calls to stories in the news — to communicate to the public when and where they can get a vaccine.
Finally, hospitals will have to take COVID-19 prevention measures into account when planning vaccine clinics. At UMMS, safety has been a major factor in deciding which facilities will be used as vaccine distribution sites.
“(We are) determining the correct infrastructure that’s going to be needed” at points of distribution, Tuggle said. “Are they appropriate for social distancing? Are they properly ventilated?”
Polinsky, Hughes and Tuggle all felt confident in the guidance presented in the draft of the state’s distribution plan and said there was no part of the rollout process about which they felt the state hadn’t provided enough information.
Hospitals in the region have been thoroughly involved in the planning process. MedStar, for example has “been on numerous information-gathering sessions and calls with (the MDH) to acquire additional details for our internal planning purposes,” Hughes said, adding that she is “confident in our ability to execute on that plan that they put together.”
Her main concerns are about how many vaccines Maryland and its different hospital systems will get. Without that information, it’s impossible to know how much room they need to store the vaccines and how quickly MedStar will be able to vaccinate its staff.
Hogan announced on Tuesday that the state may initially get as few as 155,000 doses of the vaccine, but that wasn’t enough information to alter MedStar’s current plans.
“Until we understand what our specific hospitals will be receiving, we’re still doing all the same preparation and planning,” Hughes said.