The San Antonio Military Health System's first Pfizer COVID-19 vaccine arrived at about 8:45 a.m. on Monday, Dec. 14, 2020, at Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas.
As the vaccine arrived, the immunizations team was awaiting final guidance from the Defense Health Agency. Once the guidance, training, and screening process were fully cleared and standardized, immunizations notified logistics and names were assigned to each dose of the vaccine with an electronic form through the logistics control center before removing it from the freezer.
Within hours it was administered to the first patient, Maj. Andrew Gausepohl, 59th Medical Wing Family Emergency Center medical director, in the WHASC conference room. Healthcare workers and first responders are part of the Defense Department's initial top priority group to receive the vaccine.
The logistics and immunizations teams in charge of getting the vaccine from the delivery truck to as many patients as possible, trained for three months before receiving the first shipment and continue to train regularly to improve operations.
"Ultra-cold is not something we normally deal with," said Senior Master Sgt. Wyman Herring, 59th Medical Logistics and Readiness Squadron medical materiel superintendent. "We did a lot of exercises to prepare for the vaccine to come in."
As soon as the vaccine shipment is identified, all personnel focus on ensuring it's secure.
Once the vaccine arrives, it is offloaded from the truck and immediately transported to the freezers. Before putting it in the freezer, the team has 90 seconds to verify information for the vaccine, ensure the freezers are within the -75 to -80 degrees Celsius, and check the lot numbers, expiration dates and condition of each COVID-19 vaccine.
Due to the nature of the shipment and sub-zero freezer, the team wears goggles and cryogenic gloves to protect their eyes and hands. Once the vaccine is secure in the freezer, the logistics team calls the United States Army Medical Material Agency Distribution Operations Center to notify them the vaccine has been received.
"USAMMA DOC is the Department of Defense and our Defense Health Agency entity who is responsible for the movement of the vaccine," said Herring. "We have to let them know we received it and all the pertinent information off of the vaccine itself."
The sub-zero freezers, installed by biomedical equipment technicians, are equipped with alarms that, when activated due to change in temperature, alerts logistics on-call personnel.
Freezing the vaccine stabilizes the fat component that is protecting the only active ingredient in the vaccine, mRNA or messenger ribonucleic acid. A modified messenger of genetic code that when injected, tells your cells to build a coronavirus spike protein. This produces an immune response in your body.
"In the beginning we had to transport [the vaccine] directly to immunizations on the third floor," said Herring. "[Immunizations] has to take the vaccine and count each item to make sure the number we said matches the number they see. Once they do, they sign for the vaccine and it's in their hands."
To improve previous operations, an immunizations refrigerator was installed in the conference room to reduce transportation time and distance to rapidly distribute vaccinations. This process ensures no doses are wasted. Each vaccine must be used within five days if refrigerated or within six hours from when it is thawed to room temperature. Now, the thawing, dilution process, and administering of the vaccine all takes place in a streamlined process in the conference room.
"Everything is centrally located, very easy to move back and forth, and allows us to respond rapidly," said Herring.
After confirming patients to receive the vaccine, it is transported from the freezer to the refrigerator for use throughout the day or thawed for 30 minutes to administer as soon as possible. The constant communication between logistics and immunizations makes it possible to plan throughout the day how many vaccines they will take out of the freezers.
"Having direct lines of communication, what we've setup here is essentially almost like a deployment processing type of operation," said Lt. Col. Kevin White, 59th MDW COVID-19 vaccine coordinator. "It's that type of priority. It’s that type of communication. So instead of just everybody sitting at their desks and doing things the traditional way, we're mobile, carrying radios, we're streamlining it."
All recipients are screened for any COVID-19 symptoms and given a COVID-19 Vaccine Screening and Immunization Documentation form as they enter the conference room. A brief explanation of how to fill it out is given and any further questions the patient has are answered. Once the documentation is complete, they are directed to one of six patient check-in and scheduling stations where they verify two patient identifiers, and administrators input the patient information into the immunization tracking system. Then, they are scheduled for a follow up appointment in 21 days to receive their second shot of the two-shot series. Finally, they are directed where they will receive the first dose of the COVID-19 vaccine.
The goal of the distribution plan and Operation Warp Speed is to have as many people as possible vaccinated. The logistics and immunizations team have created a process to accomplish vaccinating patients as efficiently as possible.
"The whole point of Operation Warp Speed is people are doing things simultaneously," said White. "While DHA was coming up with their guidance, simultaneously the vaccine was shipping. We were able to give the vaccine on day one, within hours of when it was received."
Along with the efforts of getting as many patients as possible vaccinated, is a deliberate plan to vaccinate people in the most effective way possible. By vaccinating healthcare workers and first responders they are able to ensure they will not expose their patients to COVID-19. This is just the beginning of Operation Warp Speed's efforts.