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SAN FRANCISCO: In late October, I received an email from a member of the California Department of Public Health.
I called the number listed in the email and a bright, cheerful voice answered and asked if the University of California San Francisco (UCSF) would be interested in the early launch and distribution of the Pfizer COVID-19 vaccine.
Of course, I said yes.
I am the executive director of pharmacy for UCSF Health and the associate dean and clinical professor for the College of Pharmacy.
My team and I are responsible for the distribution of all medicines and vaccines throughout the healthcare system, and I am also the person who leads much of the distribution of the COVID-19 vaccine for UCSF.
UCSF will receive our first allocation of the Pfizer vaccine around December 15 and the Moderna vaccine shortly thereafter.
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We project that by the end of 2020, we will receive enough vaccinations for all of our staff, students, faculty, and most of our high-risk patient populations.
This news is incredibly exciting, but it will take a lot of work to get it done smoothly.
My colleagues and I are working to ensure that the tracking of critical data, complicated storage, and the complexities of dosing go smoothly so that these vaccines are distributed as equitably and efficiently as possible.
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MONITORING, STORAGE AND PREPARATION
Before the US Centers for Disease Control and Prevention (CDC) gave us any vaccinations, the first thing I had to do was register the UCSF health system with the California Department of Public Health.
FILE PHOTO: A healthcare worker at LAC USC Medical Center tests a person at a testing center during the coronavirus disease (COVID-19) outbreak in Los Angeles, California, USA, December 10. 2020. REUTERS / Mike Blake / File Photo
I give them information on everything from the number of our medical workers who are qualified to administer the vaccine to the serial numbers on our freezers.
As a precaution, since many are considering this vaccine as “liquid gold”, our team must consider each dose at each step of the process due to the potential for diversion.
We are also not sure how many vaccines will be allocated to UCSF in these early rounds, so we must be prepared to stock a small or large supply.
The pharmacies that store the vaccine are highly regulated, monitored and safe spaces. The vaccines will not only be in a safe and backup power source in the event of a power outage, but they will also be electronically monitored for temperature.
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Unlike the flu vaccine, the Pfizer and Moderna COVID-19 vaccines have unique storage requirements, last at room temperature for a short period of time, and require a lot of preparation.
First, you cannot store Pfizer or Moderna vaccine on a refrigerator shelf. The Pfizer vaccine comes in a frozen liquid form that requires ultra-cold storage at -70 degrees Celsius.
In this freezer, it is stable for six months, but requires specific preparation before it is ready to be administered to people.
Pharmacists and technicians have to thaw the frozen liquid and then mix it in a sterile, preservative-free saline solution.
FILE PHOTO: Pfizer Coronavirus Disease (COVID-19) Vaccination Study Test Kits are viewed at the Research Centers of America in Hollywood, Florida, USA on September 24, 2020. REUTERS / Marco Bello
Each vial of Pfizer vaccine contains five doses and is stable for only six hours at room temperature. Moderna vaccine is supplied in liquid form with 10 doses per vial.
When it is time to give the vaccine to people, each dose should be prepared and labeled in a ready-to-use syringe.
At each step of this process, our staff will document and track each dose. Once we begin vaccinating people, we will send the California Department of Public Health and CDC an accountability record of how many doses we administer each day.
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WHO GETS VACCINATED FIRST?
Once UCSF receives our first shipment of vaccines, we are faced with the task of deciding who receives these precious vaccines first.
Our team has used national guidelines from the CDC and the Advisory Committee on Immunization Practices, as well as state guidelines from the California Department of Public Health to follow the implementation of prioritization by stages.
Right now, we are focusing on phase 1a, which generally includes healthcare workers and first responders, as well as high-risk patients and residents of long-term care facilities.
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While the guide says which groups should be prioritized, there is no way it will cover every decision. Our team has been working with physicians, ethicists, and health equity experts to further prioritize the most vulnerable first responders, high-risk personnel, and high-risk patients within the University of California system.
We are looking not only at clinical healthcare workers, clinical students, and patients, but anyone who may have potential prolonged and repeated exposure to body fluids and aerosols.
That includes critical personnel like medical transporters who get patients where they need to be, food service workers, police officers and environmental service workers in our hospitals and clinics.
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On December 3, California Governor Gavin Newsom announced that the state will receive 327,000 doses of the Pfizer vaccine by mid-December and 2.2 million doses by the new year.
Giving this vaccine to millions of Californians will be a huge undertaking. But our team and healthcare systems in the US have been preparing to make this implementation as effective, efficient, and fair as possible.
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Desi Kotis is Associate Dean and Professor of Pharmacy at the University of California, San Francisco. This comment first appeared on The Conversation.
