Supply shortages could slow hospitals' COVID vaccine distribution

November 20, 2020 

As hospitals race to buy special freezers that can store Pfizer's COVID-19 vaccine at extremely cold temperatures, the potential for supply shortages--a prevailing theme in the U.S. pandemic response--looms large.

A number of manufacturers make ultra-low temperature freezers--Fisher Scientific and Helmer Scientific, to name a few. But as demand skyrockets with potential emergency use authorizations coming as soon as next month, one group purchasing leader said hospitals ordering today will likely wait up to four months to get their freezers.

"Do I think there's not going to be enough ultra-low temperature freezers? Yeah," said Michael Wascovich, Premier's vice president of pharmacy field services. "We're looking at anywhere from a three- to four-month delay."

Not only that, Wascovich said there will likely be shortages of the special gloves needed to handle the dry ice used to transport the vaccines, and potentially of the dry ice itself.

Indiana University Health ordered 10 of the ultra-cold freezers, roughly doubling its supply, to ensure it will have capacity across its system to receive, store and distribute the vaccines. The state picked IU Health's Indianapolis hospital as one of five "pre-positioning sites" that will be the first to receive doses of the vaccine once it receives emergency approval, said Dr. Chris Weaver, IU Health's senior vice president of clinical effectiveness.

The plan is to be prepared to start administering the vaccines ideally the day after the federal government gives its final OK, Weaver said.

"My understanding is those will be immediate pilot sites to say: 'OK, we have it there immediately, we're ready to roll there immediately and start giving it,' " he said.

Detroit-based Henry Ford Health System has purchased freezers for each of its five acute-care hospitals specifically to accommodate the Pfizer and Moderna vaccines, Rox Gatia II, the health system's pharmacy director, said on Premier's webinar. Henry Ford also had to acquire the special freezer gloves, Gatia said. The vaccination clinics will take place on the hospital campuses, at least initially, he said.

The freezers cost between $10,000 and $15,000 each, which is not an inconsequential amount, especially for health systems that have struggled financially during the pandemic. Wascovich said he's spoken with health system leaders who are hopeful another federal COVID relief package will cover that cost. It is unclear if Democrats and Republicans in Congress can overcome deep divides to pass another round of relief funding.

Dozens of hospital and health system pharmacists, physicians and nurses participating on a Premier webinar this week said state and federal governments have "not prepared them" or have only "somewhat prepared them" to receive and distribute a COVID vaccine. Of the nearly 300 participants who responded to that question, 90% gave one of those two responses.

Wascovich said he was alarmed at some of the questions that came in during the webinar, such as how to reconstitute the vaccine. Others didn't know a vaccine was a two-shot series, or they didn't have electronic health records set up to record the vaccines.

"Really basic stuff that when you turn on the news at night or read the newspaper, you should know these things," he said. "I was a little surprised at the number of people who just don't know those things."

To Wascovich, that shows the government and its partners--especially drugmakers Moderna, and Pfizer and McKesson Corp., which will distribute vaccines--need to improve their communication efforts.

St. Louis-based SSM Health has purchased a few ultra-cold storage units, but in some of its regions, the system will partner with states that have their own freezers, said Dr. Shephali Wulff, SSM's medical director of infectious disease. In Missouri and Wisconsin, for example, the states will package the vaccines with the ancillary supplies necessary to give them and send that to providers.

Wulff said the Pfizer vaccine is more likely to go to urban areas, where more hospitals already have the special freezers necessary to store them. The Moderna vaccine, which can be stored in regular medical freezers, will likely go to rural areas, she said.

SSM is busy setting up the software to document vaccinations, training those who will administer them and picking sites where its employees can be vaccinated, said Chris Zirges, SSM's director of infection prevention.

A somewhat challenging task is working with Centers for Disease Control and Prevention guidance and local agencies to identify the priority groups that will get the vaccination first, Zirges said. That will be determined in part by which hospitals are caring for the most COVID patients, she said.

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