Coronavirus Diaries is a series of dispatches exploring how the coronavirus is affecting people’s lives. For the latest public health information, please refer to the Centers for Disease Control and Prevention’s website. For Slate’s coronavirus coverage, click here.
This as-told-to essay is based on a conversation with Nirav Shah, director of the Maine Center for Disease Control and Prevention. The conversation has been transcribed, condensed, and edited for clarity by Aaron Mak.
We began planning for COVID-19 vaccine distribution—in theory and in concept—back in mid-April. We already had in the state of Maine a robust mass vaccination plan that was developed and executed and revised from our H1N1 experience 9½ years ago. We started looking at our existing H1N1 mass vaccine plan to determine what should stay and what should go in light of what is known about COVID-19. For example, back during H1N1, there were these mass vaccination clinics with people lined up, and you don’t do that with COVID. The last thing you want to do is to create a situation that could become a superspreader event. The planning process really ramped up in June/July, when we started getting a timeline as vaccines were going into clinical trials.
We did a couple of things for freezers. The first thing we did was we ordered freezers. We spent about $12,500 ordering two massive freezers for our central warehouse. The second thing is back in September we did a needs assessment and needs inventory, so we already knew where in the health care system there were existing ultracold freezers. The third thing we did was put up a call for assets. We put out a call to say, “If you are a university, for example, who has excess ultracold storage space, we would just like to know for our planning purposes.” It turns out that there are communities that don’t have hospitals in them, but for whatever reason they’ve got a community college that has an ultracold freezer. When we get to community-level vaccination, one concept of operations is that we can store vaccines at, say, a community college and keep it ultracold, and then set up a vaccine site around that community college.
As to dry ice, one of the principal uses for dry ice in the United States is the packaging of seafood. The lobster industry is a large consumer of dry ice for their shipping and packaging. So dry ice is big in Maine, and we do not anticipate challenges with dry ice.
We have mapped out everything, and now we’re focused on what is literally the last mile. We’ve identified the hospitals that already possess ultracold storage units. We did that back in September. The phase we’re at right now is figuring out how many cubic feet of space they have this minute in their freezers. If I showed up with a box of vaccines, I want to know how many vials you can accommodate in your ultracold storage freezer and still maintain minus 80 degrees C. Another thing we’re working on is what we need for the first wave of vaccinators within health care systems: How many gloves are we going to need for them to handle the dry ice? We do that in partnership with the hospitals. If the hospitals report that the majority of their vaccinators will be individuals who wear small and extra-small gloves, but they only have 10 boxes on hand, we still have two to three weeks to get you more extra-small gloves.
It’s all the things that you just never think about. We’re trying to anticipate the unanticipated. What could go wrong? What is the informed consent process going to look like? How do we communicate to folks about what the risk of getting vaccinated is when we don’t know what the long-term risk is? How do we ensure that individuals who are hesitant get truthful, transparent answers to their questions? On the logistics front, the Pfizer vaccine can only be outside of ultracold storage for roughly five days. We’ve got to make sure we’ve got a system in place that literally tracks down to the minute how long the vaccine has been outside of ultracold storage, so not a single dose goes wasted.
We started a dry run on Monday. That’s the process of getting the vaccine to the six locations that we have identified for the very first week of distribution. The dry run is generally identical, other than there’s no actual live vaccine. So it starts with the place that the actual vaccine will ship from and uses live tracking numbers, the actual sizes of the boxes. It also includes the accessories that are supposed to be coming, meaning some of the PPE and the syringes.
Two guiding principles remain with respect to vaccines. One is velocity. That’s all the stuff we’ve talked about. My other guiding principle is equity. There’s such a big focus on velocity: How many people did you vaccinate today? But we’ve got to keep in mind: Did we vaccinate the right people today? Did I actually vaccinate the people who have suffered the most from COVID or are at the highest risk? So velocity is important. It is one of our guiding principles, but our other one is equity.