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Happy 2021. My thoughts on 2021. #SARSCoV2 vaccine distribution seems to be the major challenge, which has been left up to States. Challenges:
1) Obsessing on cold chain transport to end clinic vs. focusing on administering promptly. Pfizer vaccine is temp stable at 4C for 5 days
1) Obsessing on cold chain transport to end clinic vs. focusing on administering promptly. Pfizer vaccine is temp stable at 4C for 5 days
2/ Distribute to clinics and vaccine administration facilities at 4C on Mondays, and make sure it is all used up by Friday, i.e. prompt administration. Every Monday, vaccine centers know their supply, temp stable for 5 days at 4C.
3/ From central storage facilities in each State, don't worry about transporting at -70C (on dry ice) to each clinic. Keep it simple. Worry about clinics getting it administered ASAP within 5 days. No one should be sitting on unused vaccine for >5 days. If so, there is a problem
4/ If a clinic/center is worried that they cannot administer their allotted quantity of vaccine in <5 days, give them less vaccine. If there is excess on day 4, transport it elsewhere or expand who is being vaccinated.
5/ Don't be dumb. Two states returned vaccine shipments that had intra-transport temps registered as low as -92C. Once frozen, there is no such thing as being too cold. https://www.cnbc.com/2020/12/16/covid-vaccine-us-quarantines-pfizer-shipments-in-california-alabama-after-transit-anomaly.html
6/ This comes from having to worry about trans-continental cold chain transport to/from Africa of medicines, reagents, and specimens at 4C, -20C, or<-50C for 15 yrs. Cold chain is a routine thing. While -70C is different, this is important for initial shipping & long term storage
7/ Administration can be streamlined.
A) Use online FAQ and consent docs
B) People should print and complete consent docs pre-arrival.
-- ideally these are uniquely generated and barcoded to allow for easy uploading into EMR/database.
C) Put any screening questions on consent
A) Use online FAQ and consent docs
B) People should print and complete consent docs pre-arrival.
-- ideally these are uniquely generated and barcoded to allow for easy uploading into EMR/database.
C) Put any screening questions on consent
8/ D) While one waits is the time to ask questions
E) Have an area to undress to expose an arm beforehand F) For a nurse/Pharmacist giving shots, it's about giving shots (not about completing paperwork, asking questions, or watching one undress)
G) Design an efficient system
E) Have an area to undress to expose an arm beforehand F) For a nurse/Pharmacist giving shots, it's about giving shots (not about completing paperwork, asking questions, or watching one undress)
G) Design an efficient system
In designing an efficient system, utilize medical personnel for their appropriate level of medical skill. At @umnmedschool @MHealthFairview can vaccinate 15-20 people per hour per vaccinator.
10/ Lastly, States -- bring in experts in supply chain management. I don't recall receiving any supply chain management training/experience with my epidemiology MPH degree. Use the right expertise for the right job.
