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DHA’s immunization health care specialists support vaccine rollout

Image of military personnel getting COVID-19 vaccines ready. Click to open a larger version of the image. Click to open a larger version of the image. Naval Hospital Pensacola’s immunizations staff receives COVID-19 vaccine doses and prepares them for storage in December 2020. The Florida facility was selected to receive the vaccine in a phased, standardized and coordinated strategy for prioritizing and administering the vaccine (Photo by: Marcus Henry)

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The Defense Health Agency's Immunization Healthcare Division has been instrumental in ensuring that all the Department of Defense's military medical treatment facilities guarantee safety protocols during the complex process of receiving, distributing, storing, and administering COVID-19 vaccinations.

The process, ongoing since December 2020, involves IHD's immunization health care specialists at four regional safety vaccine hubs across the United States assisting DOD MTFs around the world to ensure COVID-19 vaccination operations follow the eight standards for military immunization, a set of guidelines IHD developed from a combination of Centers for Disease Control and Prevention-issued recommendations and joint DOD-issued policy.

"Immunization health care specialists are our 'boots on the ground' professionals strategically embedded to provide expeditious support to DOD immunization sites", said Air Force Col. Tonya Rans, chief of IHD. "They assist with the safe and effective implementation of DOD's immunization programs, coordinate redistribution of vaccines when needed, and engage during potential immunization storage or handling temperature excursions. Their input unequivocally helps us identify and close immunization training gaps in the field."

The safety protocols include ensuring the immunization staff members at each MTF adhere to cold-chain management principles during transportation, storage, and administration of vaccines; assisting the MTF staff in developing standard operating procedures and ensuring they include proper packing protocols for transporting and shipping vaccines; and supporting MTFs with mass immunization events, explained Brian Canterbury, one of the IHD's immunization health care specialists assigned to the South Atlantic Regional Vaccine Safety Hub (SARVSH), which covers 12 states, 334 clinics, U.S. Central Command, U.S. Southern Command, and U.S. Special Operations Command.

Although immunization health care specialists ensure the MTFs always follow the standard guidelines for all DOD immunization efforts, the COVID-19 vaccines presented unique challenges that required adapting standard protocols to properly handle, transport, and store the vaccines. The Pfizer-BioNTech vaccine, for example, has strict handling guidelines to ensure maximum efficacy, including the requirement to remain frozen in ultra-cold temperatures between -80 degrees Celsius and -60 degrees Celsius prior to removal and thawing, at which point it can be refrigerated for a maximum of five days before having to be discarded.

Wayne Chardon, an immunization health care specialist assigned to SARVSH, works from Naval Hospital Pensacola at Naval Air Station Pensacola, Florida, in support of all MTFs north of the I-10 corridor in Florida as well as those in Louisiana, southern Mississippi, and the Caribbean.

His initial challenge involved ensuring the MTFs in his coverage area designated to receive the Pfizer vaccine had the right type of freezer to store it safely and a list of confirmed recipients ready to receive the shot. In addition, Pensacola was also designated as a redistribution center from where shipments of vaccines would be transported to Keesler Air Force Base in Biloxi, Mississippi, and from there to the Armed Forces Retirement Home in Gulfport, Mississippi.

"The refrigeration requirements for the Pfizer vaccine presented a logistical challenge because the vaccines arrived at Pensacola frozen, in manufacturer packages with dry ice," Chardon said. "We first transferred them into proper storage freezers at Pensacola to ensure they didn't thaw, because once they thaw you only have five days at refrigerated temperatures before they must be discarded."

That added a challenge to the downstream vaccine movement, he explained. "We also had a roster of people in the first tier readily identified and available to be vaccinated, because once we begin transporting that allotment from Pensacola to Keesler and to the Armed Forces Retirement Home, the five-day countdown begins."

Military personnel wearing a face mask administering the COVID-19 vaccine
A member of the 6th Medical Group administers a COVID-19 vaccination to Team MacDill January 11, 2021. The Defense Health Agency’s Immunization Health Care Division specialists supported the military treatment facility in receiving, storing, transporting, and administering COVID-19 vaccines in a phased approach following Department of Defense distribution plans (Photo by: Air Force Airman Hiram Martinez, 6th Air Refueling Wing Public Affairs). 

To transport vaccines, Chardon explained they traditionally use transport containers that can keep the vaccines at between 2 degrees Celsius and 8 degrees Celsius. Driving the ultra-cold Pfizer vaccines from Pensacola to the other two sites required implementing careful shipping protocols with digital temperature monitors in each shipping container and downloading that data after each delivery to make sure all vaccines remained at the required temperature during transport before going into refrigerators at each facility.

"It was critical we managed how we transported and how many vaccines we were transferring to make sure we were able to use it all before that five-day expiration window so that we did not have any vaccine loss," he said. "My compliments to the staffs in Pensacola, at Keesler, and at the retirement home, who were true professionals and followed all the handling instructions to the letter to make that successful."

Transporting vaccines by air was no less complicated. The Pfizer-BioNTech vaccine has such specific handling guidelines that transporting it in unpressurized, vibrating rotary-wing military aircraft could damage it. The SARVSH collaborated directly with Pfizer to obtain stability data and ensure the vaccine's safety when transported on various airframes.

"Because of the uniqueness of the environment that the DOD operates in, we have to deal with unique circumstances that our civilian counterparts don't," said Chardon.

However, despite the anxiety and uncertainty during the initial rollout of the COVID-19 vaccines, Chardon and Canterbury agreed that spending time with their customers to review and tweak their plans, ensure everything made sense to everyone involved, and make sure vaccine safety and cold-chain management was maintained was key and resulted in strong working relationships with their customers.

"It took long hours and constant correspondence with each unit, but it paid off at the end," he said. "We were able to complete the vaccine transfer among all three locations very successfully - once we knew our team, and all the players knew each other and we trusted and were comfortable with each other's levels of competencies, it made it go a lot smoother."

Canterbury works from the CENTCOM Command Surgeon's office and supports the 6th Medical Group at MacDill Air Force Base, in Tampa, Florida, supporting approximately 14 units south of Florida's I-10 corridor, including those of the naval and air reserve, Coast Guard, Florida Army National Guard headquarters, SOUTHCOM headquarters clinic and command surgeon general's office, Patrick Air Force Base, Naval Air Station Key West; and 14 sites in the CENTCOM area of operations, which includes 21 countries.

"We knew the vaccines were coming so we started prep-mode - planning and working with our units - in October to find out what their capabilities were, particularly regarding the storage for the Pfizer vaccine," said Canterbury. "Engaging with them early on worked out great, and once we set foot in the facilities, it made things easier."

And with three unique vaccine products being distributed across the DOD, Canterbury said immunization health care specialists remain in a continuous but phased processing mode.

"Things change all the time – shortly after we had the Pfizer rollout, we had the Moderna rollout, followed by the Johnson & Johnson (Janssen) vaccine rollout," said Canterbury. "We adapt the preparation and conditions to the requirements for each vaccine, so it requires continued monitoring of processes and answering questions and being available for guidance and running things up the flagpole to see what's changing, what's coming – it's constant."

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