EXECUTIVE SUMMARY

Hospitals are scrambling to ensure a smooth and effective process for vaccinating frontline healthcare workers against COVID-19. Leaders need to quickly equip their personnel with enough information to persuade them that the vaccine is safe and effective.

  • Because of ongoing social distancing policies, hospitals may need to employ smaller, targeted approaches than they typically use for other vaccines.
  • Limited initial COVID-19 vaccine supplies mean systems must prioritize which facilities will receive the first shipments, and which healthcare personnel should be vaccinated first.
  • The Pfizer-BioNTech vaccine requires ultra-cold refrigeration, a commodity not widely in place right now. Many systems are purchasing the necessary freezers and placing them under tight security.
  • Experts advise health systems to employ consistent messaging about safety and efficacy, and to provide ample opportunity for healthcare workers to ask questions.

With two COVID-19 vaccines approved for emergency use, healthcare leaders across the country are scrambling to optimize the limited number of doses available in early shipments. This includes negotiating the myriad logistical challenges involved with putting the shots safely and effectively into the arms of workers.

Healthcare organizations maintain long-standing processes for delivering vaccinations to personnel, but there are added complexities, and the COVID-19 pandemic has caused problems. For example, Vanderbilt University Medical Center had to alter its highly successful approach for delivering flu vaccines to healthcare personnel.

“[In 2019], we vaccinated nearly 60,000 people in 12 hours,” explains Lori Rolando, MD, MPH, FACOEM, the director of Vanderbilt’s Occupational Health Clinic. “We couldn’t do that [in 2020] because of the pandemic and the need to socially distance. We couldn’t have a large event where we have lots of folks in one location at one time.”

Likewise, delivering the COVID-19 vaccine will require a special approach. “It may need to be more targeted with smaller events and scheduling at a time and in locations where there is adequate space to social distance,” Rolando observes.

There are other challenges specific to the COVID-19 vaccine. For instance, the Pfizer-BioNTech vaccine requires ultra-cold refrigeration, a commodity not already widely in place.

“Many of our members are choosing to purchase [the necessary] freezers, but some don’t have the space for those freezers,” explains Anna Dopp, PharmD, senior director of clinical guidelines and quality for the American Society of Health-System Pharmacists (ASHP) and the organization’s lead on COVID-19 vaccines. “We are hearing that some of these freezers are being placed in conference rooms, for example. They are locked down with security cameras to keep them safe and secure.”

With the limited initial vaccine supply, large, integrated health systems with multiple hospitals in their networks are grappling with how to prioritize which of their facilities receive the first doses.

However, one silver lining of the modest initial rollout is that it will allow for some pilot testing. “[Facilities] can test out some of the plans that they have been putting into place, and then make adjustments as they go along,” Dopp shares. “I suspect that the plans [health systems] make right now will be quite different than their plans ... six months from now.”

Still, with anticipation exceedingly high in states hit hardest by the virus, authorities are doing their best to perfect their distribution plans. For instance, Minnesota Gov. Tim Walz reported authorities have been running drills to ensure there are no kinks in the process.1

Use Consistent Messaging

The Pfizer-BioNTech and Moderna vaccines (and some other candidates under investigation) require two doses, with the time between shots varying in length. It is another layer of complexity leaders must consider in vaccinating their personnel. “Healthcare organizations should be making sure their electronic [medical] record systems are connected to their jurisdiction’s immunization information system, often called an immunization registry,” explains Angela Shen, ScD, MPH, a visiting research scientist at Children’s Hospital of Philadelphia’s Vaccine Education Center and lead author of recommendations on the equitable distribution of the COVID-19 vaccine.2

Shen says these registries are designed to track people and the vaccine doses they receive.

“If you get your first shot at one location and wish to get your second shot somewhere else, you will need to know which vaccine you are due for, and when,” she explains. “COVID-19 vaccines are not interchangeable. Registries help keep track of which vaccine someone received and when they are supposed to come in for the second dose.” For healthcare workers to take the vaccine, some may need to be convinced it is safe and effective. Consequently, even before any of the vaccines were approved for emergency use, some health systems were developing plans.

For instance, some hospitals in Boston developed educational videos aimed at reassuring staff the rapid process used to develop the vaccines would create safe and effective immunizations. Similarly, Maine Health, a 10-hospital system, has been holding educational sessions via Zoom with its workforce.

Rolando recommends hospitals employ a multipronged approach, using several communication channels, all of which convey consistent messaging regarding the safety and efficacy of the vaccine. There should be plenty of opportunities for interaction, too.

“With something that is new, you can understandably expect that there will be questions, concerns, and anxieties around safety and effectiveness,” Rolando says. “Have the ability [for people] to ask questions so that you can reassure them that there are people not only at the federal and state level, but also within your own institution who are looking at these issues.”

Set an Example

In a paper outlining the ASHP’s own principles for the COVID-19 vaccine rollout, the organization emphasizes the importance of minimizing vaccine misinformation.3

“Healthcare workers will be setting an example for patients, and it will be up to that frontline healthcare worker to ... translate their confidence and their willingness to take the vaccine to their patients,” Dopp observes. “It is overwhelming what [frontline providers] have been asked to do. Now, we are asking them to shoulder another aspect of this.”

Fortunately, the facts regarding safety and efficacy are encouraging thus far, according to Dopp, although she acknowledges some people are concerned about developers providing just two months of data within their applications to the FDA for emergency use.

“The farthest out that we expect to see adverse events from a vaccine is 42 days post-administration. Two months is a good amount of time to look for those safety signals,” she says. “We will need to make sure that ASHP and other [healthcare] organizations are the force of truth ... and that healthcare workers are willing to seek that information.”

Should healthcare organizations mandate the vaccine for workers? Most health systems are taking a more conservative approach. “We are hearing from most of our members that the COVID-19 vaccine will not be mandated. It will be offered voluntarily to those who want it,” Dopp reports. “This is similar to what we saw with the influenza vaccine a number of years ago. We didn’t see mandated healthcare worker vaccinations until a number of years after the influenza vaccine was around and available.”

Rolando concurs it is premature to think about making the vaccine mandatory. “This is a new vaccine. We are still looking at the science,” she says. “Right now, it is just about communicating the safety and benefits of the vaccine, and trying to encourage people to feel comfortable with it.”

Rolando adds the first use of the vaccine is coming under an emergency use authorization, not a formal, full approval from the FDA. “That is something to be taken into consideration, too,” she says.

REFERENCES

  1. Office of Gov. Tim Walz and Lt. Gov. Peggy Flanagan. Minnesota is ready for COVID-19 vaccine. Dec. 9, 2020.
  2. Shen AK, Hughes Iv R, DeWald E, et al. Ensuring equitable access to COVID-19 vaccines in the US: Current system challenges and opportunities. Health Aff (Millwood) 2020; Nov 19;101377hlthaff202001554. doi: 10.1377/hlthaff.2020.01554. [Online ahead of print].
  3. American Society of Health-System Pharmacists. ASHP issues principles for COVID-19 vaccine rollout and oversight. Aug. 26, 2020.