The Columbia SC, VAMC loaned an ultra-low freezer to Orangeburg Regional Medical Center so that the facility could store COVID-19 vaccine. Photo from Columbia VA Health Care System public affairs office

MILWAUKEE — Throughout the pandemic, VA’s healthcare professionals have risen to the challenge of meeting two of the department’s missions: providing healthcare to veterans and improving the nation’s preparedness to national emergencies. Pharmacists continue to meet the needs of veterans and the broader community as the Unites States enters the vaccination phase of the COVID-19 public health emergency.

From the beginning of the VA’s efforts to vaccinate veterans and healthcare workers, pharmacists have taken the lead. In the first 37 VA locations tapped to receive the initial doses of the Pfizer-BioNTech, pharmacists assumed control of the vaccine at delivery and administered shots to many in their facilities.

The Milwaukee VAMC received its first shipment on December 15, 2020, delivered in a heavy, white box specially designed to maintain the super-cold temperatures the vaccine required during shipping. Procurement pharmacist Luke Palmer transferred three small boxes containing 2,925 doses from the larger, dry ice-packed box under the supervision of Pharmacy Chief Kim Bell, PharmD, and Medical Center Daniel Zomcheck, MD. No one missed the significance of the delivery.

“This is symbolic,” Zomchek said. “This marks the beginning of the end of the pandemic.”

The more than three dozen sites chosen for the early deliveries all had freezers that could keep the Pfizer-BioNTech vaccine at minus 70 degrees. That made the difference in selection of the Memphis VAMC. “We had the equipment here to take care of the vaccine. It requires super low freezing temperatures to keep it stable and to store. And we were one of the VAs that had that equipment here to be able to store them properly,” Memphis VA’s Marvin Miller, MD, explained to a local television station.

Pharmacist Jarred Bowden signed up right away to receive one of the first 1,000 doses. “With us being on the front line and being essentially exposed to this every single day, the last thing that I want to do is take the chance of spreading this to someone that I work with, or our veteran population, potentially, putting them at risk,” he told the station, which was onsite during the one of the first days of vaccinations.

Doug Davis and Carol Campbell, both pharmacists, unpack Moderna COVID-19 vaccines at Lebanon, PA, VAMC pharmacy in late December. Photo from Lebanon VAMC Facebook Page

The vaccine has a shelf life of about six hours from the time it is reconstituted, making careful planning to ensure no doses go to waste critical, said Kevin Freeman, chief of pharmacy at the Memphis VAMC. Nearly one-quarter of the facilities’ staff had signed up to receive vaccines within the first few days, hoping to inspire others to take the same step and hasten a return to a more normal structure of life.

Within days of delivery of the first doses, the VA added 15 more facilities to the list of those able to receive the Pfizer-BioNTech vaccine as new equipment was delivered and installed to accommodate it. Upon the approval of the Moderna vaccine a few days later, another 128 sites came online. The Moderna vaccine does not have the same exacting storage requirements.

“Having a second COVID-19 vaccine will enable us to reach more facilities and vaccinate more health care personnel and Veterans in additional parts of the country,” former VA Secretary Robert L. Wilkie said at the time. “We continue to implement our COVID-19 Vaccine Distribution Plan and are grateful to be one step closer to seeing the end of this pandemic.”

The VA’s first tier of individuals eligible for the vaccine included healthcare personnel, long-term care residents and spinal cord unit patients. The VA plans to offer COVID-19 vaccination to all veterans and employees who want it, as supplies increase.

Achieving the Fourth Mission

As vaccine roll out continued, VA pharmacists answered the call to help out a community hospital in keeping with its mission to support other government agencies and organizations during national emergencies, the department’s fourth mission.

On January 13, the Regional Medical Center in Orangeburg, S.C., contacted the Columbia VA to ask for assistance obtaining an ultra-low freezer for storage of the Pfizer-BioNTech vaccine. Within 24 hours, the Columbia VA’s pharmacy had provided a spare freezer to the hospital.

“In these challenging times, partnerships are more important than ever,” said David Omura, director and chief executive officer for the Columbia VA. “The Regional Medical Center contacted us with a need and we happily fulfilled their request. Whenever we can assist our community, we will do everything we can to support them as we did with the loan of this freezer.”

With the new freezer the hospital can order more vaccine and hold doses for longer. Previously the hospital had to work with thawed vaccine received from the South Carolina Department of Health and Environmental Control that could only be held for six days in a refrigerator.

“This has effectively increased the potential for a greater number of people to be quickly vaccinated. We thank the Columbia VA for their community outreach to improve the health care for rural South Carolinians in the midlands,” said Matthew Hinkle, vice president of operations for the Regional Medical Center.

It was no accident that the VA pharmacy had a spare freezer. Early planning positioned the pharmacy to receive either of the first two vaccines to receive emergency use authorization from the U.S. Food and Drug Administration by having the necessary equipment for safe storage.

“We have tried to go above and beyond when it comes to not only serving Veterans, but the people of South Carolina,” said Omura. “The Columbia VA will continue to provide assistance to those who need it whenever possible.”