As demand for vaccine changes, so does delivery system

New Jersey is using EMS teams to pack up and bring COVID-19 vaccines across the state as focus shifts from mega-sites to community centers and doctor’s offices
Credit: (NJ EMS Task Force)
Ryan Kirchner, an EMT with South Branch Emergency Services, loads temperature-controlled and monitored “cooling cubes” to transport vaccine in an ultra-cold, frozen or refrigerated state.

Almost every day up to a dozen emergency response professionals from around the state gather at the New Jersey Department of Health’s laboratory in Ewing to carefully pack and then distribute a precious public health resource: COVID-19 vaccines.

Doses from drugmakers Moderna, Pfizer and Johnson & Johnson are nestled in separate “cooling cubes” designed to maintain specific temperatures; routes and drop-off locations are mapped, and the coolers are loaded into vans to be delivered to immunization sites statewide.

The vaccine transfer process is designed to match the shots with shifting public demand and prevent as few doses as possible from going to waste. So far, New Jersey appears to have succeeded, with just 0.25% of the more than 11 million doses received having expired or otherwise gone unused, according to the DOH, less than half the national vaccine wastage rate.

“The state is working to make sure vaccines don’t sit on a shelf where they won’t get used,” said Mike Bascom, president of the New Jersey EMS Task Force, a nonprofit comprising 60 local organizations, and emergency management coordinator in Neptune. For the past two weeks, task force members have handled the tracking and distribution of thousands of COVID-19 vaccine doses under a recent agreement with the DOH.

Nearly 4.4 million New Jerseyans have now been vaccinated through the state’s effort, which launched in mid-December, and Gov. Phil Murphy hopes to make it to 4.7 million by July. For months demand for the shots far outpaced supply and vaccine sites around the state were clamoring for additional doses. But interest has since slowed significantly and state figures show less than 50,000 shots given any day in June, down from a peak of more than 120,000 daily doses in early April.

Shot shuttle

The state has started to scale back its vaccination infrastructure, winding down operations at its six mega-sites. But that evolving demand can complicate allocations and leave less busy sites with more doses than needed. The DOH tapped the task force to oversee the process of tracking the daily distribution from Ewing, and to help shuttle shots among various sites, all to avoid vaccine loss.

“The Department of Health Operations Team has been working around the clock to make sure vaccines get safely to points of distribution that are closest and most convenient to where the people are,” DOH commissioner Judy Persichilli said earlier this month in announcing the task force arrangement. Previously the state had handled this transport work with the help of contractors.

“We appreciate the critical role our State’s EMS Task Force has played throughout the pandemic as one of our key response partners,” Persichilli said. “This innovative program to responsibly use existing vaccine doses through safe and effective methods of transfer once again shows the importance of state-level coordination in close collaboration with our vaccine partners.”

Persichilli said the DOH allocated $6 million in federal pandemic-related funding to assist the task force with its work to help the state prepare for and respond to large-scale emergencies. During the coronavirus outbreak, its role has included coordinating COVID-19 testing, transporting scarce medical equipment, evacuating a nursing home and organizing pop-up vaccination clinics, including several at the Jersey Shore over Memorial Day weekend.

“This is part of the evolution of our role in the state’s COVID-19 mission,” Bascom said of the task force, which was formed in the wake of 9/11. “We have gone from working behind the scenes, to supporting testing and vaccination sites, to putting shots in arms, and now assuring the vaccines are allocated to the right parts of the state to be most efficient.”

Handle with care

The three vaccines require careful storage and handling, and each must be maintained at its own specific icy temperature; Moderna requires an ultra-cold deep freezer for protection, while Pfizer doses depend on regular freezers and Johnson & Johnson shots can be stored in something akin to a traditional refrigerator. Each vial contains multiple doses and if not properly maintained, the vaccines can spoil.

Credit: (NJ EMS Task Force)
New Jersey EMS Task Force planners Frank Intessimoni (left) and Anthony Gabriel at the operations center in Ewing

According to the DOH, New Jersey has lost 28,340 doses through June 8, or 0.25% of the 11.1 million doses delivered since December. While this is higher than the waste reported in early April — when it was barely 0.1% — it remains well below the current national rate of 0.68%, the department said, and well below what federal officials set as a goal for COVID-19 vaccine loss.

The DOH continues to oversee the allocation of the vaccines statewide, placing orders with the federal government based on the capacity and number of people at each immunization site. The vaccines are generally shipped directly to the clinics, although some have been stored at the health department lab in Ewing, next door to the state’s emergency operations center.

Being able to shift supplies from one site to another is key to meeting the evolving demand, experts note. Task force members from local squads are dispatched to Ewing almost daily, with three or four individuals assigned to coordinating the operation and six to 10 more loading the vans and hitting the road. In the first 10 days the teams put some 4,000 miles on the two vans, Bascom said, which were provided by squads from South Branch and West New York.

“We have come a long way with the task force,” said task force member Mike McCabe, the deputy EMS coordinator in Hudson County and a first responder in Bayonne. “We’re very encouraged by the responsibility the state has given to us,” he said, “and we hope it leads to more” collaboration.

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