Behind the Scenes of Vaccine Distribution

As the director of pharmacy services at Southwestern Vermont Medical Center (SVMC), my job is to get medicines from manufacturers to the people who need them. Like many medications, the new COVID-19 vaccines have particular handling instructions. I thought it might be interesting to share all of the intricate steps your vaccine takes to get from the people who make it to your arm.

Step 1: Delivery
At SVMC, we are fortunate to have been able to meet the intense storage requirements necessary for the Pfizer vaccine, which must be kept at -70 degrees Celcius. Having had the forethought to purchase an extra ultra-low-temperature freezer as soon as we knew this vaccine’s storage needs means that we can receive doses directly from Pfizer. So far, we have accepted about 1,000 doses of the Pfizer vaccine, and we hope that the rate of arrival will continue. The Moderna vaccine is stored at -20 degrees Celcius and, so far, has arrived at a rate of 300 – 400 doses at a time.

Once the specialty shipped Pfizer vaccine arrives, we keep it in the ultra-low freezer until we know when it will be used. It’s essential to understand when each vaccine batch will be used before thawing doses because—once removed from the freezer—the clock is ticking. We thaw it in a standard refrigerator—at 36 – 46 degrees Fahrenheit, which takes 2 – 3 hours. After that, the vaccine is stable for five days or 120 hours under refrigeration or 6 hours at room temperature, once prepared for administration.   

Step 2: Preparation
Once thawed, a pharmacist must compound the doses by adding saline to the vials and drawing up the syringes. The dose size for the Pfizer vaccine is 0.3 mL, and for the Moderna vaccine, it is 0.5 mL. Each dose takes approximately one minute to draw, cap, label, and transfer to a light-protective bag. Then, we deliver it to the vaccine clinic.

The time it takes to prepare the vaccine is part of why walk-ins are not possible for COVID vaccine clinics. As long as each vaccine continues to have special handling requirements, we expect people will need an appointment to receive their vaccine.

At SVMC’s clinics, we can deliver 24 vaccines an hour, and we are providing up to 288 doses a day. Pharmacists are preparing vaccines non-stop throughout the day to keep up with the demand. If there is a short wait between when you arrive for your vaccine and when it is available, it is likely because the vaccine itself is being compounded and prepared.

Step 3: Scheduling
We are keeping our website, svhealthcare.org, up to date regarding whose turn it is to receive their vaccination. Frontline healthcare workers and residents and staff at long-term care facilities are being vaccinated now. Community healthcare workers are being scheduled and vaccinated too. You can visit https://svhealthcare.org/COVID-19/Vaccine-General-Public for information about when it’s your turn and to eventually schedule online. We anticipate beginning to vaccinate members of the general public starting in February.

Note that only those who live or work within the area shown on the map below may receive the vaccine from SVMC. You will be asked to register with your zip code and may be asked for proof of zip code (a driver’s license, for instance) before receiving the vaccine. Also, appointments are dependent on the expected vaccine arrival. If we do not receive your dose, your appointment will be rescheduled.

Those who have had  a positive COVID test should wait 75 days from the onset of COVID symptoms before getting vaccinated, and everyone should reschedule if they are in quarantine or feeling ill.

Step 4: Vaccination Day
You will arrive at your scheduled time and register, just like you do for a medical appointment or lab blood draw. The staff registering you will ask you to fill out a form and answer questions about how you’re feeling and whether you’ve ever had a severe allergic reaction to a vaccine in the past. The vaccinator will ask more questions, including which arm you prefer. The rest is quick and virtually painless.

When you’re done, you visit an observation area, where you must wait for 15 minutes before leaving. Allergic reactions are rare, but most present within 10 minutes. While there, you can get your “I got vaccinated” sticker and scan a QR Code that will prompt you to sign up for daily check-ins. Signing up helps the vaccine manufacturers collect more information about how the vaccine affects recipients. You will also make an appointment to receive the second dose. From start to finish, the whole process should take 45 minutes or less.

More than 10,000 Vermonters have been vaccinated so far. You can keep up to date with the latest vaccine distribution stats at the state’s new dashboard: https://www.healthvermont.gov/covid-19/vaccine/covid-19-vaccine-dashboard.  I hope, when it’s your turn, you will join me and thousands of others to get your vaccine. Getting at least 70 percent of the population vaccinated is our quickest and safest way to get back to visiting, hosting, traveling, school, sports, live music and theater performances, and all of the other things we look forward to and enjoy.

Robert Sherman, PharmD, is the director of Pharmacy Services, at Southwestern Vermont Medical Center.