Fragile COVID-19 Vaccine Providers Must Follow Stringent Dose Handling Guidelines

By Tarryn Mento

Handling Guidelines

The COVID-19 vaccine does not care to be disturbed.

It likes the cold, hates the light and prefers not to be shaken, but swirled.

The vaccine finds a happy home in a tabletop pharmaceutical-grade freezer at Family Health Centers of San Diego. The unit that’s no bigger than a college dorm room fridge is closely monitored. A smart thermometer triggers an alarm if it’s ever out of range, yet a vaccine coordinator still logs the temperature twice daily.

Once a vial is removed from the freezer, the clock starts ticking on how long it will last.

“It’s a great art and science managing this vaccine,” said Lisa Duncan, who oversees vaccinations at Family Health Centers of San Diego.

The vaccine’s fragility is an added challenge for vaccinations working to inject doses as quickly as possible — the county wants 70% of the region vaccinated by July — but also with great care. A degree too warm, or a room too bright, could render a vial ineffective at a time when shipment delays and shortages mean back-up doses are practically nonexistent.

Providers like Family Health Centers are using strict handling rules to ensure the vaccine’s potency is never compromised.

Duncan, Family Health Centers vice president of nursing and clinical compliance, said doses are carefully handled from the moment they arrive in an insulated cardboard box.

“They’re packed very carefully to minimize disturbance,” she said. “They’re frozen, so that helps — they don’t get sloshed around.”

Duncan said vials can’t even be transported elsewhere without prior OK.

“They can maybe have one transport that has to be approved in advance to transfer vaccine supplies so that everyone knows where the vaccines are,” she said.

In-house at Family Health Centers, the vaccines must be meticulously monitored as they move from the freezer to the refrigerator for thawing. Vials of the Moderna vaccine will last up to 30 days in a fridge but only hours in the facility’s repurposed breakroom where dosing takes place.

Pfizer-BioNTech’s product will only last five days in the fridge.

Both vaccines have only a six-hour shelf-life after the bottle is pierced.

“You’re constantly looking at: how much needs to go in the refrigerator? How much do we pull out and put it into the room? How long has it been in the room? How long has it been open since you took out the first dose?” Duncan said.

It’s sort of like handling chocolate, said Dr. Dial Hewlett, deputy to the health commissioner of Westchester County in New York.

“If you have chocolate, you know that when it gets to a certain temperature, it’s going to melt,” Hewlett.

He said the chocolate analogy, which he credits to another scientist, helps explain the COVID-19 vaccine’s need for a freeze.

“You have enzymes that will destroy the integrity that are not going to be active when you have a very low temperature, but when you have a higher temperature, those enzymes will become active,” Hewlett said.

Providers like Family Health Centers have coordinators whose sole job is to monitor the safe handling and storage of vaccines.

“All of us are very much aware of the paraments and back each other up on that but generally one person is in charge of making sure that the supply is moving out of the refrigerator properly And at the end of the day, everybody starts sharing the vial so that we don’t open one up,” Duncan said.

The strategy and every other detail will soon be duplicated and expanded to other vaccination sites. The small-scale operation at Family Health Centers of San Diego’s administrative offices will grow with the addition of an upcoming site at Logan Heights.

The plan is to accommodate 750 people a day in the parking lot outside its clinic. Vaccine supply shortages have delayed its opening, but they’re hoping shipments will flow early next month thanks to an upcoming federal program that prioritizes community clinics.

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