How New COVID Relief Fails Rural America
WHY YOU SHOULD CARE
Because the billions coming from Washington might not be enough to keep vaccine doses cold enough to reach rural Americans.
By Dr. David Lenihan
The availability COVID-19 vaccines offers great promise for controlling and hopefully eliminating the coronavirus. For a successful rollout, however, the federal government needs to develop a fully funded plan to properly warehouse the vaccines to safely inoculate citizens in remote regions of the U.S.
As president of the Ponce Health Sciences University (PHSU) medical school and a director of the clinical research center, Ponce Research Institute (PRI), in Puerto Rico, I oversaw the rebuilding of our campus and facilities after they were demolished by Hurricane Maria in 2017. An important component of our effort included implementing updated storage protocols for biological samples essential to our clinical work and research. The successful practices we put in place can be applied to the storage of Pfizer’s COVID-19 doses in remote America.
The city of Ponce was pounded by 174 mph winds, extreme rainfall and widespread flooding, and the hurricane crippled our power supply and back up reserves. It also destroyed our neuroscience research center, classrooms and student center. To preserve tissue samples, biological materials, plasma and pharmaceuticals, we needed to invest in new ultra-cold freezers (-60° to -80° C) with temperature monitoring sensors that would safely preserve these crucial components. We also needed to set up redundant power sources to withstand outages and designate a security perimeter to prevent damage to and disruption of the stored frozen contents.
CDC guidelines mandate that freezers for vaccine doses must be in secure locations. That means temperature sensors with remote alarms, multiple power sources and 24/7 security systems. While such capabilities exist in densely populated areas of the U.S., the clinical infrastructure in remote, rural settings lacks them. To administer the COVID-19 vaccines to Americans who live in these areas, federal government support must be allocated to the states for the purchase, delivery, security, power grid upgrades and professional staffing/training that’s needed to operate and maintain the freezers.
Along with the requirement of ultra-cold freezers to preserve the vaccine cold chain in remote/rural regions, there are numerous questions to consider:
- The freezers each hold approximately 1,000 vaccine doses. Based on the number of people in each rural community, how many freezers are needed?
- What’s the nearest supplier from which the freezers can be ordered?
- What’s the fastest delivery and setup time that can be achieved for the freezers to be operational, protected and ready to warehouse the vaccines?
- Will the delivery/setup time of the freezers align with the delivery of the vaccine doses?
- Pfizer’s vaccine, for example, requires two shots to be given three weeks apart, so how frequently must the freezers be replenished?
- How many professionals must be hired to maintain the freezers?
While the necessity for ultra-cold freezers to retain the integrity of Pfizer’s mRNA COVID vaccine in rural U.S. settings is essential, federal funding details for the initiative have not been forthcoming. The Association of State and Territorial Health Officials, the Association of Immunization Managers, and the National Governors Association have been seeking specifics about the monies that will be available to enact effective vaccine distribution and implementation, but the feedback that they’ve gotten from Congress has been imprecise.
The recently passed $900 billion coronavirus relief package allocates $8 to $9 billion to fund vaccine distribution. Unfortunately, no particulars have been provided so far about whether those funds would cover the purchase, shipping, power grid upgrade, maintenance and security costs associated with the ultra-cold freezers that are required to safely store the Pfizer vaccine doses in remote regions nationwide.
This disconnect is worrisome, since COVID-19 vaccines will not be delivered everywhere without a clearly delineated storage plan.
The lessons that we learned in the aftermath of Hurricane Maria’s decimation of Puerto Rico (and of PHSU/PRI) allowed us to establish procedures that enable stable and protected storage of sensitive biological materials using ultra-cold refrigeration. These protocols have resulted in our being selected by the CDC as one of the first approved COVID-19 vaccine distribution and administration sites in the country.
With appropriate financial support from the federal government, local authorities in rural and remote regions of the U.S. can implement the same methodology to safely preserve Pfizer’s COVID-19 vaccine doses for their residents.
- Dr. David Lenihan Contact Dr. David Lenihan