Dartmouth-Hitchcock Shares Plans to Distribute Coronavirus Vaccine

With the initial vaccine supply expected to be limited, Dartmouth-Hitchcock Health has prioritized which healthcare workers will get vaccinated first.

Under state and federal guidance, Dartmouth-Hitchcock Health is poised to distribute the first supplies of coronavirus vaccine.

Last week, the U.S. Food and Drug Administration granted emergency use authorization for the Pfizer-BioNTech coronavirus vaccine. Distribution of the vaccine is beginning this week.

In a conversation with HealthLeaders last week, Michael Calderwood, MD, MPH, associate chief quality officer at Dartmouth-Hitchcock Medical Center, and an associate professor of medicine at the Geisel School of Medicine at Dartmouth College, shared the health system's plans to distribute the vaccine. The following is a lightly edited transcript of that discussion.

HealthLeaders: What are the primary elements of Dartmouth-Hitchcock Health’s coronavirus vaccine distribution plans?

Michael Calderwood: As we look at how we are going to be distributing vaccine, we are looking at guidance from the state of New Hampshire as well as federally at the Centers for Disease Control and Prevention.

The allocation criteria consider a few things. We are looking at the risk of an individual acquiring infection and the risk to that individual if they were to become infected having severe illness or death. We are also looking at the societal impact and looking at who is most likely to transmit coronavirus to others. That is going to be an important point as we think about moving from the early phases—where we are focused on healthcare workers, first-line responders, and those people living in nursing homes—to later phases and figuring out who add first to the list and who come second, third, and so forth.

HL: If you must prioritize which members of the medical center's staff will receive the vaccine first, how will you do that?

Calderwood: There has been a lot of work in advisory groups at the state level and nationally, so we are using some of that guidance in terms of risk stratification. Regarding high-risk healthcare workers, there has been a big focus on physicians and nursing staff as well as individuals working at testing facilities, emergency departments, and urgent care centers. In addition to all of that, we need to be aware that healthcare is a broad group of individuals, so we need to consider vaccinating dentists and dental hygienists, and home caregivers and people going out into the community.

So, we have a set list in terms of the risk stratification for healthcare workers that we will be following. Even within those groups, it may be possible that we will receive insufficient vaccine in the first delivery to get to everyone in the high-risk categories. If we look at those individuals who have been prioritized as being at highest risk, we are looking at people who have high-risk medical conditions, those who are over the age of 65, and healthcare workers who are providing direct patient care—particularly working in COVID-19 units.

HL: The Pfizer-BioNTech and Moderna vaccines require extreme low-temperature storage. How are you going to be storing vaccine at the medical center?

Calderwood: This will also change over time. With the initial delivery, the National Guard will be delivering vaccine to state authorities. So, the deep freezing of the vaccines will be at state facilities. They are then going to deliver the vaccine out to sites like ours based on the vaccinations they are planning on a given day. There is variation between the vaccines in terms of how long you can have them out of deep freeze before you vaccinate people after doing some prep at your site. All of those logistics have been worked out.

Longer term as we get more and more vaccines, we will be storing vaccine at healthcare sites—hospitals, clinics, and pharmacies have all begun to develop that infrastructure. We do have minus-80-degree freezers distributed strategically across our region to support the broader vaccination effort.

HL: The Pfizer-BioNTech and Moderna vaccines must be thawed and prepared before vaccination can proceed. How is the medical center managing those processes?

Calderwood: We have a very large, multidisciplinary team. Most hospitals have had strong involvement of pharmacists. We have our chief pharmacy officer involved in the day-to-day logistics.

For the vaccination, we have a dedicated vaccination staff that has a lot of experience doing flu clinics. So, once our pharmacists prepare the vaccine, it will be administered by our vaccination staff, which has a long history of doing these types of clinics.

HL: In addition to your medical center, Dartmouth-Hitchcock Health is affiliated with several smaller hospitals. How has the health system integrated these smaller facilities into its vaccine distribution plans?

Calderwood: We are making this effort as a health system. So, each hospital has to submit their own list of who they are planning to vaccinate and a time schedule for that vaccination. That is all being coordinated centrally. And as we think about vaccination for the general public and the continued need for cold storage of vaccines, we will be storing vaccines in a couple of central locations and distributing vaccine out to the system based on need.