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COVID-19: DOD vaccinates more than 1 million beneficiaries worldwide

Image of Military personnel wearing face mask standing in line to receive their COVID-19 Vaccine. Click to open a larger version of the image. Airmen from the 60th Surgical Operations Squadron, 60th Inpatient Squadron, 60th Healthcare Operations Squadron and 60th Operational Medical Readiness Squadron are cleared through a three-step process to receive the COVID-19 vaccine Dec. 22, 2020, at Travis Air Force Base, California. The Airmen were among the first to receive the vaccine at David Grant U.S. Air Force Medical Center, the Air Force’s largest medical facility (Photo by: Air Force Senior Airman Cameron Otte).

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The Department of Defense has administered more than one million COVID-19 vaccinations.

The milestone came as the United States surpassed 500,000 deaths from COVID-19 and just over two months after the Food and Drug Administration issued the first emergency use authorization for a vaccine for the prevention of coronavirus disease in individuals 16 years of age and older.

"On (Feb 22), we surpassed more than 1 million COVID-19 vaccine doses and continue to reach new daily administration highs," said Army Lt. Gen. (Dr.) Ronald Place, director of the Defense Health Agency, in a message to DOD medical teams. "Thank you for your due diligence and attention to detail as we continue to safely vaccinate our beneficiaries."

DOD continues to distribute and administer vaccines to Military Health System beneficiaries at more than 300 military medical treatment facilities around the world, following a phased population schema as part of the federal government's COVID-19 response.

As of Feb. 25, DOD has administered 1,087,625 doses of the COVID-19 vaccine; 713,624 recipients have received the initial dose and of those, 374,001 people have received both doses.

Although winter weather and logistics have affected the availability of doses at each military medical treatment facility, the DOD has over a 90% utilization rate, according to Air Force Col. (Dr.) Tonya Rans, chief of the Defense Health Agency's Immunization Healthcare Division, demonstrating that the quantity of vaccine reaching immunization sites is quickly reaching arms.

"The credit for reaching this milestone belongs to all those involved at every stage of DOD's COVID-19 implementation plan," said Rans. "But special recognition goes to the personnel at DOD immunization sites, who professionally engage with and educate their beneficiary populations, diligently review and improve workflow capabilities, and collaborate both within and across service lines to maximize beneficiary outreach."

"Every dose of vaccine administered helps protect our loved ones, colleagues, and neighbors against COVID-19 in addition to bringing us closer to an end to this pandemic," she explained.

However, "it is important to reflect that over 500,000 U.S. individuals have lost their lives to COVID-19," she added. "The sobering stories of lives lost is a powerful motivator to efficiently yet safely provide vaccine to those who wish to receive it as quickly as possible."

Working Together

All DOD MTFs are doing their part. At the David Grant U.S. Air Force Medical Center, at Travis Air Force Base in Fairfield, California, some beneficiaries were vaccinated within 24 hours of the base receiving its initial shipment in December 2020.

"We developed a safe, efficient method to distribute vaccines that keeps pace with the highest FEMA [Federal Emergency Management Agency] distribution capabilities," said Air Force Col. Gwen Foster, commander of the 60th Medical Group at Travis. "In just two, one-day points-of-dispensing efforts, we were able to exhaust our supply during the holidays."

Since then, DGMC, the Air Force Medical Service's flagship medical treatment facility in the United States, hasn't stopped administering vaccines.

"We have a sustained vaccination effort at DGMC to vaccinate daily, ensuring we reach eligible beneficiaries according to the vaccination schema and avoid vaccine waste," said Foster.

The MTF provides health care to more than 130,000 TRICARE eligible patients in the immediate San Francisco-Sacramento vicinity and more than 377,000 from the Department of Veterans Affairs Northern California Health Care System. In the two months since having received its first vaccine shipment, DGMC has advanced vaccination administration to beneficiaries in phase 1B, which includes Department of Defense personnel who comprise the strategic national mission force, service members preparing to deploy, beneficiaries aged 75 or older, and frontline essential workers.

"Our goal is to vaccinate as many people as we safely can, but we are limited by our logistics chain," said Foster.

At the same time, the medical center continues to vaccinate beneficiaries from phase 1A, which includes medical personnel and first responders.

"More and more of the personnel these tiers are opting to get the vaccine as they begin to see its safety and efficacy," she said.

Foster added that being a part of reaching the DOD's 1 millionth vaccine administration has been a great source of pride for Travis AFB and DGMC. "This pride runs even deeper when we realize our contribution to our DOD beneficiary population reaching this historic landmark: That we were able to quickly and safely administer some of the first vaccines in the United States, and that most personnel vaccinated in our initial efforts were within the first 1 million to 2 million people vaccinated nationwide," she said.

DOD's milestone comes in parallel to the U.S., just surpassing administration of 65 million total doses.

"We are humbled and honored to have contributed to these vaccination efforts that will save lives, prevent suffering, and ensure the national defense mission continues," Foster said.

And even though there have been some challenges, "learning from them makes us better as airmen, as an air force, and ultimately as a nation," said Foster.

For Blanchfield Army Community Hospital in Fort Campbell, Kentucky, vaccination administration has progressed to phase 1C, which includes all beneficiaries between 65 and 74 years of age, those between 16 and 64 years of age with increased risk for severe illness as described by the CDC, and essential workers not previously included in phases 1A and 1B.

Military personnel wearing face mask checking in to receive the COVID-19 Vaccine
U.S. Army Maj. Jade Snader, left, chief nurse for Soldier Health Services, Blanchfield Army Community Hospital, gives 1st Sgt. David Wasierski, right, Headquarters and Headquarters Company "King of Clubs", 1st Brigade Combat Team "Bastogne", 101st Airborne Division (Air Assault), a vaccine information card during his screening prior to being vaccinated (Photo by: Army Maj. Vonnie Wright).

The hospital serves the Fort Campbell community, including more than 72,000 soldiers, retirees, and their family members enrolled to BACH services and more than 92,000 who are eligible for care in the Fort Campbell TRICARE service area.

"In our current model, we estimate we are capable of vaccinating over 700 individuals per day," said Army Col. (Dr.) Patrick Birchfield, BACH commander. "As we move into later phases of administering the vaccine, we will facilitate a larger venue on post, enabling 1,000 vaccinations daily with the capability of scaling this number higher if needed."

Most MTFs are vaccinating beneficiaries in phases 1A and 1B, however, commanders have the independent capability to move down the population schema after maximum outreach to the current tier, explained Rans.

"I am extremely proud of our team and how incredibly well they are conducting vaccine administration at Blanchfield Army Community Hospital, how they are working closely with unit leaders to ensure the eligible soldiers are receiving the vaccine," said Birchfield. "The process is flowing smoothly but, perhaps, most importantly, the process is safe and comfortable for our patients and eligible beneficiaries.

For the DOD to exceed the 1 millionth vaccination is a significant and encouraging milestone, he said. "Protecting our most vulnerable population, along with the military service members who are deploying and other high-risk populations here at Fort Campbell is critical in winning the fight against the COVID-19 virus."

Technology's role

In addition to the whole-of-community effort to make vaccination administration a success throughout DOD, technology has played a significant role in reaching the vaccination administration milestone. MHS GENESIS, the DOD's new electronic health record system, has played an important role in communication and centralized record keeping.

"Because we have standardized all data sources to a central collection point, we're now able to rapidly gather information about activity in the field to quickly assess where the vaccine has gone, and how it has been used," said Air Force Col. (Dr.) Thomas Cantilina, DHA's chief informatics officer. "This in turn has allowed us to establish a means of determining where the vaccine is most needed, and who has resources to distribute it."

The new EHR system is being implemented across MHS through 23 waves to provide enhanced, secure technology to manage health information and keep all beneficiaries' records centralized.

"Currently, we wish we were further along in the deployment of MHS GENESIS, as the system allows for documentation during administration of the vaccine," said Cantilina. "This capability is done through MHS GENESIS ability to leverage automation such as barcode medication administration, which ensures critical patient health information is made available to our providers as this shot is given, such as patient allergies and potential drug interactions, risk factors or wrong timing of the dose."

From his perspective, reaching the 1 millionth shot in arm milestone is major and signifies two things: "First, we have a strong sense that we're on the right path as far as processes and procedures at both a local and enterprise level. Second, we know our patients are taking the risk of contracting COVID-19 seriously, and there's an understanding that receiving the vaccine reduces your chances of both contracting and spreading this deadly virus."

"Coupled with the challenges so many faced in changing the way they performed their jobs while practicing social distancing makes it even more significant," he said. "You can really appreciate how this milestone is the culmination of so many people who are committed to eradicating this virus, and caring for our families, colleagues, neighbors and friends. I'm proud of the men and women on the front lines that have made this possible."

Lessons Learned

Despite unforeseen weather-related and logistical challenges resulting in delayed delivery of vaccine shipments to MTFs, "good communication allowed facilities to either change planning factors or contact scheduled participants and reschedule their immunization date," said Army Lt. Col. Carmen Bell, program manager of special projects and readiness for DHA's Plans and Exercises Division.

There were also issues in communication and data. Birchfield explained they anticipated challenges between the accuracy of data in legacy electronic health records and that with MHS GENESIS. "We've now fixed many of those issues through improvements to provider workflows, reengineering the logic of how data flows, and mandating documentation at the point of vaccine administration," he said. "Today, we have much more accurate and reliable data from MHS GENESIS and our legacy electronic health records."

"Highlighting that "the military and the Military Health System employ a wealth of experience in dealing with major challenges and are able to overcome them by strategically planning and implementing those plans," he concluded that, "the training to tackle a mission confidently and with persistence is key to overcome the inevitable challenges.

Bell echoed the sentiment. "There has been an immense number of lessons and experiences," she said. "As we reflect from our observations, we will create better policies and practices that we will communicate and disseminate throughout the organization to then practice and reevaluate until we learn and effectively change our behaviors."

As the DOD continues undertaking the mission to deliver and administer vaccines safely and effectively to all MHS beneficiaries, it's clear team effort, flexibility, coherent and consistent communication and coordination at all levels, and the military's can-do attitude will continue to be crucial. Until then, it's important that all MHS beneficiaries continue to do their part following CDC guidelines and DOD orders to protect themselves, their loved ones, and their communities.

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