The Defense Health Agency's Immunization Healthcare Division has been instrumental in ensuring that all the Department of Defense's military medical treatment facilities guarantee safety protocols during the complex process of receiving, distributing, storing, and administering COVID-19 vaccinations.

The process, ongoing since December 2020, involves IHD's immunization health care specialists at four regional safety vaccine hubs across the United States assisting DOD MTFs around the world to ensure COVID-19 vaccination operations follow the eight standards for military immunization, a set of guidelines IHD developed from a combination of Centers for Disease Control and Prevention-issued recommendations and joint DOD-issued policy.

"Immunization health care specialists are our 'boots on the ground' professionals strategically embedded to provide expeditious support to DOD immunization sites", said Air Force Col. Tonya Rans, chief of IHD. "They assist with the safe and effective implementation of DOD's immunization programs, coordinate redistribution of vaccines when needed, and engage during potential immunization storage or handling temperature excursions. Their input unequivocally helps us identify and close immunization training gaps in the field."

The safety protocols include ensuring the immunization staff members at each MTF adhere to cold-chain management principles during transportation, storage, and administration of vaccines; assisting the MTF staff in developing standard operating procedures and ensuring they include proper packing protocols for transporting and shipping vaccines; and supporting MTFs with mass immunization events, explained Brian Canterbury, one of the IHD's immunization health care specialists assigned to the South Atlantic Regional Vaccine Safety Hub (SARVSH), which covers 12 states, 334 clinics, U.S. Central Command, U.S. Southern Command, and U.S. Special Operations Command.

Although immunization health care specialists ensure the MTFs always follow the standard guidelines for all DOD immunization efforts, the COVID-19 vaccines presented unique challenges that required adapting standard protocols to properly handle, transport, and store the vaccines. The Pfizer-BioNTech vaccine, for example, has strict handling guidelines to ensure maximum efficacy, including the requirement to remain frozen in ultra-cold temperatures between -80 degrees Celsius and -60 degrees Celsius prior to removal and thawing, at which point it can be refrigerated for a maximum of five days before having to be discarded.

Wayne Chardon, an immunization health care specialist assigned to SARVSH, works from Naval Hospital Pensacola at Naval Air Station Pensacola, Florida, in support of all MTFs north of the I-10 corridor in Florida as well as those in Louisiana, southern Mississippi, and the Caribbean.

His initial challenge involved ensuring the MTFs in his coverage area designated to receive the Pfizer vaccine had the right type of freezer to store it safely and a list of confirmed recipients ready to receive the shot. In addition, Pensacola was also designated as a redistribution center from where shipments of vaccines would be transported to Keesler Air Force Base in Biloxi, Mississippi, and from there to the Armed Forces Retirement Home in Gulfport, Mississippi.

"The refrigeration requirements for the Pfizer vaccine presented a logistical challenge because the vaccines arrived at Pensacola frozen, in manufacturer packages with dry ice," Chardon said. "We first transferred them into proper storage freezers at Pensacola to ensure they didn't thaw, because once they thaw you only have five days at refrigerated temperatures before they must be discarded."

That added a challenge to the downstream vaccine movement, he explained. "We also had a roster of people in the first tier readily identified and available to be vaccinated, because once we begin transporting that allotment from Pensacola to Keesler and to the Armed Forces Retirement Home, the five-day countdown begins."