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Immunization Experts are Central to COVID-19 Vaccine Program

Medical director at Fort Riley, Kansas receives a COVID-19 vaccination In his left arm from a tech in personal protective equipment. Dr. Andrew Bloom, the emergency medical services director of Fort Riley, Kansas, receives the Moderna vaccine from Sgt. Jason Johnson, a medic at the Irwin Army Community Hospital. Dec. 23, 2020, during the Military Health System’s first wave of COVID-19 vaccinations.

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On Dec. 15, 2020, David Cortez, a Defense Health Agency Immunization Health Care Division specialist, made the eight-hour drive from his home-base at Camp Pendleton, California, to the Coast Guard Station in Alameda, California.

The Alameda facility was selected as one of the first launch sites for COVID-19 vaccinations across the Military Health System, or MHS. Over the course of a few days, Cortez, a retired Navy hospital corpsman, helped the professionals in Alameda become experts on the new COVID-19 vaccine products.

To support the initial COVID-19 vaccine rollout last year, the Immunization Healthcare Division, also known as IHD, deployed 17 specialists including Cortez throughout the MHS who provided guidance on procedures for handling the new vaccine products.

"IHD's vaccine specialists were able to deliver COVID-19 vaccinations with care, efficiency, and professionalism," said Dr. Margaret Ryan, IHD medical director, Pacific Region Office, in San Diego.

Cortez said the mission at the time carried a sense of urgency for the IHD team and others who were involved.

"We knew what we were doing was important, not just for the military, but for the world," Cortez said.

IHD Takes Center Stage

The work of the IHD has become an epicenter of military readiness over the past year as the Pentagon made vaccination of the active-duty force a top priority.

"The world was turned upside-down as COVID-19 illness and deaths mounted, and pandemic lockdowns were imposed," Ryan recalled. "Public health professionals recognized immediately that the way forward must include COVID-19 vaccines."

IHD professionals began working with federal partners at the Centers for Disease Control and Prevention and the Food and Drug Administration (FDA) in early 2020 as planning got under way for COVID-19 vaccines. "It was very intense work," Ryan said.

On Dec. 11, 2020, the FDA granted Emergency Use Authorization for the first COVID-19 vaccine, manufactured by Pfizer-BioNTech. A week later, on Dec. 18, FDA granted similar approval for the Moderna vaccine.

The military was prepared, Ryan said.

"IHD had developed strategies to manage this brand new vaccine. It required storage at unprecedented ultra-cold temperatures and special handling to ensure the fragile product would be delivered to clinics and patients absolutely correctly," she explained.

The division not only handles all COVID-19 vaccination matters but also the yearly influenza vaccination campaign and all other vaccination efforts across the MHS.

"The division ensures that all military beneficiaries have access to vaccine products that have been preserved and handled appropriately, so their safety and effectiveness is assured," Ryan said.

"IHD clinical leaders ensure that all patients – especially those with special needs, special concerns, or adverse events following immunization – receive excellent care."

Since December 2020, the MHS has administered more than 6.5 million doses of COVID-19 vaccine to military beneficiaries. The military also has provided humanitarian support to COVID-19 vaccine delivery efforts outside of the MHS.

"The hard work continues," Ryan said.

"New COVID-19 vaccine products and new recommendations make immunization programs complex," she said. "IHD professionals must ensure all clinics maintain expertise, for optimal delivery and administration of these products."

IHD professionals also respond to vaccine concerns from patients.

"Managing misinformation and disinformation about vaccines is a growing challenge," Ryan added.

Cortez recalled the polio vaccination efforts in the 1960s and compared that to the tenor and rhythm of COVID-19 vaccination efforts.

"While a few people hesitated to get the [polio] vaccine, most parents were so relieved that a vaccine would protect their children from the devastation of polio," Cortez said.

"COVID-19 vaccines are just as important as polio vaccines for changing the course of a global pandemic."

Ryan said vaccine concerns are understandable. "The IHD team works hard to compassionately address these concerns. Our goal is focused on delivering the best immunization care possible, and protecting people from COVID-19 illness."

"I am enormously honored and proud to work with this DHA IHD team," Ryan said.

IHD was originally conceived as the Vaccine Healthcare Centers Network (VHCN) and Military Vaccine Agency (MILVAX) in response to a growing need for vaccine expertise.

MILVAX was created in 1998 to administer the Anthrax Vaccine Immunization Program and was later expanded to support the Smallpox, Influenza, and all other military immunization programs worldwide.

Near the same time, the VHCN was established in response to congressional concern for ensuring quality vaccine administration and improving clinical care, surveillance, and reporting of adverse reactions in the military.

"More vaccine products were becoming available in this era. Vaccine recommendations were becoming more complex, and many patients' concerns were voiced as 'vaccine hesitancy,'" Ryan recalled.

In October 2014, the unified MILVAX/VHCN became part of the Defense Health Agency as the Immunization Healthcare Branch (now the Immunization Healthcare Division) to provide the entire Department of Defense with the highest quality immunization standards and practices.

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