Long Island hospital officials say the delivery of COVID-19 vaccines to the region has gone smoothly so far, but logistical hurdles remain in the effort to inoculate a critical mass of the Island’s residents.
Shipping, tracking, storing and distributing the vaccines require a sprawling logistical operation with few precedents, officials and supply chain experts said. While vaccinations have begun among local front-line health care workers, questions loom about getting and distributing millions more doses across the region.
Local hospitals officials said they do not yet know whether they'll be responsible for vaccinating the general public. The timing and frequency of future shipments are unclear. And a state health department spokesman did not answer questions about how future vaccine allocations will be divvied up between and within regions.
Gov. Andrew M. Cuomo acknowledged the complexity of the task in a statement earlier this month.
"I can’t think of a government operation that has been commenced that is more difficult and intricate than what governments will be asked to do here," he said.
The federal government is responsible for procuring and distributing vaccines, with FedEx and UPS handling the shipping. Congress recently allotted $8 billion toward the distribution effort in a pandemic relief bill. The federal government also has contracted with pharmacy chains to inoculate nursing home residents and staff in states, including New York.
The state is responsible for deciding where vaccines should go once they reach New York, Cuomo has said. New York is setting up regional networks to develop local vaccination plans and coordinate logistics. The Long Island hub is being managed by Northwell Health.
But exactly how vaccines will be divvied up is not specified in the state's planning documents. Health Department spokesman Jeffrey Hammond did not respond to questions on the subject.
Even getting vaccines to Long Island — and storing them — can be a challenge.
The Pfizer-BioNTech vaccine — the first to receive federal approval — must be kept at minus 70 degrees Celsius, requiring special shipping boxes and ultracold freezers.
"The cold chain logistics is the most complicated piece," Onisis Stefas, Northwell Health’s chief pharmacy officer, said of the vaccine. "This is a first for most of us."
Northwell received its first Pfizer-BioNTech shipment Dec. 14 and administered what hospital officials said was the first dose in the nation later that day. The vaccines came from a Pfizer plant in Kalamazoo, Michigan, via UPS in customized boxes packed with dry ice and equipped with GPS and temperature monitors.
Local hospitals are keeping the vials in special storage freezers that themselves were not easy to acquire.
"You can’t just go to P.C. Richard and order one," said Brian Malone, director of pharmacy at NYU Langone Hospital-Long Island, which received its first shipment of vaccines Dec. 15.
Hospitals on the Island last week also began receiving the vaccine produced by Moderna and the National Institutes of Health. Moderna's vaccine, and the one from Pfizer-BioNTech, require two doses for full inoculation.
It’s not just vaccines that need to get here fast. Hani Mahmassani, the director of Northwestern University’s Transportation Center, noted massive numbers of syringes and other equipment must arrive at vaccine distribution points in time with new doses.
"Everything has to align perfectly," he said. "What is new here is that we're trying to move so much of it so quickly."
Long Island presents its own obstacles to the shipping process, said Steven Carnovale, a supply chain expert at Rochester Institute of Technology. The region’s notorious traffic backups could slow deliveries, especially given the Island is only accessible by land on its western end.
At Northwell, Stefas said vaccine deliveries have been "going extremely well." He said shipments have been on time and appropriately cold.
But kinks are still to be worked out.
At Nassau University Medical Center, for example, hospital workers were puzzled by an order from the state health department to give 178 doses to St. Francis Hospital, although each vial contains five doses. Providing 178 would mean handing over a partially used vial — a difficult feat when each vial is only usable for six hours after it has been prepared.
"That’s nearly impossible to do unless their employees come here," said Grace Ting, associate director in the hospital’s Department of Emergency Medicine.
Hammond did not respond to questions about the order.
Julie Swann, a professor at North Carolina State University who specializes in supply chains and health systems, said vaccine distribution will get more complicated as it expands beyond health care workers mostly located at hospitals where vaccines are stored.
Mahmassani predicted squabbles could break out over the allotments given to each region of the state — and even to each part of Long Island. "There’s going to be a lot of bickering about it," he said.
Despite the challenges, Carnovale said Long Islanders should have confidence in the ability of shippers and officials to get the vaccines to the region quickly.
"There's going to be hiccups," he said. But, "If we can get a package from Reno, Nevada, to Hauppauge, Long Island, in 24 hours, we'll figure out how to get these distributions done with the vaccine."
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