The Challenges of Coordinating COVID-19 Vaccine Distribution Across NYC’s Public Health System

Pharmacy Times® interviewed Danielle DiBari, the chief pharmacy officer and senior vice president of business operations for NYC Health + Hospitals, who is in charge of the logistics associated with the COVID-19 vaccine rollout for New York public health system, which is the country’s largest public health system, on some of the challenges involved in coordinating vaccine distribution among its 11 hospitals, 7 community-based clinics, 5 skilled-nursing facilities, and other temporary vaccination sites.

Alana Hippensteele: So, Danielle, how has the coordination of the vaccine distribution in the New York public health system been structured in order to effectively supply these diverse vaccination sites?

Danielle DiBari: Coordination and execution of vaccine supply has been driven through close partnership with New York City Department of Health and Mental Hygiene and New York State Department of Health. As you may know, the supply surrounding vaccine has been limited, and the NYC Health + Hospitals system receives our inventory allocation from New York State and distribution from New York City.

Once vaccine inventory has been officially received, our pharmacy teams unpack, store according to the EUAs, and prepare and distribute in correlation with daily demand. Standing operating procedures have been developed and implemented for vaccine storage and administration throughout our vaccine sites.

Alana Hippensteele: How has NYC Health + Hospitals been able to ensure proper delivery and storage of COVID-19 vaccines throughout the public health system?

Danielle DiBari: Allocation of inventory and delivery is decided at the state and city levels. At New York City Health + Hospitals, we prepare early on to ensure that we have the capability to store and distribute vaccine where necessary by installing our ultra-cold freezers, namely for Pfizer vaccine, and standard freezers for Moderna. With relation to the new [Johnson & Johnson] vaccine, we are also prepared with the appropriate refrigerators to properly store and distribute vaccine.

Alana Hippensteele: Yeah, and how are you able to establish data tracking for appointment scheduling and supply?

Danielle DiBari: Sure. This was quite difficult in the beginning. We established a COVID-19 vaccine registry, which encompasses appointment data, that has appointments booked, and current availability or capacity throughout our health system. We're also able to track doses administered, so first and second doses, as well as total doses administered.

We also know where they were administered, as well as employee versus non-employee vaccinations. According to our state guidelines, we can only schedule appointments upon delivery and receipt of vaccine inventory at this point in time. So once doses are received, we're able to open up our appointment availability for those who are eligible via New York City Health + Hospitals appointment scheduling website.

Alana Hippensteele: How does NYC Health + Hospitals respond to new eligibility?

Danielle DiBari: New York City Health + Hospitals receives updates on eligibility directly from New York State. We immediately update the eligibility requirements on our appointment website, including our registration systems, to ensure that we are properly vaccinating all eligible individuals as soon as new requirements are released.

Alana Hippensteele: How have you managed coordination with chief pharmacy officers in different vaccine locations?

Danielle DiBari: Our directors of pharmacy are the leaders in terms of pharmacy operations system-wide and have been instrumental with relation to the coordination and management of vaccine initiative.

We have daily vaccine virtual meetings to ensure that we're working closely as a team to support one another. On a daily basis, we review inventory and supply, burn rates, and best practices.

We also have weekly executive steering committees led by our senior assistant vice president of business operations, who happens to be a doctor of pharmacy, to make sure to unlock steps surrounding proper operational management of vaccines throughout our health system. The members of those meetings include our system [chief medical officer], [chief quality officer], [chief nursing officer], [chief information officer], etc.

We also have daily operations meetings that take place to manage details surrounding field operations support. As we increase the number of vaccines we administer on a daily and weekly basis, these meetings are essential to properly support those on the front line with managing a smooth workflow and focus on safety while administering the vaccine.

Lastly, we have system [pharmacy and therapeutics meetings] and pharmacy council meetings that also entail vaccine clinical updates, as well as potential new emergency use authorizations on the horizon.

Alana Hippensteele: How have weather challenges affected the vaccination rollout in the city?

Danielle DiBari: Well, severe weather events can affect delivery logistics of medications and/or products in general. As we know, medications are delivered to us from different areas of the United States, and depending on where severe weather hits, and the timing surrounding that event, it can indeed interrupt delivery schedules.

This did in fact happen to us, and we didn't receive vaccine for roughly a week. But we were able to quickly recover once we received vaccine by rescheduling our vaccine appointments immediately upon the delivery of that vaccine.

Alana Hippensteele: How do you expect access to the single-dose Johnson & Johnson vaccine to impact vaccine distribution in the city?

Danielle DiBari: Well, access to more vaccine supply is definitely good news for our patients and New York City residents in general. Access to more supply means more individuals can be protected from COVID-19, and hopefully this will result in a step toward mitigating the pandemic with the potential for life to become more normal again over time.

A single dose vaccine may be easier and more satisfying in general, as an individual doesn't have to come back for a second dose to gain immune protection from COVID-19.

Alana Hippensteele: Yeah. What is the value of the pharmacist in the effective rollout of New York’s vaccination program?

Danielle DiBari: The pharmacist is invaluable and at New York City Health + Hospitals, the role of the pharmacist is imperative throughout the entire process of COVID-19 vaccinations. It begins with the pharmacy team placing an order for the requested number of vaccine doses on a weekly basis. Once approved, the pharmacist is the clinician to receive, appropriately unpack, and safely store this precious commodity.

As we know, the pharmacist is the one who is trained and has to pay attention to detail to ensure the vaccine remains stable during storage. Once the dose is requested for use, the pharmacist appropriately prepares each individual dose for administration, whether it must be thawed, reconstituted, or individual doses drawn with strict accuracy, the pharmacist is the clinician to prepare vials and or syringes for administration.

Pharmacists are consistently present in all clinical areas of vaccine administration, whether it be for preparation, administration, council, clinical, or operational support, the pharmacist is the nucleus to the entire process. It is a pharmacist's specialty to understand the crucial elements of medications, including vaccine, which, in this instance, is paramount when supporting our physicians, our nurses, administrative teams, and, most importantly, our patients and fellow New Yorkers.

Alana Hippensteele: Thank you so much for taking the time to speak with me today, Danielle.

Danielle DiBari: Of course.