At 8:06 a.m. on Tuesday, a plain cardboard box about the size of a large suitcase was placed on a dolly and wheeled out of a building near the busy runways at Denver International Airport.
The precious cargo inside represented — hopefully — the beginning of the end of the coronavirus pandemic: vials of a mock COVID-19 vaccine.
Even though the vials were useless against preventing infection, ensuring their safe transport was one of the final hurdles before Coloradans start getting inoculated against the coronavirus.
“It’s amazing, to be completely truthful,” said Leo Gomez, co-owner of the medical transport company Swift Courier Services, who wheeled out the box. Jet engines roared in the background.
Gomez loaded the package into a waiting Acura sport-utility vehicle headed to Vail as part of Colorado health officials’ final preparations for accepting and distributing the COVID-19. His company has a contract with the Colorado Department of Public Health and Environment to deliver vials across the state.
Colorado is expecting to start receiving doses from Pfizer, shipped via FedEx alongside your holiday gifts, perhaps as soon as 24 hours after the FDA grants emergency-use authorization. Officials are rushing to make sure transport and storage procedures are squared away before then.
“Developing a vaccine is only one herculean task,” President-elect Joe Biden said on Tuesday. “Distributing it is another herculean task.”
The Colorado Sun was invited to join the high-stakes road trip to better understand the logistical challenges. One major hurdle is that the Pfizer vaccine must be kept at a temperature of about -75 degrees Celsius, or colder than -100 degrees Fahrenheit.
There’s also security to consider, given the limited supply of the vaccine and worldwide demand, and more mundane obstacles like Interstate 70 traffic and snowstorms.
“The state has been preparing for this for just about two weeks now,” said Brig. Gen. Scott Sherman of the Colorado National Guard, who is serving as director of Colorado’s Vaccine Task Force.
Colorado is slated to receive 46,800 doses of the Pfizer vaccine at first, an amount allotted to the state based on its population size relative to the rest of the U.S. That’s enough to inoculate 23,400 people since the vaccine must be administered in two doses three weeks apart. Health care workers are expected to be first in line. Nursing home residents are next.
“We are going to move it as fast as possible — and safely,” Sherman said. “It is crucial that we get the vaccines that are received in Colorado distributed to the local public health agencies and to the hospitals. In order to do that, we need to make sure we are doing it efficiently and safely.”
“We’re trained to maintain a low-key profile”
Once the vaccine package was loaded in Gomez’ car, it began its journey west, escorted by two Colorado State Patrol troopers.
Authorities declined to disclose exactly what security measures they are taking to ensure vaccine packages aren’t hijacked en route to one of the state’s eight distribution hubs, but they are confident the vials won’t be stolen.
“We’re trained to maintain a low-key profile,” Gomez said, explaining that his drivers have received explicit instructions not to tell anyone what they are carrying given the value of the cargo.
Until Tuesday, Gomez had never done a medical transport with a state trooper. Was he nervous? “Absolutely,” he said with a chuckle. He said he’s seen law enforcement in his rearview mirror before, but never had an officer leading him through traffic.
Even if someone was able to somehow hijack a vaccine shipment, they would have to know how to mix it with saline to be administered. (More on that later.)
The shipments are also tracked by the Trump administration’s Operation Warp Speed via GPS monitor.
With security procedures ironed out, the package hit its first speed bump on I-70 near Central Park Boulevard in Denver: rush-hour traffic. Gomez and his State Patrol transport were caught in gridlock.
Luckily, the Pfizer vaccine is shipped in thermal packages cooled to extremely low temperatures with dry ice. Those thermal packages can serve as temporary storage units for up to a month as long as they are refilled with dry ice every five days.
Otherwise, as long as the vaccine is kept around -75 degrees Celsius with no more than a 15-degree variation, it has a shelf life of up to six months. There are ultra-cold storage facilitates around Colorado — their locations are not being disclosed for security reasons — so if a shipment is delayed because of traffic or weather or some other unforeseen circumstance, that’s OK.
To help with distribution, those ultra-cold facilities will also be able to divide up packages of the vaccine, which are shipped with a minimum of 900 doses. It’s actually more likely that the doses will be sent out to hospitals from the ultra-cold facilities rather than directly from DIA or another Colorado airport.
The vaccine can be kept at between 2 and 8 degrees Celsius for up to five days and still be effective, according to the state and Pfizer.
Another vaccine that’s nearing approval, made by Moderna, can be shipped in smaller quantities and only needs to be kept at 0 degrees Celsius. It could be approved by the FDA for emergency use sometime before the end of the year, though likely after Pfizer’s vaccine.
A 30-minute wait, saline and then: voila
After traffic delays — including a long slowdown in Idaho Springs — Gomez arrived at Vail Health Hospital at 11 a.m.
He was greeted at the emergency room entrance by a team that included a security guard and a Vail police officer. The box was then moved to the hospital pharmacy, where Jessica Peterson, the hospital’s pharmacy manager, ushered the package into a “cleanroom” to be prepared for use.
It takes about 30 minutes for the Pfizer vaccine to thaw and then it is quickly mixed with saline to be administered to patients.
To prevent contamination of the vaccine during the reconstitution process, Peterson donned full personal protective gear. Something as minor as dust particles could be problematic, so the cleanroom also has positive pressure, meaning its airflow pushes contaminants out.
“It’s all about decreasing the probability of contaminating any products,” Peterson said. “This may not be something that’s required by Pfizer, but in order to just to err on the side of caution this is definitely the most sterile that way we can compound these medications. We want to make sure we can extend the life of these.”
Vail Health Hospital has two ultra-cold freezers in which it can store the Pfizer vaccine if it’s not going to be administered right away. The facility estimates it can store thousands of doses if need be. Peterson showed off thick safety gloves she must use to handle the vials of frozen vaccine.
Once the vaccine is reconstituted, health workers have six hours to administer it to a patient before it goes bad.
Soldiers as vaccine couriers
Vail Health Hospital, which has 900-plus health care workers, isn’t sure how many doses of the vaccine it will receive at first. Gov. Jared Polis is slated to hold a news conference later this week during which he will unveil more details, including the location of the seven other hub distribution sites.
The first doses of the vaccine will be distributed across the state and not prioritized to any one region, such as the Denver metro area, according to the governor’s office.
But because Colorado is so large, and because of its difficult-to-navigate landscape, state officials are trying to develop plans to get the vaccine to far-flung corners. That includes using the Colorado National Guard as a courier service, and finding counties that can partner together to distribute the vaccine.
Vail Health Hospital, for instance, likely will be part of broader mountain-area distribution plans.
“The hard part of it is working with people that you haven’t worked with before in an environment you haven’t worked with,” said Lt. Col. Andrew Pollart, a Colorado National Guard soldier who serves as deputy director for Colorado’s Vaccine Task Force. “It’s getting (different) groups to come together to put the syringes in the arms at the end of the day.”
The state is confident it will be successful. It hopes Tuesday’s exercise will reveal gaps in the system so they can be addressed before the real vaccine arrives in Colorado. By the time the test vials arrived in Vail and were reconstituted with saline, however, there hadn’t been any major red flags.
At 12:24 p.m., a little more than four hours after beginning its journey from Denver International Airport, the mock vaccine was plunged via a syringe into the arm of Caitlyn Ngam, a health care worker at Vail Health Hospital.
Ngam said she barely felt a thing.
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