Airport to arm: How AHS is moving COVID-19 vaccine around the province
Timing is everything with ultra-cold storage and short shelf life
Once seated, the appointment to get a COVID-19 vaccine in Alberta takes about five minutes.
After getting the shot, patients are asked to wait another 15 minutes to be monitored for an adverse reaction, and then they can go on their way.
A 20-minute process seems blissfully speedy after a year that has seen close to 2,000 Albertans die of COVID-19 and thousands more fall ill. Families have been separated, businesses have closed and gatherings of all kinds have been cancelled.
But the process of moving, storing, and administering the first two vaccines approved by Health Canada, Pfizer-BioNTech and Moderna, has posed new challenges for the province's public health team. Both Pfizer and Moderna are mRNA vaccines and have complex transport, storage and timing requirements. AstraZeneca has less stringent requirements, but all three of the vaccines that have arrived in Alberta so far require two doses be administered for full immunization.
"I think the logistics is probably our largest challenge, just in terms of ensuring we have the right vaccine in the right places to meet our commitments," said Andrea Thain Liptak, an executive director in Alberta Health Services' central zone, who is part of the leadership of the province's vaccine task force.
AHS has the capacity to administer 10,000 to 15,000 doses a day based on the availability of supply and, according to a spokesperson, this can increase to 20,000 doses a day.
CBC interviewed Thain Liptak and dug into AHS's vaccine transport and storage policies to get a better understanding of how the health authority is moving COVID-19 vaccine around the province.
How does it get here?
All of Alberta's vaccine supply is flown into the Calgary International Airport where contracted courier companies pick up the doses.
The trays of Pfizer and Moderna — both mRNA vaccines — vaccine arrive in thermal shipping packaging provided by the manufacturers. Inside the Pfizer packaging, dry ice helps keep the vaccine in its ultra-frozen state at a temperature of -70 C. Though Health Canada approved slightly eased temperature requirements in early March, an AHS spokesperson said it is continuing to follow Pfizer and Alberta Health's transport and storage guidelines.
The Moderna shot also requires a special container, but no dry ice because it doesn't need to be quite as cold — a mere -20 C. Upon arrival, AHS staff check the shipments make sure the cold chain — the process for managing the temperature of a perishable product — didn't get disrupted.
"Those ultra-low temperatures are something that we haven't typically needed to be accommodating for, so that's required a whole new skill-set for our vaccine management teams," Thain Liptak said.
AstraZeneca can't be frozen, and instead should be kept between 2 C to 8 C. It needs to be kept in cartons to be protected from light.
Courier companies deliver the doses to 36 vaccine storage sites set up around the province. Couriers have been instructed to handle the shipments with a lot of care — they're not to jostle or shake the transport containers; they must keep them upright and ensure they're nowhere near the vehicle's vent. And the vaccine shouldn't be left alone at any time.
Ice, ice baby
The vaccine storage sites are spread out across the province because once the thawing process begins, there's a limited window of time to get the vaccine into arms before it expires.
Some of the vaccine is being stored in health-care facilities where AHS can administer vaccine, but for trays that need to travel on to other sites, like a long-term care centre, a pharmacy or a rural clinic — the shots are thawed, and then there's a six-hour window to get them to the new site. On arrival, thawed Pfizer can be kept at refrigerator temperatures for up to five days and thawed Moderna for 30 days. With the arrival of AstraZeneca shipments this month, some of those finicky transport issues for remote sites may be eased.
Getting the jab
When it's time to administer the shot, both Moderna and Pfizer are both brought to room temperature.
Through all this, the manufacturers warn that the vials should not be shaken. Rather Moderna should be swirled before doses are drawn, while Pfizer vials are to be gently inverted a few times.
The less delicate AstraZeneca doesn't require thawing or mixing.
Originally, Pfizer's vials were said to contain five doses but, when it turned out health-care workers were able in many cases to pull an extra dose, Health Canada updated its guidelines to state a vial could supply six doses. The Pfizer vaccine can't be given right out of the bottle: it needs to be diluted with sodium chloride first.
Moderna and AstraZeneca both come with 10 doses in each vial. Both can be given straight.
Once the vials are punctured, both types of vaccine must be used within six hours or be discarded, adding another level of complication. The post-puncture shelf life is much shorter than what's allowed for an open vial of influenza vaccine, and once the vial is opened it can't be moved to another site, Thain Liptak said. Again, AstraZeneca offers some relief here: once open, it can be stored for six hours at room temperature or 48 hours in a refrigerator.
What about other COVID-19 vaccines?
Health Canada approved the use of Johnson & Johnson's one-shot vaccine on March 5. Canada has ordered 10 million doses from Johnson & Johnson, with options for up to 28 million more, though details about when supply will begin arriving in Canada have not been confirmed.
Developed in the United States, the Johnson & Johnson shot is widely seen as one of the easiest to distribute because it requires only one dose and can be stored for long periods of time at regular refrigerator temperatures of 2 C to 8 C.
I got both shots. Can everything go back to normal now?
Even though vaccine is an important part of decreasing the rate of COVID-19 transmission in the community, it's not a free-for-all once a person gets their shots. It will take some time for everyone who wants a vaccine to get one, and Thain Liptak said that even vaccinated people need to be patient and to continue to observe public health guidelines like handwashing, mask wearing, and social distancing.
"The vaccine, especially in the early days, is not a solution to COVID. It's going to be really important that we continue to be vigilant around some of the other measures that are really important in preventing the spread of COVID-19," Thain Liptak said.