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— Clinical

Dose of Reality

Creating vaccines was the first step; getting them into arms required the often unseen efforts of pharmacists

On December 11, 2020, the U.S. Food and Drug Administration FDA granted emergency use authorization (EUA) for the first COVID-19 vaccine (Pfizer), with the Moderna vaccine given EUA just a week later.

Those approvals were the breathmaking result of medical science working at breathtaking speed — developing, testing and approving new vaccines in less than a year when the typical process can require a decade or more. But for all of the celebrating that vaccines were finally available — the only true way to mitigate and end the pandemic — the moment also marked the beginning of an unprecedented time of effort and innovation, of fear, worry and sleepless nights for myself and my colleagues.

As a pharmacist, my fundamental job is to ensure that medicines are delivered, dispensed and used correctly, to help ensure that whatever treatment is prescribed, it works as safely and effectively as possible.

“The approved COVID-19 vaccines represented a monumental challenge at every level.”

They were brand new. Clinical trials aside, a lot remained unknown about how well they would work, what effects and results might be seen, short- or long-term. The vaccines were simple to use — an injection into the muscle of the upper arm, just like a flu shot — but they were complicated to store and distribute, with different refrigeration needs and shelf lives.

Both the Pfizer and Moderna vaccines rely upon mRNA molecules, which are very fragile. To keep them intact, the molecules are encased in tiny droplets of fat, which must be stored at very low temperatures to maintain their shape and shield the mRNA. For the Pfizer vaccine, that meant transporting and storing it at -70 degrees Celsius. (-94 degrees Fahrenheit). For the Moderna vaccine, it was a slightly more balmy -20 degrees C (-4 degrees F).

(The third vaccine, Johnson & Johnson, uses a different approach and can be stored at normal refrigerator temperatures.)

UC San Diego Health has multiple specialized, ultra cold freezers capable of keeping the vaccines appropriately frigid. Still, we fretted about unpredictable power outages or unforeseen temperature deviations. We prepared for every contingency and, on the day after FDA authorization, we received our first allocation of the Pfizer vaccine.

There was huge anticipation. We knew the day of arrival (by FedEx), but not when or in what exact form the vaccines would appear. They came in a single box, which I remember expecting to be much larger. Still, there was so much excitement, hope and worry. This box would start everything! We had reviewed advance instructions on how to remove the vaccine vials from the box, but we read them again and again. We weren’t taking any chances. There were three trays in the box, totaling 2,925 doses. We put one tray in each of three different freezers, just in case one went down.

Our job was to reconstitute and distribute vaccine doses where needed. Initially, vaccines went to health care workers and then over time more broadly to patients and the public. We began delivering first to vaccination sites within the hospitals, carefully calculating the number of doses that could be dispensed during operating hours. We didn’t want to waste a single dose.

When vaccination eligibility expanded and we launched our super stations, everything got more complicated. We were preparing thousands of doses a day to sites indoors and outdoors, across the county. We didn’t sleep. I drank more black coffee than I care to admit. Everybody on the team went all out, and I worried about their physical and mental health. It was hard, but I believed we were making a difference.

I got certified to help vaccinate people; anything to help. My first inoculation was a fellow pharmacist at the RIMAC super station. He said it didn’t hurt, so that was an accomplishment.

“Later, I was asked if I would like to throw out the ceremonial first pitch at the Padres’ “reopening day” game June 17, 2021 at Petco Park. I would be representing UC San Diego Health and all health care workers.”

My kids were so proud. My daughter asked if I would be only throwing out the first pitch or pitching the entire game. I told her it was likely the manager would pull me after my no-hitter (and no-batter). Pregame instructions said there would be no autographs. My children said it was a shame the players couldn’t get mine.

I have been asked what I will remember about the pandemic. I will remember everything as much as I’m sure many would like to forget. Although I wish this didn’t happen, there were good things that came from this pandemic. I will remember the time, effort and energy that my team put in; I am so proud of them and so grateful to be a part of this amazing group of people. There was so much teamwork, not only from the pharmacy team but also in collaboration with people I may not have worked with otherwise.

Through it all, there was fear, frustration and exhaustion, but also excitement, hope, appreciation, gratefulness and love that came from so many directions. You don’t forget such things.