Giving it Our Best Shot

“It’s here!” Nancy Yam, PharmD, was chatting with colleagues outside her office at UC San Diego Medical Center in Hillcrest early in the morning of December 15, 2020 when her smart watch pinged with the message they had all been waiting for.

The group darted for the stairs leading to the shipping and receiving area. Yam glanced at another message on her watch. “No, it’s already been taken up!” The giddy group reversed course and a few moments later, they burst through the back door to the hospital’s pharmacy.

There, two cardboard boxes sat on a cart. The boxes might have contained anything, but Yam and her co-workers knew exactly what lay within. They had been waiting for this shipment and this moment for months, along with the entire country. The first COVID-19 vaccines were in the house.

Word spread and within minutes people from neighboring work areas arrived to take pictures of the boxes and to text families and friends.

It was a historic moment, but Yam, associate chief pharmacy officer at UC San Diego Health, and her team could not pause to appreciate its significance. They needed to get work. Carefully following instructions from Pfizer and the Food and Drug Administration (FDA), they moved the vaccine into supercool freezers in the “Freezer Pharm.” They collaborated with team members from Facilities and Emergency Management to coordinate delivery of doses and ancillary items, such as needles, syringes and vaccine cards, to Jacobs Medical Center in La Jolla. They consulted with physicians and nurses to determine how and when the vials would be thawed and reconstituted, and how nurses would administer doses.

On December 16, the following day, doctors, nurses and staff lined the hallway and cheered as the first employees were called in to receive their vaccinations. Within four weeks, more than 10,000 UC San Diego Health employees had been vaccinated, an effort led by Shira Abeles, MD; Marlene Millen, MD; and others.

“Before the vaccines became available, we were working around the clock to prepare for surges of patients with COVID-19, to make sure that we could provide them, as well as our other patients, with outstanding care and to make sure we weren’t going to run short of medications — all with so many unknowns and things changing daily,” Yam said. “ “At the same time, many people were dealing with so much loss, anxiety, weddings delayed and kids out of school.

“That’s why it was so meaningful to be able to play a part in equitable distribution of the vaccine, starting with our own health care heroes. It was a day of pride, and hope.”

Partnering
to expand

A few weeks later, UC San Diego Health CEO Patricia Maysent was on the phone, strategizing with San Diego County and other UC San Diego Health leaders about how best to quickly and safely vaccinate all of the remaining health care workers in the region. “That was a Wednesday, and I asked ‘What would it take to get 5,000 vaccines in arms a day starting Monday?’” Maysent said. “’What would that take? Can you do it?’”

Everyone was eager, but one of the limiting factors was the need for a space large enough to accommodate thousands of people. Maysent thought of the San Diego Padres, with whom she had worked closely for several years. (UC San Diego Health is the Official Health Care Provider of the San Diego Padres, the region’s Major League Baseball team.) Five days later, the state’s first drive-through Vaccination Super Station opened in the Tailgate Lot next to Petco Park, the Padres’ stadium.

“The rapid buildout and staffing of the COVID-19 vaccine hub at Petco Park was a massive undertaking, and it would not have been possible without our partners at the county, city and the Padres,” Maysent said. “We are extremely proud of San Diego for coming together during this crisis, leveraging the innovation and collaboration for which our region is known, to support the health and safety of the entire community.”

The massive undertaking, led by Lydia Ikeda, senior director of COVID-19 operations; Will Ford, director of project management; and others, involved 42,000 square feet of tenting, 5,700 feet of power cable, 85 laptop computers on wheels, wireless internet provided by the Padres, and a self-scheduling website integrated with UC San Diego Health’s electronic health record system. The site was run by 300 clinical and administrative staff and volunteers per day. Yam’s pharmacy team and their Storehouse colleagues prepared and delivered the doses and ancillary items daily, and remained on call, ready to drop everything and drive downtown with more doses if the team was able to open up more appointments.

“After all that work, on the first day, when we had the first patient enter the site, the feelings I had were awe, inspiration and hope,” Ikeda said. “It felt like the first step in a long journey, and amazing that we accomplished it in such short order.”

The Vaccination Super Station administered approximately 5,000 vaccines per day, 12 hours per day, seven days a week.

The community’s response to the superstation was overwhelmingly positive, including an outpouring on social media to express gratitude and pride in the San Diego region for being able to rapidly collaborate to scale-up and streamline vaccine distribution at a time when most regions were struggling to implement the basic infrastructure. More than 25,000 people signed up to volunteer.

The site was visited by many elected officials, including California Governor Gavin Newsom and representatives from other health systems. Petco site leaders were asked to present to national organizations and were interviewed frequently by local and national media. Petco even received a shout-out during a White House news conference.

“What I’m probably most proud of is that the Petco site served as a model for other similar mass vaccination centers in the state, and around the country,” Maysent said.

Staff and volunteers were treated to donated meals and treats, visits from Padres alumni, high-fives from the Padres mascot, an impromptu concert from an opera singer during her post-vaccination observation period and thank-you cards from kids grateful that their grandparents had been vaccinated.

The Petco site operated for 68 days, administering more than 225,000 vaccine doses. It permanently closed March 20, 2021 with the advent of the Major League Baseball season. As the County began to open up vaccine eligibility to additional occupations and age groups, UC San Diego opened a second super site at the Recreation, Intramural and Athletic Complex (RIMAC) on the La Jolla campus. The site served UC San Diego employees, students and patients, as well as members of the community. In the almost four months it operated, more than 195,000 doses were administered at the RIMAC site.

“One of the things I’ll never forget is how grateful people were to get their vaccines, how they thanked us for saving their lives, even if they’d been waiting in traffic for hours to get there,” Ikeda said. “It was a privilege to be able to help our community this way, and we, in turn, were buoyed by them. It was exactly what we needed after months of being ‘COVID-weary.’”

Reaching the
underserved

While the supersites were exceptional at vaccinating huge numbers of people, they often weren’t accessible to those who needed them most. In March 2021, with support from philanthropists John and Sally Hood, UC San Diego Health, led by Abeles, Ikeda and others, began collaborating with trusted community-based organizations to expand outreach and support widespread deployment of vaccines to San Diego County communities affected by the greatest number of COVID-19 cases and highest rates of hospitalizations and deaths. These mobile vaccine clinics were designed to reach more patients more effectively, and help ease barriers, such as lack of transportation to vaccine appointment sites and distrust in health care providers outside of local communities.

One of the first stops was a complex of warehouses and trucking services in Otay Mesa, where a team vaccinated approximately 1,200 people who deliver food and goods throughout San Diego County and the nation. In following weeks and months, the team administered vaccines in churches, high schools and work places.

“No virus, especially one as infectious as COVID-19, recognizes borders,” said Abeles, dubbed the “vaccine czar” in a February 2021 Science article. “As a leading advocate and provider for health care across our region, UC San Diego Health quickly recognized the public health benefit in joining our binational community in expanding outreach and supporting the widespread deployment of COVID-19 vaccines to help end this pandemic.”

In May, UC San Diego Health set up a mobile clinic at the Mexican border in San Ysidro, where a team vaccinated 10,000 maquiladora workers employed by United States subsidiary companies over seven days. The clinic was made possible through the efforts of the Consulate General of Mexico and County of San Diego.

“Our ability to vaccinate a quarter of San Diegans, and save so many lives, it was historic,” Ikeda said. “We’ll be telling these stories to our grandkids the way our grandparents talk about the polio vaccine.”