How one hospital system is relying on a fleet of Dodge minivans to make sure healthcare workers in remote areas can get their COVID shots

  • Distributing COVID-19 vaccines to rural areas hit hard by the pandemic will be one of the many difficult challenges that states and health systems face in vaccinating Americans.
  • Sioux Falls, South Dakota-based health system Sanford Health is planning to use a fleet of Dodge minivans to courier Pfizer vaccines to rural hospitals throughout the Midwest.
  • Some states and health systems have decided against re-distributing Pfizer vaccines to rural hospitals. In those cases, rural hospitals will wait for the Moderna vaccine to be authorized.
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Dodge Caravans packed with COVID-19 vaccines will soon be zipping across the rural Midwest.

They'll be on their way to drop the precious vials at small, remote hospitals across a region that spans 200,000 square miles.

The vans, emblazoned with the logo of Sioux Falls, South Dakota-based Sanford Health, are part of the rural healthcare system's courier network that typically ferries supplies, medications, and lab specimens.

Now, Sanford's 180 couriers will be transporting the vaccines that are key to ending a pandemic that has killed about 300,000 Americans.

On Friday, the US Food and Drug Administration cleared Pfizer and BioNTech's COVID-19 vaccine, the first one in the US to get the green light. Vaccines were shipped on Sunday and began arriving at on Monday.

Sanford's courier network will be used to ensure COVID-19 vaccines reach the system's frontline healthcare workers — and later, the general public — in rural areas that are far from its big hospitals equipped with expensive, ultra-cold freezers that will store Pfizer vaccines.

"We have many COVID hospital units even in the small locations, so we want to equitably distribute the vaccine to make sure we're getting it to everyone that meets the criteria established by the state," Jesse Breidenbach, Sanford's senior executive director of pharmacy, told Business Insider. 

Sanford is embarking on an ambitious plan to re-distribute Pfizer vaccines to small, rural hospitals in the Dakotas and Minnesota. Other health systems that Business Insider spoke with said they had no plans to move the Pfizer vaccines from the big, often urban hospitals where they will be shipped.

Instead, rural healthcare workers in those systems are waiting on Moderna's vaccine, which is set to be reviewed by an FDA panel this week.

Sioux Falls, South Dakota-based Sanford Health's courier vans will carry COVID-19 vaccines to remote hospitals in the rural Midwest.Sanford Health

COVID-19 is hitting rural America hard

Getting vaccines to remote areas is logistically challenging, but it's critical as COVID-19 cases surge in rural America.

Coronavirus hospitalizations spiked in the Dakotas in November and remain high. North Dakota said Monday that there are roughly 3,500 active coronavirus cases in the state, with 277 currently hospitalized. In South Dakota, there are 12,623 active cases and 441 people are currently hospitalized with the disease.

US officials said they began shipping 2.9 million doses of Pfizer's vaccine to 636 locations across the US this week. They expected 145 sites to receive shipments on Monday. 

Sanford said it received its first shipments of Pfizer vaccines, totaling 4,500 doses, at its hospitals in Fargo and Bismarck, North Dakota, on Monday morning and gave nearly 300 shots that day.

Healthcare workers at two of Sanford's smaller medical centers in the North Dakota cities of Mayville and Hillsboro will come to Sanford's Fargo hospital to get shots this week, a Sanford spokeswoman said. Later this week, Sanford will use its couriers to bring vaccines to those locations, where shots will be given on-site on Friday and Saturday.

Sanford's fleet of Dodge Caravans will courier the shots in coolers around the Dakotas and Minnesota

Sanford has fine-tuned its plan over several months.

The health system bought six freezers that can handle ultracold temperatures, and parked them at hospitals and a clinic in three states to act as distribution hubs for its facilities in each state, since the vaccines aren't allowed to cross state lines. Those freezers can each store up to 75,000 doses of Pfizer's vaccine.

Across its footprint, Sanford will be able to store up to 500,000 doses of the Pfizer vaccine and a million doses of the Moderna vaccine.

Smaller hospitals will place orders for vaccines from those larger facilities, Sanford's pharmacies will pack the vials in coolers, and then the couriers will drive the vaccines over, Breidenbach said. In some cases, Sanford couriers will also deliver to non-Sanford healthcare facilities. 

Breidenbach said Sanford will track the temperatures in the coolers to make sure they maintain the right temperature all the way up until the vaccine reaches the patient.

The operation requires a lot of coordination because once the vaccines leave the freezers, the small hospitals will have just five days to give their workers shots before the vaccines spoil.

"We don't want to ship it out to a location unless we know they're going to use that quantity within the five days, but having that capacity gives us a lot more flexibility and control on how and when we do our vaccination clinics," Breidenbach said.

Pfizer's vaccine is shipped in large quantities that must be kept extremely cold, which could be hard for rural hospitals to handle

Rural hospitals are at a disadvantage when it comes to meeting the requirements for Pfizer's vaccine.

The vaccine comes in packages of a minimum of 975 doses and must be kept at the extremely cold temperature of  negative 70 degrees Celsius (negate 94 degrees Fahrenheit). Small hospitals and clinics serving remote communities likely don't have the expensive freezers needed to store the vaccine for long periods of time. 

They may also lack enough arms for nearly a thousand shots, making it somewhat impractical to ship Pfizer vaccines to those locations. That means rural healthcare staff working in COVID-19 hospital units may have to come to the larger facilities for a vaccine, at least in the beginning of the vaccine rollout.

In most states, frontline healthcare workers will be some of first to get COVID-19 shots.

"We might have people drive two hours to get a vaccine because of the logistical challenges of getting those around," said Dr.

Dr. Amy Compton-Phillips.Courtesy of Amy Compton-PhillipsAmy Compton-Phillips, chief clinical officer at Providence, a health system with 51 hospitals in seven states, including rural areas in Alaska, Montana, and Texas.

But that could cause other problems. Some rural hospitals are "drowning" in COVID admissions and don't have the staffing capacity to allow a nurse to take a day off to drive long distances for a shot, she said.

"The fact that they are completely underwater right now when we have this limited distribution system — it's really, really challenging," Compton-Phillips said. "I would love to have regulatory relief that trusts us to get the vaccine to the highest risk first and that somehow makes sure we're able to serve the needs of those rural facilities, because we need to throw them a life ring."

State governors and their public-health departments are calling the shots, however, and so far, Compton-Phillips said she hasn't heard of a solution.

Dr. Clint Seger, the chief regional medical officer at Billings Clinic in Montana, said it doesn't make much sense for rural healthcare workers to drive a long distance to get a vaccine, as they'd have to make the trip again a few weeks later for a second dose. 

"The travel, the potential adverse effects and then another day out creates a lot of complexity to where it almost becomes not worth it when you're going to have the Moderna vaccine coming in not that far behind the Pfizer," he said.

Read more: Every US state will start receiving Pfizer's coronavirus vaccine Monday morning, with immunizations starting by the end of the week

In some states, rural healthcare workers will have to wait on the Moderna vaccine before they get shots

Some states have decided against re-distributing the limited supply of Pfizer shots to rural hospitals. Instead, they plan to have Moderna vaccines shipped to those facilities.

Those vaccines come in smaller packages of 100 doses and can be stored at a normal freezer temperature.

That's the case in Tennessee, where the first round of Pfizer vaccines will go to 27 large hospitals.

After that, the Moderna vaccine will ship to small and medium-size hospitals, and the state health department will send strike teams to vaccinate the smallest critical access hospitals in rural areas, said Wendy Long, president of the Tennessee Hospital Association.

Officials in North Carolina also said rural hospitals will receive the Moderna vaccines, while the first round of Pfizer shots will go to 11 centrally located hospitals.

As the supply of vaccines grows, however, the state plans to make its vaccination clinics "more mobile" and set up clinics in remote areas, said Dr. Mandy Cohen, North Carolina's secretary of health during a recent media briefing.

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