More than 23,000 initial shots of COVID-19 vaccine have been administered across Missouri so far. But before doses are even delivered, a herculean amount of work has gone on behind the scenes to ensure its smooth arrival.
Approved as a vaccinator with the state, Alps Pharmacy, an independent, locally-owned pharmacy in the Springfield area, has had to assess all possibilities as they await their first shipments to start administering doses to long-term care facilities.
Leah Gregory has started most of her days reaching out to vendors she never thought she would work with in her role as director of clinical services for Alps Long Term Care Pharmacy.
"I've worked with people in refrigeration to try and purchase ultra-low freezers. I've worked with dry ice vendors," Gregory said. "Those were all infinite phone calls and emails and follow ups. And so it's definitely a process that you have to stay on top of because so many people want this all at one time."
As of Tuesday, 285 facilities across the state were approved to administer the vaccine, according to a news release from Gov. Mike Parson's office.
Missouri's first week-and-a-half of vaccinations is in the books, but with details changing day to day, unforeseen delays and more than 700 additional facilities expected to be approved in the coming weeks, providers still have plenty of questions.
On the Department of Health and Senior Services' weekly planning calls, questions have ranged from whether personal protective equipment will be included with vaccine shipments to how doses will be redistributed from one facility to another.
Meanwhile, CVS will begin administering vaccinations in nearly 600 of Missouri's long-term care facilities Monday - a key facet of the state's effort to vaccinate some of the state's most vulnerable residents, whose deaths have made up nearly half of all COVID-related deaths in the state.
Hy-Vee has been ramping up hiring, with the hopes of bringing on 1,000 technicians in order to administer COVID vaccines in eight states, including Missouri.
"This whole thing has been kind of fly by the seat of your pants," Ron Fitzwater, the CEO of the Missouri Pharmacy Association, said in an interview earlier this month. "We haven't been through this before."
Pharmacies have had to quickly assemble systems and put plans in place. For smaller, community pharmacies that are often located in more rural areas, having access to a vaccine will be critical, Gregory said.
Roughly 16 percent of the independently owned rural pharmacies in the U.S. shut down between March 2003 and March 2018, according to a 2018 policy brief from the RUPRI Center for Rural Health Policy Analysis based at the University of Iowa.
During that time period, 16 of Missouri's rural ZIP codes went from one or more pharmacies to one, or from one to zero.
"Those patients are just as important as any patient that lives within a 10-mile radius of a larger chain pharmacy," Gregory said.
To ensure Alps Pharmacy would be prepared, Gregory looked into purchasing an ultra-cold freezer, and possibly a portable one, too, that could constantly monitor the temperature to keep Pfizer's vaccine at the necessary minus 94 degrees.
"As a small company, looking at liquefying $15,000 for vaccine storage that you don't even know if you're going to need in November, we had to make a pretty hard choice about where we wanted to fall in the pecking order," Gregory said.
However, they've been able to find solutions. If they receive shipments of Pfizer's vaccine, the pharmacy has lined up dry ice suppliers to replenish the special containers the vaccines arrive in.
They've prepped clinical screenings and created intake forms to ensure they have the necessary information for insurance, billing and data entry. And they've enlisted the help of pharmacy interns from the University of Missouri Kansas City School of Pharmacy in Springfield.
What might take Gregory an entire day to vaccinate 120 nursing home residents, could take just a few hours with the help of two interns.
Gregory estimates her staff have poured in at least 120 hours to prepare for doses they likely won't get for weeks. The long hours have left Gregory feeling tired - but excited - for the chance to help usher in a small sense of normalcy back to their community.
"We've proceeded forward without a lot of information about whether this will make financial sense to us or not," Gregory said. "But we do know that for the rest of the country to heal and persevere and move forward, we're going to have to answer this call."
CareSTL Health, a Federally Qualified Health Center that provides affordable healthcare to underserved communities throughout St. Louis, is expecting its first shipment of Pfizer and Moderna's vaccines in a week, a spokeswoman said.
Angela Clabon, CareSTL Health's CEO, said the center will take away lessons learned from its flu shot clinics and COVID testing efforts and apply them to distributing a COVID vaccine. CareSTL has been trying to reach residents in as many ways as possible, from setting up drive-thru sites and going directly to them.
Reaching sometimes transient residents in order to make sure they come back in three to four weeks for their second dose of a COVID vaccine will be a challenge, Clabon said. In some instances, when COVID test results took five days to get back, "believe it or not some persons' phones disconnected in that time," Clabon said.
However, despite the questions that remain in the early stages of planning for the vaccine's arrival, Clabon knows CareSTL will be there.
"When you're responsible for your community, you just don't say no," Clabon said. "You just deliver."
The Missouri Independent is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.