We passed a big milestone this week.

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It’s probably the most significant development in this entire, long, agonizing year: COVID-19 vaccines have finally started making their way across the country — and into the bodies of front-line health care workers and long-term care residents.

Phil Fogg is the CEO of Marquis Companies, which oversees a number of senior long-term care facilities. His company is also responsible for providing vaccines to the vast majority of long-term care facilities in Oregon. He says the last several months has been like running a marathon without knowing what mile marker we’re at.

His best guess on where we are in the marathon today?

“It feels like about mile marker 18 to me right now,” Fogg told OPB’s Think Out Loud this week.

Considering a marathon is just over 26 miles — 18 is a big step forward.

But now his company has to get 3,000 doses of the Pfizer vaccine to residents and staff at long-term care facilities across the region. He says it’s nowhere near as easy as just lining everyone up and giving them a shot.

First of all, those thousands of doses of the vaccine need to be kept very, very cold.

“Early in this process we acquired freezers that enable us to take the vaccines as they’re delivered from Pfizer and keep them in the cold storage they need,” Fogg said.

The next challenge is having a meticulous plan in place to vaccinate people as efficiently as possible.

Fogg said the vaccine comes in something that looks like a high-tech pizza box. That box contains trays of vials, each with about five doses of the vaccine. Those doses need to be thawed, diluted and distributed within six hours. And even though they come in packs of five, it’s essential that no dose gets wasted.

“We have to get all the work done before we arrive,” Fogg says. “That means we have to get all of the consent forms from residents and staff, and we get all of their data and information before we get there, so that we literally only have to give the vaccine when we come into that building. So we can complete it in six hours.”

The challenge facing health care workers

Hospitals and clinics across the region are wrestling with those same logistics as they try to get thousands of frontline health care workers vaccinated.

Steven Nemerson is the Chief Clinical Officer for the St. Alphonsus Health System, which operates two hospitals and dozens of clinics in Eastern Oregon.

This week, he told OPB’s All Things Considered that health care workers generally aren’t at risk of getting sick from treating patients right now: they’re more at risk of contracting COVID-19 like the rest of us, out in the world.

“Our health care workers don’t live within the four walls of our facilities,” Nemerson says. “Their risk of contracting the virus is equivalent to someone who protects themselves properly but is going about their business in the real world — that’s where this virus is being transmitted.”

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But with a shortage of health care workers across the country and especially in rural areas, he says vaccination is essential to keep them safe — and able to help the rest of us.

“By protecting them from acquiring COVID they’ll continue to be able to work,” Nemerson says. “One of the biggest problems that we’ve had is that health care providers are getting this virus out in the real world, and then they’re sick for a minimum of 10 to 14 days.”

Nemerson echoes the challenge of keeping those doses of the Pfizer vaccine cold. Some remote areas of eastern Oregon and Idaho don’t have turbo-freezers to keep the vaccine stable. That’s why he’s eager to gain access to the Moderna COVID-19 vaccine, which was just approved for emergency use by the FDA on Friday.

“That does not require the ultra-cold storage,” Nemerson says. “As a result, that will be easily distributed to rural areas. Part of our strategy is to use the Moderna vaccine in the more remote locations and the Pfizer vaccine in the areas that are closer to our distribution hub.”

The butterball effect

It’s worth pausing to address the question: why is it so important to keep the Pfizer vaccine so cold anyway?

Corey Casper, President CEO of the Infectious Disease Research Institute in Seattle, told OPB’s Think Out Loud that it comes down to the specific MRNA vaccine being used by Pfizer.

Older vaccine technology takes dead virus cells and introduces them to our bodies. But, it’s a dirty process that has nasty side effects.

MRNA vaccines instead take just a piece of the infectious agent and then uses our own cells to create a protein, which our immune system responds to. We then make our own defenses against the virus, even though the whole virus never gets introduced into our bodies.

“What that means is that a protein will look to our immune system just like it does when our immune system encounters the virus,” says Casper

The trouble is, MRNA vaccines are very unstable. Our bodies are trained to kill RNA quickly; that’s a good thing, as it’s usually a foreign invader.

“It doesn’t do well in the environment where there are many different enzymes and just temperature that destroys that RNA,” he says.

But how to deliver these vaccines without being super-chilled?

You can freeze-dry an RNA vaccine, but again, RNA is fragile, and such a process can damage or destroy it. So what Casper’s team is developing is something called nanostructure lipid carrier.

His own description is a bit more memorable:

“I call it a butterball,” says Casper. “It’s a concoction that’s a collection of fats and other structures that allow the RNA to be protected and allows it to be frozen and reconstituted.”

Casper says that fat pocket could eventually develop a shelf-stable vaccine that could be shipped around the world, with no super-cold pizza box necessary. It would require a lot more coordination between the major pharmaceutical companies and small nonprofits like the one he leads, though. And that could be a long way off.

In the meantime, Steven Nemerson is encouraging everyone to stop worrying and learn to love the vaccines we have today.

“This is an incredibly safe and one of the most highly effective vaccines developed,” Nemerson says. “People should get it as soon as it becomes available to them based on the criteria that are established.”

“I personally intend to get this vaccine as soon as my place in line comes up, as will my own family members,” he adds.

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