It was in December that AUBMC first became aware of Lebanon’s intention to sign a deal to secure millions of COVID-19 vaccines, starting with the Pfizer-BioNTech product which would start arriving in February. Dr. Umayya Musharrafieh, interim chair of the Department of Family Medicine, urgently drew up names for a multidisciplinary taskforce that could ensure the Medical Center could play its role to the full at this historically important moment. Occupational medicine specialists, administrators, nurses, pharmacists, IT experts, communication and quality and infection control staff would begin planning to receive the vaccine, while Musharrafieh would act as the point person for contact with the Ministry of Public Health (MOPH).
The task force had to setup a new workflow and devise a plan from scratch. “This vaccine is pretty complex in terms of handling and for its thermal requirements. It’s not just a refrigerated flu shot,” says Dr. Carine Sakr, employee health director and assistant professor of clinical specialty at the faculty of Medicine. For this reason, a formal training was administered by the Pfizer team in Lebanon and was attended by the multi-disciplinary taskforce. Additionally, multiple mock sessions at the vaccination site were conducted to identify potential challenges.
The difficulties involved in running a nationwide vaccination program are well-documented. New Yorkers have had difficulty securing vaccine appointments due to supply shortages and a poorly-designed, decentralized scheduling system. Musharrafieh foresaw that Lebanon, with its well-documented infrastructure and organizational challenges, would also struggle. “I recall very well that in order to launch [the electronic healthcare records system] EPIC, we had to hire many people and receive lots of training, and even after implementation we still faced occasional glitches. So I expected that there would be issues,” she says.
AUBMC created a backup registration system on EPIC should the MOPH registration platform hit a snag—a wise decision as it turned out. “We setup an internal pre-vaccination form, vaccine registration, mostly taken from CDC, Pfizer, and MOPH. We did not reinvent the wheel.”
The first batch of the Pfizer-BioNTech vaccine arrived at the Beirut-Rafic Hariri International Airport in the twilight hours of Saturday, February 13 on a Middle East Airlines Airbus A321. The precious cargo was met on the tarmac by an array of officials filming the event on their phones. From there it was transported to a Health Ministry warehouse attached to Rafic Hariri University Hospital (RHUH), and stored overnight. AUBMC would be one of three launch sites, along with RHUH and Saint George Hospital, to begin administering vaccinations on February 14, Valentine’s Day.
A few days before V-Day, the MOPH told AUBMC it would receive 180 doses for the pilot. Then word came that AUBMC would receive additional vials, and the immunization team sprang into action to register additional frontline healthcare workers. “Even within category 1, there is priority. These were people working in the COVID units, in the Emergency Department,” Musharrafieh says. The actual number of doses that arrived was more than 500, necessitating a frantic effort last-minute push to ensure as many frontline staff as possible would benefit from the vaccine at this first opportunity.
On the morning of February 14, the shipment was delivered in sealed boxes, stacked inside refrigerated trucks. Pharmacists unsealed, counted, and checked each vial against its batch number, while ensuring temperature logs were verified. At the vaccination site, the pharmacy team handled vaccine preparation, then distributed the trays of vaccines ready to be administered to the nurses staffing the 10 stations inside the vaccination room.
Smiling eyes shone through masked faces on the vaccination line, which wrapped around the glass façade of the Halim and Aida Daniel Academic and Clinical Center. “It was an extremely positive vibe,” notes Sakr. Nurses and doctors struggling on the frontlines against COVID were eager finally to have some protection in addition to PPE.
The operation went very smoothly and AUBMC vaccinated 536 of its frontliners that Sunday. A small number of doses, about 20, that had been prepared and would have gone to waste otherwise, were administered to members of staff in category 2 who had registered on the MOPH including protection officers. Attempts to turn this into a “scandal” about vaccine prioritization were quickly dismissed and AUBMC has acted with utmost transparency and compliance with the MOPH rules throughout the immunization campaign.
After 11 days, 6,765 people have been vaccinated at AUBMC. Many of these have been people over 75 who were included as category 1 recipients, and for them it has been rare respite from the compounding pandemic miseries of isolation and anxiety. One 90-year-old woman described her experience. “It’s been very good. People should register. If one is going to die, let them die not from this virus, but with God’s will.”
With a system that could comfortably accommodate 1,200 or 1,500 people daily at AUBMC, it is frustrating that the number of vaccines being made available is just a few hundred, but Musharrafieh and Sakr are hopeful that the immunization center will be operating nearer its full capacity with the imminent arrival of more vaccines in addition to the Pfizer consignment.
Scheduling via the MOPH platform also remains a challenge. “People are coming and asking me to schedule them, but I can’t. It must go through the ministry. Although the platform is gradually improving, however we still have people who have registered a month ago and haven’t received a scheduling SMS.” Musharrafieh says.
Vaccine skepticism adds to that delay. “Some people are cautious about the Pfizer vaccine and want to wait for other more conventional ones,” Musharrafieh says, despite the fact that the mRNA vaccines have proved to be very effective.
For now, AUBMC is keen to spread the message that the vast majority of people will not experience any side effects from taking the vaccine and that mass vaccination is crucial to stopping transmission. To that end, one 87-year-old patient offered words of wisdom and encouragement, “if I can get infected and infect others, let me get vaccinated. I encourage everyone to get vaccinated, to quit smoking, to quit going around without a mask. I didn’t even feel the shot. It was really a wonderful experience.”
The sooner everyone heeds this advice, and the sooner Lebanon can procure enough vaccinations to reduce the spread of infection through “herd immunity,” the sooner the country can get back on track to reopening its economy and start tackling its myriad other challenges. Meanwhile, the AUB@Work team and all our readers can thank and congratulate everyone at AUB and AUBMC for what they have achieved so far.