U.S. Army 1st Lt. Tucker Salls, 143rd Military Police Company, receives the Moderna COVID-19 vaccine at Bradley Air National Guard Base in East Granby, CT, earlier this month. The Connecticut National Guard began administering the vaccine in accordance with the DoD COVID-19 Vaccine Distribution Plan, with doses voluntarily administered to soldiers and airmen on the front lines of the COVID-19 pandemic response. Air National Guard photo by Staff Sgt. Steven Tucker
WASHINGTON — The National Guard has stepped up again to help states in their battle against the novel coronavirus. Throughout the spring, National Guard units distributed personal protective equipment, sanitized nursing homes, staffed testing sites, buttressed hospital staff, and operated food banks for the suddenly unemployed. Now, they’ve been called on to assist states in the final mile—and final inches—of the country’s massive vaccination program.
While the DoD and Department of Health and Human Services (HHS) coordinated vaccine development under Operation Warp Speed, actually vaccinating people has been left to state governors and public health officials. That’s proved more challenging than expected, as each state adopts slightly different priorities and distribution approaches, the quantity and date of vaccine delivery changes with little notice and the sheer volume of immunizations required in the midst of the pandemic’s biggest surge yet overwhelms state and local healthcare infrastructure.
Just a Pinch
Some states that have delegated vaccine administration to hospitals and healthcare systems have found that the facilities lack the space and the providers necessary to run effective immunization programs while caring for record numbers of infected patients. Others have found that hospitals and local public health departments have inadequate IT skills and server capacity to offer functioning sign up and communication programs in the face of tremendous demand.
While IT problems may need another solution, HHS saw a way to help states get the vaccines in arms. To provide flexibility and increase capacity for immunizations, HHS authorized qualified members of the National Guard to administer U.S. Food and Drug Administration-authorized COVID-19 vaccines to anyone age three or older.
Qualified individuals must be authorized by their Guard unit to administer vaccines, have a current certificate in basic cardiopulmonary resuscitation, maintain appropriate records and follow reporting directives, and comply with U.S. Centers for Disease Control and Prevention and other federal requirements for COVID-19 vaccine administration. Granted under the Public Readiness and Emergency Preparedness Act (PREP Act), the HHS authorization overrides any state or local restrictions and provides immunity to qualified Guard vaccinators from claims in connection with vaccine administration.
Michigan jumped on the opportunity to augment healthcare providers with the National Guard. “We will provide medics and administrative support to hospitals and local health care organizations and work to fill their needs,” said Army Col. Ravindra Wagh, Michigan National Guard joint operations officer. “For some locations that will mean directly administering the vaccine to their staff. We will also provide administrative support when needed, freeing up critical front-line hospital employees and allowing them to focus on the ongoing battle against COVID-19.”
The Michigan Guard will field about 50 COVID-19 vaccination and testing teams composed of one uniformed medical technician and one or two support members to help administer vaccines at four high priority hospitals. In addition to assisting with inoculation of hospital staff, the Michigan Guard is prepared to increase its support across the state to meet the demands of the healthcare system.
As of mid-December, 16 states had asked their National Guard units to make their medical personnel available to administer vaccines, according to Gen. Daniel Hokanson, chief of the National Guard Bureau.
One problem arose in West Virginia when the National Guard administered the Regeneron monoclonal antibody drug cocktail that fights COVID-19 instead of the Moderna vaccine at a clinic hosted by the Boone County Health Department in late December. The antibody did not pose any risk of harm, and the 42 affected individuals were quickly contacted and encouraged to return for vaccination. The state Department of Health, Boone Health Department, and West Virginia National Guard reviewed all policies and procedures to understand the causes and avoid a repeat of the event.
“The moment that we were notified of what happened, we acted right away to correct it, and we immediately reviewed and strengthened our protocols to enhance our distribution process to prevent this from happening again,” said Maj. Gen. James Hoyer, adjutant general of the West Virginia National Guard. “I remain incredibly proud of all that our team has accomplished. Our number one goal has been to save lives, and, as we continue to ramp up distribution of the vaccine all across the state, we continue to save more and more lives every single day.”
Transportation and Logistics
A total of 26 states have asked the Guard for assistance with transportation and logistics connected with the vaccines. The National Guard has been training for this responsibility for some time.
“When you look at the current vaccine with Pfizer, it has to be stored at extremely low temperatures,” Hokanson told National Public Radio. “And so we’ve actually done rehearsals in the states that are currently out there supporting this. And so they’ve walked through this before to identify any significant changes or adaption of equipment that we have so that they can make sure that the vaccine stays within its constraints to the point of delivery. And so we’ll be working very closely with the manufacturers and really the governor to meet their requirement to get the vaccines where they need to be.”
In Ohio, about 30 members of the state’s National Guard is repackaging large shipments of the Pfizer/BioNTech vaccine at the Ohio Department of Health’s warehouse. Nearly 100 West Virginia guardsmen are performing a similar role, while a total of 500 will be transporting vaccines across the state directly to long-term care facilities, pharmacies, and health departments.
“It’s a very scripted and very disciplined process for getting it out of those ultra-low temperature coolers,” said Army Maj. Gen. John Harris, the Ohio National Guard’s adjutant general. The process requires detailed training and specialized PPE, he noted.
In Oklahoma, Gov. Kevin Stitt authorized 120 guardsmen to transport the vaccine from five primary sites to satellite locations and assist in other ways as needed. They will be escorted by the Oklahoma Highway Patrol to ensure security while moving the vaccines. Other states are working with state and local law enforcement to maintain the vaccines’ integrity and safety and protect the individuals distributing the doses.
While it is highly unusual for so many National Guard units to be activated to address one crisis, the demands of 2020 and 2021 have just tapped into the training and constant preparation the Guard does year in and year out.
“I think what makes the Guard so well suited for this is No. 1, we are a surge force for our state. We bring a wide variety of not only capacity to augment the size of the workforce, but also specialized skills within that workforce,” said Harris. “So, when you have a special response requirement like this, a need to respond for our communities, this is exactly what the Guard does.”
