OKLAHOMA CITY — Preparing for the first coronavirus vaccine release later this year, state health officials face unprecedented challenges.

The COVID-19 vaccine developed by Pfizer, which is expected to be the first available to Oklahomans, is unique. That’s because the vaccine requires ultra-low freezers to store for long periods of time, said Dr. Jared Taylor, the state’s epidemiologist.

“It is concerning,” Taylor said. “It is an added challenge that doesn’t exist for influenza or other vaccines. It’s a novel requirement and nothing we otherwise have an infrastructure in place to deal with. We are building or very much preparing to deal with that.”

To retain maximum efficacy, unused vials of Pfizer's vaccine must be stored at about minus 100 Fahrenheit. Taylor said he didn’t know how many ultra-low freezers Oklahoma has, but said most are located in research settings and are filled with things like bacterial, viral or tissue specimens.

“This is the first vaccine that’s ever required ultralow freezer storage, and so we don’t have those capacities in our county health departments, or in our hospitals or just our normal care (facilities),” he said.

Taylor said Pfizer has the ability to store the vaccine on dry ice by manufacturing what they call “pizza boxes,” which wouldn’t require a freezer at every distribution site.

But with 975 Pfizer doses in each box, that vaccine is not really amendable to distribution in areas of Oklahoma where there likely won’t be large, rapid uptake, Taylor said. The moment a pizza box is opened, the use clock starts ticking, and smaller, rural communities may not be able to use all doses.

“That’s something we’re trying to figure out and navigate around,” he said.

The doses can last between five days to as long as 30, depending on how they’re stored, he said.

However, the state also doesn’t have dry ice machines in their existing public health infrastructure and will likely have to purchase the necessary supplies to keep the vaccine viable.

“Dry ice is available on the market,” Taylor said. “Is it going to turn into the next toilet paper shortage? Obviously, that’s a reasonable concern, but hopefully some of those issues get mitigated if we get other vaccines coming onto the market as well.”

In all, somewhere between 60-70% of Oklahomans will need be to immune to COVID-19 — whether through vaccines or exposure — in order to reach the basic idea of so-called herd immunity, Taylor said.

Once herd immunity is reached, the number of coronavirus cases will slowly begin to decline and the outbreak will end.

The initial vaccine rollout will focus on first responders, health care providers and the most exquisitely sensitive. By the time the COVID-19 vaccine is available to the general public, health officials are hopeful there will be several different options, he said.

A second vaccine, manufactured by Moderna, doesn’t have the same storage requirements. Taylor said health officials may distribute the Pfizer booster in urban areas that have ultralow freezers, and the other in rural areas. But that would be dependent on vaccine availability and production scale.

He said dry ice placed inside the pizza boxes will keep the doses adequately frozen as long the boxes aren’t opened excessively.

“It’s not like you can’t use it in the absence of those freezers,” he said. “It’s just that it’s going to require a lot of logistical support.”

Dr. Judith James, vice president of clinical affairs with the Oklahoma Medical Research Foundation, said she expects the state will receive a small number of vaccines to start. While that’s disappointing, it will also be beneficial.

“It will help us work through some of the logistical issues with a few thousand vaccines as opposed to 50,000 vaccines,” she said.

James, who is from Pond Creek, near Enid, said she’s been thinking about how they’re going to get vaccines out to rural Oklahomans.

She said she’s excited that Pfizer’s vaccine is expected to be nearly 95% effective at preventing COVID-19, and said if given the opportunity, she’d be first in line to get inoculated.

James said several tribes also have ultralow freezers, but the big discussion is how to free up enough space to store the vaccines.

“The question is if you have one of these super-low freezers, is it already full of other (things) that have to stay at a super-low temperature?” she said.

James said she’s certain health officials will work out the logistics.

“It’s definitely going to have some challenges, but I definitely think Oklahomans will rise to the challenge and make this work,” she said. “The one thing that’s amazing about Oklahomans is we’re resilient, and we’re creative problem solvers.”

Stecklein covers the Oklahoma Statehouse for CNHI's newspapers and websites. Reach her at jstecklein@cnhi.com.

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