How Health Systems are Navigating Rollout of the J&J COVID-19 Vaccine

Mass vaccination efforts are picking up steam, particularly with the Johnson & Johnson (J&J) vaccine entering the market.

As of mid-March, about half (49 percent) of Premier member health systems surveyed have received the J&J vaccine.

Throughout the pandemic, Premier has been convening a forum of pharmacy leaders from its member health systems across the nation to discuss trends and challenges related to COVID-19 - and strategize around vaccine best practices and improved rollout strategies. Last week, Premier surveyed member pharmacy leaders to get a pulse on how J&J vaccine receipt and rollout is going, with insights shared below.

Where we stand today with U.S. vaccinations:

• 71 million Americans, or 21 percent of the U.S. population, have at least partial protection from COVID-19 as a result of the vaccines.
• Approximately 2 million additional vaccinations occur daily, but we need to ramp up to 3 million shots per day to reach herd immunity by mid-summer.
• More than 1.4 million Americans to-date have received the latest vaccine entrant, the single-shot J&J vaccine.

Below are the key takeaways and best practices from member health systems on the J&J vaccine, including insights on patient vaccine perception and choice, population prioritization and logistics considerations.

1. The J&J vaccine is enabling mass vaccination of teachers, community groups and at-risk populations.

The J&J vaccine is a single-dose, refrigerated product, versus a frozen type like the Pfizer and Moderna vaccines. This has the potential to ease certain logistics concerns and create a more amicable rollout in rural and remote areas that may lack cold-chain storage capabilities.

As a result, nearly 60 percent of Premier members are using the J&J vaccine in mass vaccination settings, including community vaccination clinics, churches and places of religious worship, and homeless shelters. In Michigan, for example, 90 percent of the initial statewide J&J vaccine allocation went to local health departments, and with this influx of product, counties need help from area health systems to get shots in arms.

Examples of deployment of the J&J vaccine include:

• Mass vaccination events, partnerships with health departments and mobile vaccine clinics. One pharmacy leader talked about a new J&J-specific mass vaccination clinic that their health system will start this week, with pharmacists onsite to assist with vaccine prep as well as patient education and documentation. Another pharmacy leader discussed a partnership with their county health department to run a mobile vaccination clinic that’s immunizing thousands of patients closer to home.
• Vulnerable, at-risk patients with co-morbidities – including those already in the hospital or those who may struggle with transportation to return for a vaccine. For those with J&J allocation, many health systems are offering the single-dose injection to individuals at greatest risk for loss to follow-up, either in the community setting (57 percent) or upon hospital admission or discharge (37 percent). That’s because it’s highly effective: The vaccine reduced severe disease by 85 percent and prevented COVID-related hospitalization or death – important protection for individuals who may not be able to return for a second shot of an mRNA vaccine. One health system discussed J&J vaccine use in patients 55+ with co-morbidities at hospital discharge and following an emergency room visit.
• Getting educators and students back to the classroom. Premier members are following state and jurisdictional guidelines on J&J vaccine rollout to patient populations, and critically, a number of states and health systems are holding the J&J vaccine for educators – including PreK-12 teachers, staff and childcare workers – which could speed students’ return to school full time.

2. Vaccine availability remains the biggest challenge, and providers are coming up with ways to prevent waste.

The availability of three COVID-19 vaccines in one year since the World Health Organization declared the novel coronavirus a pandemic is a remarkable scientific achievement. And recently, the Biden Administration announced that the U.S. will now have enough vaccines for every adult (260 million people) by the end of May, two months earlier than previous estimates.

While this added and accelerated supply is welcome news, more than half (54 percent) of Premier members continue to report that vaccine availability remains their greatest challenge. With current patient demand for COVID-19 vaccines outpacing supply, members need product in-hand as soon as possible to kick their vaccination efforts into over-drive.

Recent polling suggests a continued drop in the vaccine-hesitant population overall as more and more people get vaccinated - however, the pharmacy leaders agreed that many patients want the ability to choose which vaccine they receive, which is problematic with the current rollout strategy.

Many health systems have developed waitlists since the vaccines were made available three months ago; one pharmacy leader discussed leveraging their waitlist, and a backup waitlist, to quickly identify patients willing to receive a vaccine, further leveraging the J&J product to limit waste of precious supply.

Regardless of which vaccine is being scheduled, these waitlists are vital for health systems who have a certain number of doses prepped and need to manage against patient no-shows. Some providers are also scheduling certain vaccine products on specific days and informing patients at scheduling which product will be available in that clinic by date.

Premier continues to advocate for critical action to overcome vaccine hesitancy, including:

• Ongoing patient education
• Releasing more of the science and data behind all vaccines
• A massive public campaign

3. Puncturing a J&J vial starts a two-hour countdown, and members have figured out how to optimize the clock.

With hospitals used to receiving the Pfizer and Moderna vaccines at frozen temperatures and with a different set of logistics considerations, Premier pharmacy leaders are sharing best practices on J&J vaccine storage and temperature-window timing.

After first puncturing a vial, the J&J vaccine can be held for up to six hours refrigerated or at room temperature (up to 77°F) for up to two hours, whereas the Pfizer and Moderna vaccines retain viability at room temperature for up to six hours after reconstitution (Pfizer) or first vial puncture (Moderna).

To accommodate these tighter timeframes for the J&J vaccine, 35 percent of Premier members polled are using runners to optimize timing and logistics for doses at room temperature. Half of these health systems are also leveraging their pharmacy teams to pre-draw the vaccine and/or help administer at the point of use.

For example, one pharmacy leader described in detail their efforts to operationalize:

“Our nursing staff completes all screening up to midnight and generates our J&J vaccine order for the next business day via our electronic health record (EHR) platform. Our morning-shift pharmacy team will then sort and prepare doses based on the geography of our facilities - batching doses in increments of five and personally delivering them in a cooler that notes the six-hour expiration. When nursing takes the vaccine out of the cooler for prep and administration, our process is to put a two-hour timestamp on individual doses and administer those doses first pulled per the timestamp.”

Americans are seeing meaningful COVID-19 vaccination progress, but lags in supply distribution, as well as patient vaccine hesitancy, endure as contagious variants continue to circulate and emerge across the county.

As we work to speed a path toward COVID-19 immunity, Premier continues to share the latest education, best practices and solutions - working closely with our members to help ensure vaccination efforts run as smoothly as possible.

Premier members can:

• View our regularly updated FAQ sheet, providing intelligence on the various vaccine candidates, storage and handling requirements, distribution information and more.
• Check out information and guidance on various storage and handling requirements for vaccines, as well as helpful links to connect to dry ice and freezer suppliers.
• Visit the Pharmacy Community on PremierConnect® for more information.

Further reading.

• Speeding the Path to COVID-19 Immunity with a Third Vaccine
• Actions the Biden Administration Should Take to Expedite COVID-19 Vaccinations of the American People
• Providers’ Take on the First Week of the COVID-19 Vaccine

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