Ahead of Keck Medicine of USC beginning distribution of the Pfizer-BioNTech COVID-19 vaccine to patients, three experts from Keck Medicine and the USC School of Pharmacy held a press briefing on Jan. 21 to offer an update on employee, patient and community vaccination efforts as well as the USC School of Pharmacy’s role in helping the County with the wider vaccination push. Krist Azizian, PharmD, MHA, chief pharmacy officer at Keck Medicine; Felipe Osorno, executive administrator for continuum of care operations and value improvement at Keck Medicine; and Richard Dang, PharmD, RPh, assistant professor of clinical pharmacy at the USC School of Pharmacy, briefed local media outlets at the event.
Below are some of the questions and answers from the event, edited for length and clarity. Watch the full video here. Information is current as of 1/21/21.
For the Jan. 6, 2021 briefing, click here.
For the Dec. 15, 2020 briefing, click here.
Where is Keck Medicine in terms of vaccine distribution? Who is able to receive the vaccine?
Krist Azizian: We actually just surpassed our 14,000 dose mark as of yesterday, which we administer to our health care workers and providers: medical, pharmacy, occupational therapy and physical therapy students, and I believe to date 35% of those doses are second doses, so we can say that number of people are fully vaccinated. We’ve essentially vaccinated 65% of our employees and about over 80% of our physician providers. So we’re very near the end of our Phase 1A and are working very diligently towards establishing availability to those who are 65 and older under Phase 1B.
What is the health system’s progress in vaccinating non-employees, and how is that tracking against our vaccine distribution objectives?
Felipe Osorno: We’ve reached out beyond our employees because we are part of the University of Southern California. So we have medical students, pharmacy, (physical therapy), (occupational therapy) students, dental faculty and staff. So we’ve vaccinated over 2,400 of these individuals across the university. Last week we also opened up a drive for health care workers who are relatives of our own health care workers who might have not have access to the vaccine in other venues. So overall, we’re following the guidance of the Los Angeles County Department of Public Health. We’ve expanded beyond our four walls and today we’ve probably vaccinated 2,600 individuals total who are not employed by Keck Medical Center of USC.
How did the USC School of Pharmacy become involved in the Los Angeles County’s vaccine distribution efforts through their Point of Dispensing (POD) sites?
Richard Dang: As we were navigating the pandemic last year, we realized that COVID-19 vaccines would be an important tool kit that we would need to have in order to help us bring this pandemic to an end. And so with that in mind, the USC School of Pharmacy began partnering with the City of Los Angeles and Los Angeles Fire Department last fall to start a pilot program with the influenza vaccine clinics that we provided through mobile and fixed locations. And as a result of those efforts we delivered over 15,000 flu vaccines to Angelenos in three months. Taking that experience, we were able to really quickly bring COVID-19 vaccine PODs to Angelenos as soon as the COVID-19 vaccines were authorized and distributed within California. So with that, the City of Los Angeles currently operates five vaccine PODs and the USC School of Pharmacy is involved in operating the Lincoln Park location as well as contributing to the Dodger Stadium mega-POD location.
What is the university’s overall involvement with the POD locations?
RD: We’ve had so many partners who have been involved in setting up these vaccine PODs. It really took a village to get everything started from USC School of Pharmacy to the city of Los Angeles, Los Angeles Fire Department, CORE (Community Organized Relief Effort), Curative and Carbon Health. We’ve also had the support of the university, the medical center, as well as students from the School of Pharmacy, from the Physician Assistant Program and from our nurse practitioner programs.
What do you think are some of the bigger challenges in distributing the vaccines, specifically in Los Angeles County?
RD: I think we have to recognize that L.A. County has well over 10 million residents and that’s a lot of people to try to get vaccinated. So two primary barriers that may be unique to Los Angeles County would be the number of individuals that we have who are trained to vaccinate — so we need as many people to assist with these clinics as possible. It’s really an all-hands-on-deck situation, we need any ready and willing individual to volunteer who can work and contribute to these clinics. In addition, we need as many vaccine doses allocated to L.A. County as possible to help us deliver vaccines to everybody who wants it. We can set up as many PODs as we want, but without the vaccines, we won’t be able to move quickly.
How do the vaccination challenges the city and county face compare to the health system’s challenges?
FO: The scale is very different between trying to vaccinate our own population, which is around 9,000, to 10 million (in Los Angeles County). We as health care workers were prioritized given our COVID exposure risk. So although the scale is different, some of the challenges are similar. As Dr. Dang mentioned, one of the key things that is weighing on our mind today is supply. We will depend on allocations from the county every week, who in turn depend on allocations from the state, who in turn depend on allocations from the federal government. And fortunately to this date it’s been a week-by-week process, so it’s been hard to do long-range planning without knowing exactly how much vaccine you’re going to have, which will dictate how many appointments you can open up. So that’s one of the main concerns.
I think one of the things that we’ve been trying to be very diligent about is making sure we follow the guidelines and really try to vaccinate those at the highest risk first. So that’s one of the things that we try to ensure, that we went with the highest risk. And now that the county’s opening up to those who are 65 and older, we need to ensure that we’re capturing the right information and targeting those who really need the vaccine at this point. And of course, depending on what IT system you’re using, we need to reach out to patients, schedule them, register them, get their consents, and that’s part of the process that we’re all trying to streamline to make sure we can increase our speed.
That, tied with higher supply availability, will help us move closer to vaccinating these 10 million residents as quickly as possible.
What is Keck Medicine’s next step regarding vaccinating patients?
FO: There still are health care workers to be vaccinated. So that’s still our first priority as, although the county has opened to those 65+, the data last week showed that across the county there were close to 400,000 healthcare workers that still were not vaccinated. So we’re still pushing internally and doing campaigns to get our vaccination rates higher. And as I mentioned earlier, expanding to other health care workers not employed by us.
Now that we’ve opened up as a county to 65+, we’re focusing on that. So we’re standing up our operations on multiple fronts. We serve over 200,000 patients a year and about 60,000 of them are over the ages of 65, so we’re planning to open up to those patients, the first week of February — again, supply-dependent. We also have our own staff and employees who are over 65 both at our Health Sciences Campus and at the University Park Campus. So we’re also starting to plan on how we can reach out to them. And finally, there’s the 65+ relatives of our own health care workers. We also want to help with access, so we can get as many folks vaccinated as possible. We’re still step by step, following the guidelines of the county and we’re also trying to increase our capacity so we can vaccinate more people.
KA: Our teams are working diligently to transition to the next phase, which is basically patients 65 and older. We are targeting a Feb. 1 date, given the numbers (of people who need a vaccine in Los Angeles County) we need to expand to other sites. And so we are looking at standing up a second site near our health care facility as soon as February 15 potentially, and then looking at a third, larger site with the ultimate goal, hopefully, to be able to do about 1,000 to 1,500 vaccinations a day to be able to go through all of our patient population that truly needs this vaccine.
I think one of the primary things we’re looking at is how to scale in either direction. Right, so we probably will have to scale up slowly and ramp up this process based on supply availability and then ultimately scale up to be able to potentially have to scale down again. Given that this has been a week-to-week process, not knowing how many doses you’re going to get the week after, we may need to potentially have to cancel some scheduled appointments based on availability.
What should patients expect once they are eligible for the vaccine?
KA: My recommendation would be that all patients who are eligible for vaccination should use all available methodology possible to schedule. I would certainly recommend for those patients who have questions about vaccinations based on their preexisting conditions to reach out to their health care provider for consultation prior to scheduling, but given the scale of people we need to vaccinate at this point in time, I would highly recommend to get it where you can.
What about Keck Medicine patients?
FO: We will be starting our outreach campaigns and we have been updating our patients as the information changes very quickly, as all of you know. So we are starting our outreach campaigns through our patient portal, through text messages and other means of letting patients know when we’ll be available to start scheduling their appointments. We’re actually enabling some self-scheduling options, similar to what the county sites do, so folks can schedule their appointments. But we will also have phone lines available for those who might need a different route to schedule their appointments.
After you get your appointments there are some prescreening consent forms you need to prepare. Then, you come to your appointment, we’ll take care of you and upon receiving that first vaccination we will be scheduling that second appointment, and as you’re registered in our system we’ll be sending text and email reminders about your second appointment as well. So I think a lot of hospitals right now are in this holding pattern to launch all this patient outreach. If you can go into these county websites and you want your vaccine today, please do so. Both vaccines are great. It’s not like the hospital is giving a different vaccine than the PODs.
What about at the L.A. County PODs?
RD: The patient experience for locating a COVID-19 vaccine appointment as well as scheduling that appointment really begins at the L.A. County website, vaccinateLACounty.com. That is the website where individuals can locate county or city-run PODs, as well as any medical centers, pharmacies, clinics or doctors’ offices that are currently offering vaccines to members of the public for eligible population. Speaking for the city-run PODs, the scheduling links will be found on that website and individuals who are eligible to receive the vaccine can go online to schedule their appointment, which involves completing some screening questions to determine the eligibility and safety of the vaccine for that individual. They complete several consent forms and receive some communications about the Emergency Use Authorization.
And then from there, the patients arrive on site and they may encounter two different types of clinic experiences. One is the walk-in, walk-up model. And the second is the drive-thru model. Currently, with our city-run site, the Dodger Stadium is a drive-thru model where you drive in and you stay in your car when you receive your vaccination, while the other sites at Lincoln Park and San Fernando Valley and Crenshaw Christian Center are walk-up models where you’ll park and then you’ll join a line to receive your vaccine in an outdoor environment. It’s a really seamless experience where your information is found in the electronic medical records that you signed up with. They will be able to locate your appointment, your screening questions and can complete any clinical screening assessments before you get vaccinated and receive your record of your vaccination so that you know when your next dose is. Depending on the site, we are trying to vaccinate a lot of people so there may be lines and we do appreciate everyone’s patience as we try to get through as many people as possible.
How are we addressing vaccine hesitancy?
RD: There are some people who have concerns about the vaccine because of information that they may have heard from their friends, family, or even from the news. I think it’s important to engage individuals in conversation to find out what their specific concerns are, whether it has to do with the timeline of approval and authorization, whether it has to do with the safety, or the side effects. Whatever their concerns are, I do encourage individuals to have conversations with trusted sources of information, including their doctors, their pharmacists, or other medical professionals. And as a university we are engaging in those efforts. We are trying to connect with local organizations to facilitate those conversations by hosting webinars and town halls to be able to address individuals’ concerns. Overall, the message for anyone who has a concern is that it is a very safe and very effective vaccine. It has been thoroughly studied, no corners have been cut and the information has been independently reviewed by many scientific communities.
KA: For our organization, we have better information by area and by unit, letting us know percent completion of vaccination, basically. And we’ve been using that data to provide focused education to our health care workers. We answer any questions they may have and encourage vaccination. Furthermore, our marketing team has done a fabulous job at capturing various frontline health care workers’ journeys as they go through the first dose and the second dose. These employees talk through their experiences, why they decided to take it and then the team makes that information available to both internal as well as external-facing platforms.
FO: So we know that although our overall vaccination rate among our employees is about 65%, we noted that certain areas have much lower vaccination rates and one of these groups was our environmental services team where the vaccination rate is about 40%. This is not dissimilar to what we’re seeing throughout the country, that Latinx and people of color communities are getting vaccinated at much lower rates. So we started a campaign that we launched yesterday, actually. And as we open up vaccination to those who are 65 we actually did a specific outreach to our it Environmental Services employees so they can come this weekend with family members over 65 to get vaccinated. This has been received extremely well. Because again, a lot of folks in these communities live in multi-generational families. This is where we’ve seen very high numbers of COVID infections and mortality, so we wanted to make sure that we started our outreach in a way that was more specific to those who are very vulnerable.
In addition, one of the things we’ve learned is, just putting out emails and electronic communication is not enough. So I’ve actually been meeting in person with a lot of our Environmental Services staff to address their questions in Spanish and in English. We created posters with a QR code so people don’t have to go through an email, to eliminate a lot of the barriers to access. Once you have a chance to answer questions in person, usually a lot of folks feel a lot more comfortable. And I know there are many resources online, but a lot of these resources are not really in a language that a lot of these folks can easily understand. So I think eliminating those barriers from a health literacy standpoint is important. So we’re excited about our campaign for this weekend where we will be able to take care of the 65+ family members of our Environmental Services team.
How many vaccine doses does Keck Medicine have on hand?
KA: As of yesterday, we essentially have 5,000 vaccine doses on hand, with about 3,000 between now and next week scheduled to be administered. So I think that’ll provide a pretty good picture of how narrow our margins are in trying to plan ahead.
FO: We did not receive any new allocation this week. We have requested for next week, but we have not received confirmation. So even though 5,000 might sound like a lot out there, it actually only will last us a week. And if we don’t get more it’ll inhibit our ability to keep on moving with the 65+ patient population.
RD: For the city-run sites, I would encourage you to reach out to the Los Angeles Fire Department for the exact numbers and updates. But what I do know is we currently have about 70,000 vaccines on hand for all of our POD sites and we do receive weekly allocations.
How close is the Dodger Stadium POD to the 12,000 daily goal and what can be done to get closer?
RD: We are very quickly ramping up our daily capacity at the Dodger Stadium. We are currently at 8,000 to 10,000 capacity and we hope to reach the 12,000 capacity by the end of the week. What would help us ramp up much more quickly is, again, as many people as possible to help us staff the events, both clinicians and non-clinicians, and more doses coming in through the allocations.
Is there a concern that second doses will not be available in time for the recommended guidelines?
KA: At this time, we don’t have concerns so much about second doses as I think the county is truly trying to prioritize the need for second doses. Our concern is primarily with first doses being available.
How many people total have been vaccinated?
RD: At the city-run vaccine POD locations, through all of our efforts across all locations we have vaccinated over 83,000 individuals.
FO: I can speak for Keck Medicine of USC, we have administered over 14,000 doses and 9,500 of those are first doses and 4,600 are folks who have already received their second dose.
In what category will patients with underlying conditions fall?
FO: So, at this moment, we’re focusing only on Phase 1B tier, which is those over 65. I believe that those with underlying medical conditions under the age of 65 are in a subsequent tier within Phase 1B so we’re not quite there yet. I think it’s the next phase. We have 10 million residents in the county, of which 1.5 million are over the age of 65, so it’s a big group to vaccinate. Staffing availability and vaccine availability will tell us when we can move to patients under the age with underlying medical conditions.
RD: The phases are being determined at the state level and there are various committees and task forces that have been assembled by the California Department of Public Health and the governor to have those discussions and they’re actively still making decisions to provide guidance to the local jurisdictions. As we know, Phase 1A included health care workers and residents of long-term care skilled nursing facilities and we’ve now added on 65 and older as the beginning of Phase 1B. The next groups we anticipate to receive allocations would be frontline essential workers and then after that, that would include any adults under 65 with high-risk conditions. But as more information comes in, the state continues to evaluate the status and they will provide the guidance to the local jurisdictions, as far as when and how to open up the next phases.