Town Hall: A look at School efforts to distribute the COVID-19 vaccine

[Dean Joe Guglielmo, PharmD]
Good afternoon. Welcome to the first town hall meeting of 2021, for the School of Pharmacy, and I thank you all for your active participation. I'd like to go through the usual tips before we begin, your audio and video will be automatically muted. Only the panelists can unmute themselves, the chat function is disabled. For questions for participants, please use the Q&A function at the bottom of your screen. Any questions that we're not able to answer today, as always, we'll be answered via email or if anonymous, we'll try to answer it at the next town hall. As always, we'll hold all questions until the end of the presentation.

So just a few announcements as always, I thought I would first to spend a few moments talking about UCSF and where we are on the surge. You all read the newspapers, so you know how the Bay Area is doing how California is doing the US the world and beyond but, and Desi [Kotis] can probably talk about this a little bit later as well. We're kind of hanging in there in the mid 50s in terms of COVID infected patients at UCSF. This is actually what a welcome number, because at one point, just a couple weeks ago, we were in the mid 90s. Of those 54 patients today, when I checked today, 24 are in critical care areas. And that's important always to highlight that because it's the needs in critical care that are particularly important. And we also keep track of how much space we have in the critical care area. So with 24 in critical care, that's at a 77 percent filled at the moment, and of those 24, 16 require actual ventilation and one is on ECMO. And for those that don't know what ECMO is that is a what's called extra corporeal oxygenation. What that is, is literally oxygenating the blood but not doing it in traditional ways through the lung. That's for particularly sick patients.

A few recent changes. One, some incredibly good news. We have all these student vaccinators in the school who already have done a lot and are being asked to do a lot. And I will tell you and I'm really gonna compliment the State Board of Pharmacy at this point. Literally, Tuesday, all the deans of schools of pharmacy in the state of California sent a letter to the State Board of Pharmacy. The topic was specifically asking if the state board could loosen up the requirement that only pharmacists, frankly, pharmacists that are already been trained to vaccinate, could be the preceptors of pharmacist interns. We said didn't make sense that, why not nurses or physicians or other individuals. We literally sent the letter to them on Tuesday, by yesterday, Wednesday, they replied that they were going to bring a waiver forward. And so now in fact it does not require a pharmacist to be there for these intern pharmacists to be vaccinators. So incredibly important especially and Lisa [Kroon] and Desi [Kotis] will talk about this later, student vaccinators are an incredibly important part of the workforce as it relates to trying to take on this really massive national state and local undertaking.

A couple other things. I want to remind you, and you received a notice of it today already, that UCSF’s third antiracism town hall will take place tomorrow at 12 noon. There will be a bit more of a focus this time on faculty. But I welcome everybody to join with what has been really informative and wonderful communication about anti racism efforts at UCSF. All of you should have received an email and emphasizing that we launched the foundations of Diversity Equity and Inclusion Training Module. This is something all UCSF members must take. You should have received notice just three days ago January 25, about if you have any doubts, do what you can to look at. You can just basically go on the UCSF website and you will find that in the training module section, this one particularly. And so, if you have any trouble with that, please contact me and I'll point you in the right direction.

[Dean Joe Guglielmo, PharmD]
I want to take a moment here to first acknowledge Michael Nordberg. We've done it in writing, we did the full faculty meeting. But I want to do it now at this last town hall, our outgoing Associate Dean for Administration and Finance, the School of Pharmacy. Michael has given his heart and soul to the School of Pharmacy, the ultimate team player, the ultimate firefighter, and a man with a vision as well, in terms of taking our school in a place where I feel quite comfortable. I'm uncomfortable of Michael's leaving but I'm quite comfortable that we will not miss a beat. And a lot of it has to do with the preparatory work that Michael is done. You all know him well, past recipient of the Chancellor's Award for Exceptional University Management. And again, just a wonderful colleague. I wish we could, you know, have a celebration. I suggested maybe another one of those virtuals. I think Michael said, "well, why don't we hang tight for a little bit on that." My real goal is, I'm hoping we can celebrate all our retirees and other individuals who essentially are leaving chairships, etc, I'm really hoping we're going to use Elizabeth Daniels funds to really put on a nice get together for the entire school. But of course, there's a big asterisk to that, and that'll be when we can, but that is still going to be the goal. So Michael, from my heart, thank you for everything that you've done for us. And I wish you and Suzanne your very best in retirement.

So that means I also would like the opportunity to introduce the incoming Associate Dean for Administration and Finance in the School of Pharmacy, effective March one, and that's Alesia Woods. I'm going to while I wrote about this to all of you, I want to just remind you that Alesia comes to us with a couple decades of experience in administration and financial management. And the last 10 years she served as the Chief Administrative Officer for the Department of Physiology. As with Michael, Alesia has been the recipient of the Chancellor's award for Exceptional University Management. She is also a three time recipient of the School of Medicine's Achievement Award. I know for a fact she has exquisite ability to take on the most complicated financial, space, and HR situation, while still maintaining supervision and strategies. We're very lucky to have her. And I also want to thank the search committee one more time. And that was chair Amal Smith, and our School of Pharmacy colleagues, Diana Koeplin, Jacqueline Fabius, and Joanna Trammell, and Associate Dean for Administration David Ryan with the School of Nursing. So now, before I move on, I actually let me just say one more thing. Before I turn this over to Alesia, just for a bit here. I also want to acknowledge Michael, who his last day will be next Monday. I want to thank James Joves, our chief financial officer, who is willing to accept the Interim Associate Dean for Administration and Finance for the week, I mean, for the month of February. Thank you, James. I thank you before personally, but I want to in front of everybody, as you've always done, step into the about the various departments, the dean off dean's office, and I'm grateful that you did this as well. So with that, I'm going to turn it over to Alesia and who will then turn it back to me and I will get things going for the specific topics in this particular town hall. So Alesia,

[Alesia Woods]
Thank you. I'll be brief. I'm super excited to be joining the School of Pharmacy family. I'm looking forward to working with everyone and hopefully seeing everyone when the time is right. Thank you.

[Dean Joe Guglielmo, PharmD]
Thank you, Alesia. So back to me. So as I so our topical program today is going to center upon the Coronavirus vaccines. There are so many questions about this. There's so many misconceptions. And I'm now going to hand it over to Grant Burningham, the School's editorial director, who will introduce today's presenters, Grant.

Grant Burningham
Thanks, Joe. As Joe mentioned, the topic the town hall today is the COVID vaccines, and critically the efforts at UCSF to vaccinate our population and the country at large. So on that note, we're lucky Have Desi Kotis. with us here today. She's the chief Pharmacy Executive at UCSF health and an Associate Dean and faculty member in the School of Pharmacy. And we also have Lisa Kroon, who's the chair of the Department of Clinical Pharmacy. Both of both of them have been instrumental in distributing the COVID vaccine for UCSF. As Joe said, we will have some time after their presentations for questions and answers. So feel free to type those into Zoom now and we will get to them as soon as Lisa and Desi are done speaking. So first up, Lisa Kroon. Lisa, thank you for joining us.

[Lisa Kroon]
My pleasure. Thank you for having me. I'm going to switch to my slides. Okay, can you see my slides? All right. Okay.

So, just as a starting point for us with the COVID pandemic that started last February, March, really, you know, what was our School and our Department of Pharmaceutical Services commitment around caring for patients with the COVID pandemic. And our stance was really that our pharmacists must remain in the frontlines to continue to provide care during the COVID-19 pandemic. And that our pharmacy profession is an essential part of the efforts to vaccinate communities, and to prevent the spread of COVID-19. So that's really our framework for what we were doing here.

Joe mentioned that the recent change or waiver in the Board of Pharmacy, but just some background around COVID-19 vaccination. So licensed pharmacists in the state of California are able to independently initiate and administer vaccines. But these need to be part of what's considered the routine immunization schedule that's set forth by the CDC and the Advisory Committee on Immunization Practices. So we actually had to go to pharmacy law and have waivers or executive orders instituted by the governor to allow us to administer the COVID-19. And that was issued in September 24. And then mid-December, the ratio of a pharmacist to pharmacy intern who's administering vaccines was expanded. So usually the ratio of a pharmacist to an intern is one to two, it was expanded to one to three. And then mid December, it was even further expanded to four to one which really provides another great opportunity for our students to play a role. And then as Joe mentioned, just yesterday, the supervision of our students was expanded to allow physicians, nurse practitioners, and physician assistants to be able to supervise our pharmacy interns or pharmacy students and this is going to be really critical as California starts more vaccination kind of mega sites where we may not have faculty but if there's a physician organizing it or nurse practitioner, they'll be able to supervise so really exciting about that.

Grant Burningham
I'm just gonna interrupt for one second. We're having a little bit of mic problems. I don't know. Maybe you can get closer to the microphone.

[Lisa Kroon]
Let me, can you hear me now?

Grant Burningham
Yeah, that's very clear.

[Lisa Kroon]
Okay. I'm just gonna talk louder. Sorry, All. So, if you go to the UCSF website right now, you're gonna see Dr. Valerie Clinard's picture. And the title is leaders and learning. So as Joe mentioned in early September, we anticipated our students playing a key role in vaccinating patients for the COVID-19 vaccine. And we trained our entire first year class in order to partake in this effort. So currently today our pharmacy support has been primarily around two different roles, serving as vaccinators and helping with the pharmacy operations with Department of Pharmaceutical Services. So in December, when we first kicked off the first site at Parnassus on December 16, it was actually our pharmacy students and pharmacists that were playing the main role is vaccinators starting January agency nurses have been brought in, but we're really proud that it was actually our pharmacists and students really serving in that role.

Val Clinard conducted a training for six additional pharmacists to play this role, one faculty member and actually five of our medical center pharmacists colleagues, And she's planning to repeat this training for UCSF and some of our UC partners and other key sites. Our students are also playing a key role to support the pharmacy operation. So at each of these sites, we basically have a mini pharmacy on site and so our students are helping staff serving as compounders and dose issuers for them. So a lot of the efforts in December were really just in time we were working minute by minute day by day, we developed zoom training that was held on December 16. Trang Trinh, our faculty member led that with the first clinic starting the next day, all the training materials needed to be developed. Our school played a lot of role in that. Lots of logistics, won't go into the details, I want to do a shout out to Lisa Duke and my executive analyst who worked with me off hours and weekends to get all these logistics put together.

Believe it or not, UCSF didn't have an acute allergic reaction protocol of what to do if somebody actually has an anaphylaxis reaction, which we know is a concern for some of the vaccines. So we were able to put that together in short order. Fortunately, this is are already part of pharmacy scope of practice, so we were playing that role. The vaccines are drugs and so we, as any UCSF new drugs, we have to have a monograph it has to be approved by their pharmacy and therapeutics committee, and executive medical board. So those monographs were produced, Candy Tsourounis and our medication outcome center worked in short order to get those rush approval.

So moving forward, our students, as I mentioned, are really going to be supporting or prioritizing the pharmacy operations role. I didn't want this to be a separate rotation for them. I work closely with Tram Cat and Judie Tran, our experiential directors, to see how we can incorporate this into I.P.P.E.S and A.P.P.E.S for our students. And we did a similar approach for our residents. And then moving forward, of course, lots of opportunity for volunteering still as vaccinators.

So the mobilization efforts in December were just really amazing to see. It was actually a remarkable response from all health professional students, that were medical, dental, nursing there as well as pharmacy. But if you just take a look here, we've had over 190 students participate already in these shifts. All of our residents are involved, and more than 100 pharmacists and technicians have been redeployed to support this effort.

And I'll close with just some pictures here. This shows the first arrival of the Pfizer vaccine on the left, kind of the size of a pizza box. These are some pictures of the first day Matthew Aludino, a third year pharmacy student actually was the first to administer a vaccine to an employee at UCSF. And then the other shot there is Marilyn Stebbins, one of our students, who were serving as vaccinators there.

[Lisa Kroon]
We of course are very concerned around making sure people get the right vaccine, these are not interchangeable. So the pharmacy department has bought special labelers called Codonics to make sure there's absolutely no confusion. And they've tried their best to have, you know, the Moderna vaccine just at Mission Bay and the Pfizer vaccine at Parnassus. So Mission Bay "M" and "P" for Parnassus, Pfizer. This just shows you an example of these mini pharmacies that we've built on each of the sites where the compounding is happening.

And then I know this is all about vaccine, but I did have to put a shout out around our pharmacist providers actually caring for patients with COVID. Many are heavily involved, our infectious disease pharmacists faculty, Conan [MacDougal], Katherine [Greenberg], Kathy [Yang], that service is just you know, so busy, they're working 24 seven supporting that, of course, we have new therapeutics, treating patients with COVID. And so our faculty and pharmacists in ID have been playing a really important role there, including Kathy Yang.

And then finally, the school was working to develop some public education mini videos to help put out, you know, dispel some of the myths and questions that people, the public have about the COVID vaccine. So I just want to put a huge shout out to the entire pharmacy team for all of their efforts. And then it's my pleasure to pass it off to my colleague Desi.

[Desi Kotis]
Good afternoon, everyone. My screen up here really quick.

[Desi Kotis]
All right. Well, it's great to be with all of you and we will have time for questions and discussion. So Lisa gave you some really great background. I wanted to show you a couple [inaudible]. As you know, we started on December 16. You know, as I reflect, and I've been in this profession a long time, this is not only a historical moment, but just an amazing, amazing time for our profession, and for everybody who is a pharmacy provider, from a technician to a student to a pharmacist. So you can see here where we are. And again, you can see, we started around January 15, vaccinating patients, those were patients 75 and older, looks like this weekend, we will open it up to 65 and older. And then you could see where we are, the blue line being health care workers, students. And again, these were all vulnerable populations or vulnerable workers who worked with COVID patients or persons of interest.

And we'll talk a little bit about what we’re doing next in future phases with those who are either complete remote workers or those who don't see patients, in our administrative, and may come in at least a couple of times a week to campus, and where the phasing will begin. For those that are on site at least once a week, they will be in the next phase. And so we could talk about that more.

So here are the statistics in a little different format. We are also vaccinating non-UCSF health care workers and first responders. So, almost 20,000, we're probably over 20,000, now, since these slides were done. And then we show you what we've done with our folks, and this does not include the mega-site that opened just about a week ago, at City College, where, our first day, we did 550 patients over 75. And starting tomorrow, they've been closed for a couple of days due to high winds and the weather, starting tomorrow, they'll be ramping up to 1000. So we are really increasing our numbers of quite significantly.

This is everybody's favorite slide, super busy, and again, you could see this was from the beginning of the week where you see the vertical line. But again, we're pharmacists, so we need to color track by brand of Pfizer, Moderna, is this first dose allocation or second dose. So you can see, for example, on December 22, the 7900th first dose matches another 7900, right here, second dose. So it's sort of a Jack-and-Jill mix of, you'll get your allocation of your second dose for people and where you are.

And this is really Avi Tutman and Julia Wang and others, Sarah Coleman, Sana Weiss, our analysts who are working on our run rates, and when we will run out of vaccine depending on the scenarios. So again, the supply has been somewhat erratic, it's not your normal flu vaccine supply or any vaccine supply. So we are being allocated through University of California as a multi-county entity. So all five campuses in California receive allocation. You know, sometimes I hear on Wednesday what we're going to get next Tuesday, sometimes I'll hear, like I haven't heard yet this week. So hopefully it'll be by 10pm tonight that we'll know what we're going to get and about when delivery will happen. So again, it's a very slow and erratic process. But we keep going and I am really proud of what all of you, the School, the students, and the faculty and the entire pharmacy team has accomplished.

So here's where we are as far as the phasing. You can see we started the day we receive vaccine on December 16. So everyone in that high risk worker, first responder, 1a group, whether you're a custodian, whether you're a patient transport, a respiratory therapist, a pharmacist, doctor, nurse, that group is pretty much done. There still are some that are coming in. They may have gotten their first dose rotating in Fresno. Now that, that person is on rotation in San Francisco, they may be getting their second dose.

[Desi Kotis]
We started, as I said, on the 15th of January with our patients 75 and older. And then on the 19th, we started with health care workers that are not UCSF first responders that are coming to the Parnassus site. And I know there's no date here. But this, they're actually making the decision at a meeting that I'm missing right now. But I'm almost positive that 65 and older will probably start, if not tomorrow, over the weekend. We are going seven days a week, we're not breaking for any holidays or weekends. And then you can see the next group will start, this looks like it's in February, these are fluid changes. Monday, we heard that the governor is going all age based. And so every day we hear new things, and we need to make some changes. But again, we will see onsite workers probably, I know this says February, but it's basically next week, where if you're on site at least one day a week, you will be able to come and get your vaccine. And then again, as we phase out, you can see those plans up above.

[Desi Kotis]
Lisa showed our sites. Parnassus will be ramping up, there's a, probably a ramp up to close to 1000 vaccines a day. Mission Bay, we move to the Rutter Center, that will be at least 1000 a day. And then we do have a site at Oakland. And then the City College site. We were also doing about 40 percent San Francisco city, people, residents in San Francisco County as well. And that site starts ramping up from like the 550 a day that they did to now 1000 a day.

This is a photo of the City [College] site and you can see the various lanes, it's completely drive thru. We're going to open a site, because there is a Muni station nearby, for walk ins. And right now, the city is, again, this is a city site, it's we're helping staff it. We're providing vaccine, obviously doing a lot for it. But the city wants to make sure they have safety precautions for a tent for walkups. But this is what the site looks like.

Here you can see another view from lane one all the way down. And we can adjust doses and the thought is to ramp up to at least 3000 a day or whatever the City would decide.

[Desi Kotis]
Alright, thank you.

[Grant Burningham]
Thank you so much, Desi. And thank you, Lisa. I'm going to start out with a question which came up while we were preparing this video series on the vaccine, which is there seems to be kind of a lack of information in certain areas. And one of the questions was whether or not pregnant women should should get the vaccine. The CDC seemed to recommend that they should get the vaccine, and then the World Health Organization said in particular that they should avoid the Moderna vaccine for the time being. What do we know about pregnant women? And how do we balance all this information we're getting from different sources?

[Desi Kotis]
Lisa, do you want to start,

[Lisa Kroon]
I can start so I mean, for any guideline, different bodies have different recommendations. It is my understanding that we are still going by the CDC, Center for Disease Control, and not the change in the WHO, where our guidance to pregnant women is to discuss with their health care provider in shared decision making, and certainly if they're at an at-risk or high risk group that they are being encouraged to consider taking the vaccine.

[Grant Burningham]
Okay, great. Just a reminder for everyone. The question and answer is open. If you want to ask them in Zoom. We're gonna go a little bit long so we can get to some of these questions. And we will also take questions on School business generally. So any type of questions you have. This was answered in the chat, but I'm going to ask it really quick. Is there any word on the staff receiving vaccines who are not in the greater San Francisco area, for those of us who are working from home away from campus.

[Desi Kotis]
So again, as I said, if you're on campus at least once a week, you will be in the next phase, which starts in the beginning of February. If you're 65 or older, that could be as soon as this weekend. But the state and others, CDPH, really states, you'd have to be on site and how we're defining on site through the Chancellor's executive team is at least on site one day per week.

[Grant Burningham]
This is a question for both of you. Does vaccinating the health care workers outside of UCSF slow down the ability to vaccinate UCSF workers? Or do you get extra vaccines to accommodate the community?

[Desi Kotis]
Yeah. Do you want me to start that one, Lisa? So actually, we did, and we have been receiving vaccine from the county, from SFDPH. Again, it's about the people at highest risk. So what we've been vaccinating, or who we've been vaccinating, since the 19th, are health care workers at very high risk, in that 1A population. We've completed 1A for UCSF quite a bit ago, except for maybe a few people. But again, there's definitely room for UCSF. But this is first responders and high risk healthcare workers in San Francisco and we are getting supply. We actually got our first tranche from San Francisco Department of [Public] Health. There are a couple weeks where the surges were so bad in Southern California, that as a collective, we all decided that our vaccine should go to Southern California. So UC Davis, UCSF did not receive vaccine for two weeks. So guess who gave us vaccine? That was San Francisco Department of Public Health.

[Grant Burningham]
Okay, thank you. I see Lisa, typing out an answer to this, I'm going to interrupt her typing. For cancer survivors, would it be safe to take the mRNA vaccine?

[Lisa Kroon]
Oh, verbally, I was just typing that. There's no reason that you should not be able to. The CDC does have guidance on people who may be immunocompromised, you may have less of a response. There could be a concern about certain chemotherapy agents. And so the question was about a survivor, but you may be on something still, so best to speak to an oncologist or other health care provider before getting vaccinated.

[Grant Burningham]
And this is a question for both of you. And this is something I'm curious about. When will the vaccination start to make an impact on the spread of the virus at large?

[Desi Kotis]
So you could see from the data that after the first dose, and again, Pfizer and Moderna are very, very similar. There's quite a bit of protection. I think, Lisa, isn't it around eight to 10 days, even after the first dose? But again, these are a two dose combination. And there's this thing called herd immunity that I'm sure Joe could talk about, but we need to get quite a few people vaccinated before we can let down our guard. So even though we receive our first or even both doses, we still need to social distance, mask, and obviously use proper hand hygiene. So it will be some time. Lisa, did you want to add the specifics?

[Lisa Kroon]
I think that's it. There's differing, depending who you listen to, Dr. Fauci versus others. Paul Offit in Philadelphia, that they have different thresholds for the herd immunity, but I think we'll just have to see.

[Desi Kotis]
Yeah, I think they say, George Rutherford 65 percent, 70 percent vaccinated. Again, whether you're in your house, you might feel more comfortable if you're a few weeks post your second dose of vaccine, but, again, a lot to follow. I know the one real controversial thing right now is the data and the announcements about getting your second dose within six weeks. So whether it's Moderna or Pfizer, now, you know, Moderna's 28 days, Pfizer's 21 days, it's still recommended to get your second dose in that time, 21 or 28 days respectively. But now, because it is a booster, there is some thought that it could go six weeks. We're not recommending that. But right now, again, things are changing and we're seeing more and more evidence come out. So I just wanted to bring that up as well.

[Grant Burningham]
Okay. This is a quick comment from one of our faculty members, Conan MacDougal in the chat. The vaccine protects well against symptomatic disease, but the extent to which it protects against transmission of the virus is not known. Israel will be the place to watch as they have vaccinated 25% of their population already. So not a question there but a comment. Here's a question. How is the campus staff being notified of when to book an appointment?

[Desi Kotis]
Yep, so if you do have My Chart, or if you don't have My Chart, it's recommended that you, this is kind of the old way, there is a new scheduling, an open scheduling system that's coming on board. But what has been done thus far for UCSF employees and patients is through My Chart. There's quite a bit of this new open scheduling happening that should be easier. It's on the website. And for those that may have language difficulties, or technology isn't their friend, there is a phone line that can be utilized for booking appointments.

[Grant Burningham]
Okay, I'm just gonna do two more questions really quick. First up, do you see differences of efficacy and side effects in various race, ethnicity, and age groups?

[Desi Kotis]
Go ahead, Lisa.

[Lisa Kroon]
My understanding is we are actively tracking at UCSF Health and UCSF for adverse events. And that data will be analyzed for any differences by age, race, ethnicity. The clinical trials for the Pfizer and Moderna vaccine did see a difference by age. So more senior people seem to have actually less side effects such as the flu like symptoms, which are just a sign of the immune system response being mounted. So there is a difference by age, certainly for some of the more acute reactions.

[Grant Burningham]
Okay, thank you. And last question, will the vaccine need to be annual like the flu?

Desi Kotis
Yeah, I don't think anyone knows yet. I know there's some data, probably Conan can answer this question as well, if there will be boosters needed at two years or at three years? I don't know, Lisa, if have any other data on that.

[Lisa Kroon]
They're speculating now and then with the variants out there, whether that will trigger a need for a booster but I don't think we know exactly when that will be. We don't know.

[Grant Burningham]
Okay, thank you both so much for your time and for answering those questions. Joe, I'm gonna toss it back to you really quick.

[Joe Guglielmo]
Thank you, Grant. And thank you, Desi and Lisa, I appreciate you taking the time especially Desi when you had another meeting that you, maybe we got you out of a meeting so maybe you should thank me come to think of it. But no, seriously, thank you both. And, thank you Alesia, for joining us for your inaugural Town Hall. We look forward to having you meet all of us. And best of luck, Michael Nordberg. In the meantime, please be safe everybody and enjoy the rest of your day. Bye.