Demand for dry ice and ultracold storage freezers has spiked as COVID-19 vaccines begin shipping across the country. Vaccines like to be kept cool, but none more than the Food and Drug Administration-approved Pfizer vaccine.

Novant Health has closely monitored vaccine development over the past year and is finding ways to maintain what’s known as the “cold chain” around these vaccines. Andrea Reed, senior director of pharmacy clinical operations, and Joe Maki, vice president of pharmacy services, explain how the process works.

What is a cold chain?

Maki: A cold chain is a temperature-controlled supply chain that maintains the quality and efficacy of a vaccine from the time it’s manufactured until the moment a patient receives it. While most flu vaccines are refrigerated between 35 and 46 degrees Fahrenheit, Pfizer’s COVID-19 vaccine must be stored at an ultracold temperature of -94 degrees Fahrenheit. That’s colder than winter in Antarctica.

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Why do the COVID vaccines need to be kept so cold?

Maki: mRNA vaccines are a new type of vaccine to protect against infectious diseases. They teach our cells how to make a protein that triggers an immune response in the body that produces antibodies. While they are new, they are held to the same safety standards as all other types of vaccines in the United States.

mRNA vaccines are fragile and unstable at regular temperatures. These are stored in the same ultracold temperatures human tissue is stored in to prevent it from degrading.

How will Novant Health keep the vaccines at the right temperatures?

Maki: In September, Novant Health purchased four ultracold freezers dedicated solely to COVID-19. They are the size of a domestic, French door fridge/freezer combo – not much bigger than an appliance you’d have in your kitchen. We ordered enough freezers to give us capacity for any potential scenario we could envision happening in 2021, so we are very well prepared.

Where will the ultracold freezers be installed?

Reed: Freezers have been installed at Novant Health Forsyth Medical Center, Novant Health Presbyterian Medical Center. We installed special electrical outlets to handle the power for these freezers since the motors are large. Novant Health Brunswick Medical Center and Novant Health Rowan Medical Center also added freezers capable of storing the Pfizer vaccine, as has Novant Health UVA Health System in Virginia.

How do the vaccines arrive?

Maki: The COVID-19 vaccines are delivered in vials that contain the frozen vaccine material. They must be thawed out and diluted before they are administered.

Ultracold storage freezer dedicated solely to COVID-19
Ultracold storage freezer dedicated solely to COVID-19.

I hear dry ice is involved in the process, as well.

Maki: Our supply chain has worked with a dry ice vendor to secure 500 pounds of dry ice each week. This will help us with a couple of things. The vaccines come in a thermal shipper, which looks like a suitcase. We can use the dry ice to replenish the thermal shippers, allowing us to use them as storage, if needed. We’ll also use dry ice if we transport vaccines between our facilities. Overall, it gives us more flexibility to use temporary storage and move things around.

How will Novant Health ensure the vaccines are stable while they’re being prepared?

Maki: Each COVID-19 vaccine has its own parameters for moving it from a storage temperature, allowing it to warm up and reconstituting it. Once the vial is open, or punctured, we have six hours to use it. So, if there are five doses per vial, once we take one dose out, we must administer the next four doses within six hours.

Novant Health has a team of pharmacists and pharmacy technicians who will walk around with thermometers and temperature gauges. We’ll know what temperature they are at, when they were opened and how long they’re in various storage conditions to make sure we comply with all parameters set by the manufacturers and the Centers for Disease Control.

How will people know which vaccine they received?

Reed: While medical records will track which vaccine people receive, anyone who gets a COVID-19 vaccine at Novant Health will also receive a card that indicates the manufacturer. It’s also suggested they take a picture of that card should they lose it. This is important because people must receive two doses of the vaccine (3-4 weeks apart for Pfizer and Moderna, respectfully) to get to the greater than 90% efficacy the manufacturers were able to achieve. Future manufacturers such as Johnson & Johnson may not require two doses.

We are not suggesting one manufacturer to our communities, and instead, view our role as a partner to help people make an informed decision.