Ahead of Schedule, Vaccination Distribution Follows Guidelines, Recommendations from CDC & MDHHS
Since receiving its first shipment of Pfizer vaccines in later December, Hillsdale Hospital has utilized vaccine allocated by the Michigan Department of Health & Human Services (MDHHS) according to the separate tier systems outlined by both the Centers for Disease Control & Prevention (CDC) and MDHHS. As of January 29, the hospital has administered more than 3,000 doses of vaccine in Hillsdale County.
When vaccine became available in Michigan, the hospital requested roughly 800 doses from MDHHS to vaccinate tier 1A healthcare workers in Hillsdale County. Initially expecting to receive 400 doses of the Moderna vaccine, Hillsdale Hospital was able to amend its requests to the state for either Pfizer or Moderna when Hillsdale College offered use of its ultra-low temperature freezer required to store the Pfizer vaccine.
“In rural healthcare, we are used to operating with fewer resources than our urban and suburban counterparts,” president and CEO Jeremiah J. Hodshire said. “Our partnership with Hillsdale College for the use of their ultra-low temperature freezer is a perfect example of how we have to get creative to care for our community. Were it not for the freezer access they provided us, we would have received 400 doses of Moderna. Instead, we received 975 doses of Pfizer followed by another 975.”
The hospital received more Pfizer vaccine than requested, as Pfizer is only distributed in shipments of 975 doses. Within seven days of the hospital receiving vaccines, Hillsdale County tier 1A healthcare workers who opted in received their first doses—staff from the hospital and its owned and operated clinics, as well as healthcare workers in local independent doctor’s offices, dentist’s offices, chiropractors, home health agencies, etc. The hospital also learned of long-term care locations in the county waiting for vaccinations for their staff and residents through the pharmacy program that were told they would have to wait several weeks for vaccination. Hillsdale Hospital immediately stepped in to vaccinate their staff and residents so those long-term care facilities would not have to wait on the pharmacies.
Having completed tier 1A, the hospital developed a detailed plan to utilize remaining doses. In the interim, Hillsdale Hospital received a second shipment of 975 Pfizer vaccines. The plan included tier 1B essential workers covered under CDC-identified tiers—specifically those working in Hillsdale County with frequent contact with the public or large groups of individuals in order to minimize the potential for exposure and spread. This included law enforcement officers, critical infrastructure workers and those in the education sector.
“We have done exactly what the state has asked of us, which is to get shots in arms,” Hodshire said. “When we had remaining vaccines, we had two choices: leave them sitting in a freezer until the state moved tiers or come up with a plan to use them as quickly as possible. We opted for the second choice. Because the state had not yet moved tiers, we referred to the tier system outlined by the CDC while remaining in communication with MDHHS rather than arbitrarily select individuals or groups to vaccinate for the sake of control or convenience.”
In addition to K-12, the CDC includes higher education, trade and vocational schools in the education sector under tier 1B. In this category, Hillsdale County happens to have more than most rural communities: Hillsdale Beauty College, Hillsdale College, Jackson College’s Hillsdale campus and the Litchfield Regional Training Center. For the education sector, the hospital only offered vaccination to those who actively teach in the classroom with students or engage in activities that involve frequent contact with others in large groups and are therefore at higher risk of either being exposed or spreading the virus to a large number of people. For all sectors, the hospital did not allow vaccination for those working remotely or primarily from home even if they work in an included sector or occupational group.
“Higher education, trade and vocational faculty/staff were part of a list of essential workers from a variety of employment sectors under tier 1B who were vaccinated by Hillsdale Hospital,” Hodshire said. “This was not a dump of vaccines to specific organizations based on their status in the community. This was a methodically planned out process to move through the tiers identified by the CDC until further prioritization from the state was provided. Healthcare and long-term care workers, childcare and K-12 workers, first responders and law enforcement make up the vast majority of those we have vaccinated.”
Michigan’s chief medical officer Dr. Joneigh Khaldun and MDHHS have continued to encourage vaccine providers to get shots in arms, stressing that tiers can be crossed to continue vaccinations. MDHHS does not require submission or approval of a plan for use of vaccines, as stated by MDHHS spokesperson Lynn Sutfin on multiple occasions, saying “we do not want providers to waste vaccine and would rather they provide vaccine to someone outside of the prioritization groups as opposed to losing doses.” Though not required, prior to the plan being to put into place, Hillsdale Hospital pharmacy director Jeff Kauffman shared the hospital’s plan for use of remaining doses with the state’s vaccine coordinator. It was met without pushback or concern.
All of this occurred before the state of Michigan announced that it was moving beyond tier 1A and moving those 65 and older into its next category of eligible individuals. In fact, Hillsdale Hospital had completed registration for tier 1B essential workers by January 6 for vaccination clinics held on January 7 and 8. The hospital had already administered more than 1200 of its 1950 doses to tier 1A and tier 1B by the time the state announced on the afternoon of January 8 that it was expanding its eligibility effective January 11.
“Hundreds of essential workers were vaccinated in Hillsdale County while we continued to hear reports of other communities sitting on doses for weeks waiting for the state to move tiers,” Hodshire said. “Instead of taking that route, we took what Dr. Khaldun and MDHHS had been telling us to heart and crossed tiers in order to continue the vaccination process in our community. Once we learned that the state was moving into tier 1B and moving seniors aged 65 older from tier 1C into tier 1B, we immediately began developing plans to vaccinate seniors in our community as well.”
A clinic was already scheduled, and registrations already completed, to continue vaccinating tier 1B essential workers on January 28 and 29 with remaining doses from the hospital’s second Pfizer shipment. The hospital still had additional doses which it reserved for seniors to receive during the same January 28 and 29 vaccination clinics. Coincidentally, many of the tier 1A and tier 1B individuals who had already received the vaccination were themselves 65 or older. As of January 29, 30 percent of all individuals vaccinated by the hospital were seniors aged 65 or older. In addition, the warden of Lakeland Correctional Facility in Branch County reached out to Hodshire directly for help getting his staff vaccinated. As a result, Hillsdale Hospital also vaccinated corrections officers actively working in the facility who live in Hillsdale County.
“Hospitals like ours have been dealing with a pandemic for 10 months now with limited resources, staffing issues and debilitating financial challenges,” Hodshire said. “Now, as public health struggles to get people vaccinated with limited resources and staffing, hospitals are stepping up yet again, standing in the gap and making sure our communities are taken care of in collaboration with our local health departments and community partners. Hospitals and health departments are under immense pressure to quickly accomplish this tremendous task.”
Of those individuals vaccinated by Hillsdale Hospital, local K-12 teachers and workers make up 21 percent.
“Hillsdale Hospital has been an invaluable partner of the school system throughout this COVID-19 pandemic,” Shawn Vondra, superintendent of Hillsdale Community Schools, said. “The most recent impact occurred with the vaccination clinics provided to K-12 teachers, school support staff and childcare workers throughout the county. The vaccines provided for these staffing positions are an essential strategy for keeping in-person instruction available for the students of Hillsdale County. We are so very fortunate to have a health care system dedicating itself to providing high-quality care to our community.”
School officials credit the vaccination of their staff not only for safeguarding their ability to continue in-person instruction, but for reducing anxiety for teachers, students and parents alike.
“The vaccination means that faculty and students will be able to be together in the classroom each and every day focusing on teaching and learning without the ever-present worry of the coronavirus,” Colleen Vogt, director of Will Carleton Academy in Hillsdale, said. “Parents will be able to know that we have taken the steps to protect ourselves, and therefore their children, in the fight against COVID-19. The WCA staff members who received their vaccine are so grateful for the opportunity to participate in the ultimate mitigation strategy.”
As of January 29, Hillsdale Hospital had vaccinated more than 550 seniors aged 65 and older in Hillsdale County—roughly 30 percent of all those vaccinated by the hospital. Moving forward, the hospital and local health department (Branch-Hillsdale-St. Joseph Community Health Agency) will continue to collaborate to vaccinate Hillsdale County, including holding joint vaccination clinics. In addition to a joint clinic on Thursday, February 4 with the week’s 500 Moderna doses the hospital and health department received from the state, the hospital is hosting a second clinic on Friday, February 5 with an additional 460 doses targeted for seniors. By the end of the week, seniors will account for more than half of the hospital’s total vaccinated individuals.
“I am extremely proud of my healthcare team and volunteers who have made these community clinics possible,” Hodshire said. “While fighting the pandemic each day on the floors of our hospital, advocating for our long-term sustainability with federal funding and having lost a family member to COVID-19 myself, it is encouraging to know that we are saving lives of Michiganders and safeguarding our community members. We have followed the guidelines and instructions being given to us by the state and we have worked with partners in our community to vaccinate hundreds, soon to be thousands, of individuals in Hillsdale County. We can’t do it alone and we hope that other rural communities in our position will reach out to organizations in their area that might be able to help them with the challenging logistics of this vaccination effort.”