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By LENZY KREHBIEL-BURTON

CPN Public Information 

One arm at a time.

One shot at a time.

Within days of emergency use authorization from the Food and Drug Administration, Citizen Potawatomi Nation Health Services began receiving and administering vaccines to combat the coronavirus in central Oklahoma.

Along with the other self-governance tribes across Oklahoma, CPNHS opted to get its primary vaccine doses through the Indian Health Service rather than through the Oklahoma State Department of Health.

CPNHS Chief Medical Officer Dr. Adam Vascellaro said the decision to go through IHS was deliberate. This move increases the chances of both the tribe and its pandemic vaccination partner, the Pottawatomie County Health Department, having dual distributor access to the COVID-19 Pfizer vaccine for the populations they serve.

"There's twice the chance we'd get the vaccine out in our rural locations versus us all relying on the same supply chain."

"Plus, with both ourselves and the state health department using the same Pfizer ultra-cold vaccine, if someone got their first dose here and we ran out, they could get their second dose from the state's lot or vice versa. Our stocks are complementary."

For the initial phase, IHS received 46,000 doses of the Moderna vaccine and 22,400 doses of the Pfizer vaccine nationwide. Originally, IHS was not slated to receive additional funds to cover costs associated with administering them. However, as part of a $900 billion CARES Act bill signed into law in late December, IHS and other entities will share $8 billion specifically earmarked for vaccine distribution expenses.

The IHS Oklahoma City Service Area, which along with all of Oklahoma includes Kansas and part of Texas, received 5,850 doses of the Pfizer-BioNTech vaccine and 8,900 doses of the Moderna vaccine.

Combined, Citizen Potawatomi Nation's East and West clinics received about 400 doses of the Oklahoma City Service Area's first allocation of the Pfizer-BioNTech vaccine. As of Jan. 29, CPNHS alone has administered approximately 3,000 first and second doses.

With IHS relying on a wheel and spoke model for distribution, CPN's clinics are also serving a distribution hub for several other Oklahoma tribes and some in Kansas and Texas. The two clinics began receiving the vaccine in mid-December, with an initial 2,000 doses passing through on their way to other tribal facilities.

Although both the Pfizer-BioNTech and Moderna vaccines require two doses, they are not interchangeable. Someone who receives an initial dose of the Pfizer-BioNTech vaccine has to receive a second dose of the same medication in order for it to be as effective as advertised.

First to receive Food and Drug Administration approval, Pfizer-BioNTech's vaccine presents an additional logistical challenge. To remain potent, it requires storage at around -70 degrees below 0 Fahrenheit or lower and should not be thawed and kept in a refrigerator for more than five days before administering. Doses are not given at sub-freezing temperatures, but they can only stay reconstituted at room temperature for six hours before having to be wasted.

However, for health care providers, that means either procuring plenty of dry ice or expensive ultra-cold freezers in order to keep the vaccine sufficiently chilled until it is time to administer the doses.

The CPN used some of its CARES Act money to invest in three full-sized and one portable ultra-cold freezers in order to be among the first in the state to receive the Pfizer vaccine. Combined, the four freezers have enough space for about 400,000 doses - more than enough to meet the needs of CPNHS but also act as a hub for OCA IHS and the Pottawatomie County Health Department with storage capacity.

Captain Brian Wren is the pharmacy and lab contact for OCA IHS. He said his agency's partnership with CPNHS has been a key component in IHS' vaccine rollout efforts.

"The robust capacity within this health system for ultra-cold vaccine storage allows us to have greater flexibility among our sites," Wren, Doctor of pharmacy, CHC Area Pharmacy & Lab consultant/AVPOC, OCA IHS. "It allows us to move vaccine to our other sites from the central hub. So essentially this collaboration has allowed us to be more efficient with our distribution processes and reach more individuals with vaccine much more quickly."

Health care providers and tribal elders were among the first to receive vaccinations from the doses allocated to CPNHS. Senior housing residents and long-term care and senior housing residents also obtained priority consideration for vaccine access.

Additionally, the nation spread early doses across multiple essential departments within the tribe in order to maintain operations in the event of a worsening outbreak or natural disaster. Among the departments with a handful of employees getting vaccinated early on include information technology, electrical, emergency management, law enforcement, first responders and Pottawatomie County Rural Water District No. 3, which the tribe owns and operates.

"Our clinics are in rural Oklahoma," Dr. Vascellaro said. "Occasionally the power goes out. Occasionally the water goes out. Occasionally the heat goes out. Occasionally the air conditioning goes out. Occasionally the internet goes out. On top of our augmented work flow but still significant normal clinic functions, I've got hard working, dedicated medical providers, nurses, lab techs and others working outside in the COVID-19 tents in the ever-changing Oklahoma weather ranging from 100 degrees this summer to 20 degrees or less. They must have air conditioning and heat to function for long hours in a consistent manner especially when COVID-19 patient testing and evaluation needs are high.

"If the water goes out, we can't keep the clinic open. We've had a few departments that have been almost come to a halt operationally from COVID exposures and cases."

With many people initially skittish about taking the COVID-19 vaccine, inoculating tribal officials and leaders in various departments has also provided an opportunity for tenured, respected employees to give testimonials to debunk rumors and be an up-close-and-personal demonstration of the Pfizer COVID-19 vaccine's efficacy.

Neither vaccine has microchips, and no formal studies have documented any link between either medication and fertility issues. As per the Mayo Clinic, neither vaccine is made with fetal tissue or egg. The vaccine also does not integrate into your DNA, according to the CDC website.

However, at least for a day or two, the muscle pain at the injection site is real, and people can have side effects including fever, chills, body aches, fatigue, dizziness, etc. especially after the second dose. However, almost all side effect symptoms Dr. Vascellaro has seen resolve within one to two days from onset.

"I chose to lead by example and take the vaccine early. My arm was a little sorer than a flu shot, but less sore than a tetanus shot," Dr. Vascellaro said.

For more information about the vaccine and Citizen Potawatomi Nation Health Services, visit potawatomi.org/COVID-19 or cpn.news/health.