“You have heard me refer to today as D-Day,” said Gen. Gustave Perna, the chief operating officer of Operation Warp Speed, the public-private partnership speeding the development of vaccines and therapeutics. “Some people assumed that I meant the day of distribution. In fact, D-Day, in military, designates the day the mission begins. D-Day was a pivotal turning point in World War II. It was the beginning of the end. D-Day was the beginning of the end, and that’s where we are today.”

The initial distribution to hospitals, which are battling climbing case counts and mounting deaths, marks the beginning of one of the most complicated logistical missions in U.S. history. Nearly 3 million doses of the vaccine, manufactured by Pfizer and BioNTech, are being sent by plane and guarded truck. The shots must be stored at ultracold temperatures.

Perna said boxes were being packed and loaded with vaccine following Friday’s green light from the Food and Drug Administration, and would begin moving Sunday morning from Pfizer’s manufacturing facility in Kalamazoo, Mich., to FedEx and UPS hubs nationwide.

Vaccine, he predicted, would arrive at 145 sites, mostly large hospital systems, on Monday, with another 425 sites receiving supply on Tuesday. The final 66 of the 636 locations poised to receive doses in the first round of Pfizer shipments would receive their supply on Wednesday, Perna said.

The general made clear that earlier-than-anticipated clearance from federal regulators, which took place late Friday instead of Saturday after pressure from the White House, did not alter the timetable for the distribution or actual administration of the shots. Delivery, he told reporters on Saturday, had to occur when “professionals are available to receive it, and then eventually administer it.” He added, “Our ultimate goal was to get it there no later than Monday morning.”

The initial shipments include just 2.9 million doses, with an equivalent amount set to be shipped 21 days later for a booster shot. According to recommendations from the Centers for Disease Control and Prevention, the nation’s 21 million health-care workers and 3 million residents of long-term care facilities should receive the vaccine first. A CDC vaccine advisory committee is expected to issue guidance Saturday stating that the vaccine should be administered to people 16 and older, paving the way for immunizations to begin.

Health-care workers, who have been prioritized because of their exposure to the virus and critical role in sustaining the nation’s strained health-care system, will begin receiving the shots within days. Inoculation at long-term care facilities could begin by the end of the week, Perna said. Separate kits with needles and alcohol wipes are being shipped so as to sync up with vaccine batches at each site, underscoring the complex choreography of the operation.

The general tempered his confidence with an acknowledgment of the challenges involved in a mass vaccination campaign against a rampaging virus, with limited supplies available for a country of 330 million. “We know that the road ahead of us will be tough,” Perna said.

Hospitals have spent months grappling with the ethical and logistical challenges of distributing the vaccine. At some institutions, intensive care unit staff members will receive priority; others include those who work in housekeeping or with cancer patients or newborns. Hospitals wrestled with whether to include those working with covid-19 patients in full protective gear ahead of masked staff members interacting with people who may be asymptomatic carriers.

The vaccines are arriving as hospitals are overwhelmed with covid patients. As of Friday, more than 108,000 were hospitalized nationwide, according to Washington Post data.

At many health-care institutions, surveys are quietly being sent out, lotteries launched and invitations issued to one of the most highly anticipated events of 2020: the opportunity to get in line for a shot. At the same time, institutions are trying to combat hesitancy among staff members concerned about a brand-new vaccine.

On Thursday, Temple Health in Philadelphia emailed 3,000 invitations to employees deemed at “high risk” of infection. Within minutes, housekeepers and anesthesiologists began sending in their RSVPs. And within 24 hours, every one of the 252 slots at the main campus’s vaccination site was taken.

The rate of uptake seemed likely to assuage Chief Medical Officer Tony S. Reed’s fears that vaccine hesitancy will keep people from signing up, wasting precious vaccine. Among the first takers, who will likely start receiving shots Wednesday, will be people working on covid-19 floors, in the emergency room and at the Fox Chase Cancer Center, where the goal is reducing risk to patients who have little ability to fight off infection.

The goal is simple, Reed said: “To do the most good for the most people.”

With a second vaccine from Moderna expected to follow suit shortly, as many as 40 million doses could be delivered by the end of the year — enough to vaccinate the CDC’s first priority group.

The Pfizer-BioNTech vaccine presents another logistical challenge. Hospital officials this week watched a company video walking through each daunting step of distribution: trays containing 195 vials of vaccine can be at room temperature for no more than five minutes while being transferred from frozen storage to an ultracold freezer or three minutes for transfer between low temperatures and thawing. The vaccine must remain in frozen storage for at least two hours if it is put back in an ultracold freezer after room temperature exposure.

In Philadelphia, all of the city’s the hospitals will be receiving vaccine, either directly from the federal distributor or from the city health department’s ultracold storage.

“We know we’re in a unique situation in that our city is small enough that we can feasibly distribute from our facility,” said James Garrow, the department’s director of communications, “provided [the hospitals] can administer them quick enough.”

The multi-facility Cleveland Clinic has set up a “refrigeration farm” with rows of gleaming white freezers capable of keeping the vaccine at Antarctic temperatures. The yawning atrium at the UF Health Jacksonville hospital in Florida is being turned into a vaccination site. And other hospitals are preparing to receive the ancillary supplies needed for the finicky Pfizer vaccine.

On Thursday, a package needed to administer the Pfizer vaccine suddenly showed up at the University of Pittsburgh Medical Center’s Presbyterian hospital, including vaccination record cards, masks, visors, information sheets, syringes and the diluent that needs to be mixed with every dose before it is injected.

Other hospital systems are devising their own approaches. In Detroit, close to Pfizer’s Kalamazoo plant that will ship out vaccine, the Henry Ford Health System will put health-care workers such as anesthesiologists who are at high risk for exposure first in line, spokesman David Olejarz said.

But much depends on the supply of vaccine.

Dora Anne Mills, who is overseeing the vaccine rollout for MaineHealth, which operates 10 hospitals, said they may get around 970 doses in this first round for the entire hospital system — covering a fraction of the 17,000 patient-facing employees the system would like to vaccinate as soon as possible.

“We are all facing the same dilemma. How do we stabilize the hospital systems at a time when we have so many doctors and nurses out because of covid exposure?” she said.

The hospital has been holding Zoom sessions to explain the vaccine to staff and convince them that it is safe to take. Mills said she is fine with her two adult children receiving the vaccine; she was not over the summer, but is now convinced of its safety and efficacy.

At Salt Lake City-based Intermountain Healthcare, a 23-hospital system that serves Utah, Idaho and Nevada, officials have asked those in the first group to receive the vaccine to sign up at the end of their week of shifts in case they have mild to moderate side effects in the days after they get the vaccine.

In Minnesota, which has reported one of the nation’s highest per capita rates of infection, state health officials have meticulously planned for months the rollout of the vaccine. The Minnesota Department of Health designated 25 main distribution hubs around the state that will deliver the vaccine to 118 smaller facilities, including in rural areas.

Gov. Tim Walz (D) said the state had embarked on several “dry runs” in recent weeks, trying to game out “every possible scenario” in the distribution process using a box sent by Pfizer containing “everything but the vaccine.”

But as obsessively as the state has planned, Walz acknowledged lingering concerns, including access to dry ice, which Walz said could pit the state and health-care industry against Upper Midwest cheese and dairy producers that use dry ice to ship cheese curds.

In Florida, Gov. Ron DeSantis said this week that the state expects to get 180,000 doses of the Pfizer-BioNTech vaccine in the first release. Of those, 100,000 doses will go to five hospitals that can store the finicky vaccine.

The rest of the doses will go to nursing homes and long-term care facilities, and will be administered to both patients and staff, the governor said.

“It’s a very fluid situation, things are changing. But the plan is to get it on or before December 15,” said John Couris, president and chief executive of Tampa General Hospital.

Couris noted some hesitancy among staff and will plan for that.

“If we say you must take the vaccine, if you don’t, what are we going to do? Terminate them?”

At the UF Health Jacksonville hospital, the atrium will allow for social distancing and also has space so those who get vaccinated can be monitored for 15 minutes after receiving the shot. The space is large enough to accommodate 500 to 1,000 people a day, said Leon Haley Jr., chief executive of UF Health Jacksonville and Dean of the University of Florida’s College of Medicine.

Haley said he doesn’t know how many doses to expect. He will be videotaped getting one of the first doses of the vaccine as a PSA for other staff.

“We definitely have some people that are very enthusiastic, they can’t wait to be in first,” Haley said. “But we have a couple of people that are still on the bubble.”

Riverside Health System, based in Newport News, Va., will receive 975 doses for five hospitals. It expects to start vaccinating personnel at the highest risk for covid exposure Wednesday, including doctors, nurses and housekeeping staff, said Cindy Williams, Riverside’s chief pharmacy officer.

Like many hospital systems, Riverside’s loading dock operates Monday through Friday. If the vaccine is shipped Sunday, the hospital would receive it Monday. Ancillary supply kits of needles and syringes are being sent separately.

“There are so many moving pieces,” Williams said.

The system is used to administering flu shots, but must change its clinic layout for the coronavirus vaccine to allow for social distancing and recipients to be monitored for 30 minutes post-jab.

The health system had previously surveyed employees before news about the efficacy of the two vaccines and found about a third of respondents were willing to get a shot. But a more recent survey this week found that about 60 percent were interested in getting the vaccine, Williams said.

At the University of Pittsburgh Medical Center, a team of in-house experts is reviewing the vaccine data, to double-check the FDA’s decision before vaccinations are given to health-care staff.

“We have convened our group of experts to independently review the data on these vaccines,” Graham Snyder, medical director for infection prevention and hospital epidemiology, said at a briefing this week. “I want our experts … to tell us that the vaccines are safe and effective to use in our communities.”

Lauren Sauer, director of operations at the Johns Hopkins Office of Critical Event Preparedness and Response, which has hospitals in the District, Florida and Maryland, said she is concerned about the emotional burdens being placed on already exhausted health-care workers as they are turned into role models. They will be asked about their experience and whether they did or did not take the vaccine, she said, possibly for personal health reasons.

“We are asking them to take a brand-new vaccine and then in addition to be advocates for patients, friends, family members,” Sauer said.

“That is a lot to ask during a pandemic.”

Andrew Becker in Salt Lake City, Lori Rozsa in West Palm Beach, Fla., Kayla Ruble in Detroit and Cid Standifer in Cleveland contributed to this report.

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