illustration of doctor blasting a virus with a syringe

Gray Matters

The Honor of My Career

A Race to Deliver COVID Vaccines at Michigan Medicine

By Dana Habers

Summer 2021
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This is the story of a life-changing phone call.

Not the life I had built before COVID-19, but the life I found myself drowning in when it hit. The year leading up to that call went something like this:

January 2020, I gave birth to a third child. Joy.

February, the State of Michigan Emergency Operations Center was activated, which meant a sudden return to work for me. Denial.

March, public schools shut down, and my two oldest kids were sent home with all of their belongings. Fear.

April through August was a blur — of risk assessing, disinfectant, decisions I’d never imagined facing, disaster preparedness, field hospital planning, working women resigning, remote education, breastfeeding, Zoom calls with a sleeping infant on my lap just below the camera’s view, running out of supplies and not being able to buy more, news of deaths, thermometers, plastic shielding, masks, and very little sleep. Survival.

September was a turning point — discussions with family about how to safely take calculated risks, our heartbreak over skipped annual traditions, regaining control, and addressing the unsustainability of the current state. Commitment.

October was the call. Action.

 

“This was not a choice, but a calling”

It was our chief medical officer at Michigan Medicine, Jeff Desmond, M.D., whose calm voice and thoughtful words were simultaneously overwhelming and also (oddly) such a relief! He asked if I could help. Our executive leadership had written a charge for a new task force to launch COVID-19 therapeutics and vaccinations across the health system. I would co-lead the effort with Stan Kent, R.Ph., our chief of pharmacy, and Sandro Cinti, M.D., an experienced infectious diseases physician. For a split second, I questioned how I could possibly do one more thing right now and survive. But the thought was quickly eclipsed in realizing this was our way out. This was how I could help. This was not a choice, but a calling.

As introductions began, it felt like I’d been invited to an elite superhero headquarters. Over the next few weeks, I slept even less but excitedly met with amazing colleagues and pulled the team together. We all shared a drive. It was in us and unspoken, gluing us all together. The COVID-19 Vaccine & Therapeutics Taskforce formed fast and on an underlying commitment to a shared goal that was powerful and brought a richness to our work. Every day became a testament to the value, the invincibility, of true multidisciplinary teamwork.

Our task force included experts from all walks of life: ethicists, pharmacists, physicians, infection prevention specialists, supply chain experts, software engineers, writers, data analysts, communications professionals, workflow designers, patient experience liaisons, volunteers, scientists, survey methodology advisers, behavioral psychologists, mothers, fathers, daughters, sons, dog people, cat people … Everyone contributed with all their might, despite incredible personal sacrifice and the toll on our own lives at the time.

Challenges and solutions

December 14, 2020, was our first vaccination. Joy again! The team had become a new type of community. We worked intensely together all hours of the day. learned to prop each other up through hectic days and listen, challenge, and support one another. It has been a sincere honor to be among such brilliant and talented people from across our organization. Words don’t suffice to describe the power of our collective.

New information was becoming available on COVID-19 and the vaccines all the time, a reality that required us to remain nimble and adaptive every second of the way. Tough decisions we made with limited information grew obsolete days, or even hours, later, and our structures required revision along the way. We faced mashups of operational obstacles and ethical quandaries — without enough vaccine supply, who would get it first? How would we deliver this precious resource so perfectly that we waste not a single dose? There were conflicting demands: to stop deaths, we needed to deliver vaccine fast, but also we need to get it to our most vulnerable communities, which required processes that were inherently slower.

We faced repeated criticisms and saw fear continue to swell from our community, and we stood together and steadfast on our guiding principles. Our leaders were present and provided wisdom, support, and gratitude. They felt it too — that drive, that glue.

One of the most unforgettable weeks was in January when the state of Michigan announced movement into Priority Phase 1B, persons age 75+ and front-line essential workers. This news came just after we’d received their letter indicating additional vaccine supply was predicated on the state’s ability to deploy what was already in freezers at the time. We aligned with the local health department and other hospitals on an expansion of Phase 1A, health care workers, to include all essential personnel working for the health system, even if they were not directly involved in patient care. The number of arms now eligible skyrocketed overnight, and vaccine supply went the wrong direction. Some leaders opted to defer their shots to make sure others got shots first.

The rapid expansion of eligible populations was exciting because we were all anxious to open up vaccination to our patients. However, a simultaneous plummet in vaccine supply put the goal to preserve infrastructure required to save lives in direct competition with decreasing COVID deaths. The CDC’s Advisory Council on Immunization Practices had set three goals while supply remained limited: decrease death and serious disease as much as possible; preserve the functioning of society; and reduce the extra burden COVID was having on people already facing disparities. Phase 1A fully aligned to the preservation of infrastructure: our health care system had to remain functional to care for our community, we knew that. We also knew it did so thanks to the efforts of many individuals who would never lay hands directly on a patient. We spent hours discussing how to balance it all. We called other academic institutions across the country to learn from one another and align efforts. There were no perfect answers, but we succeeded in administering every drop of vaccine we were given week after week — with every shot making our entire community safer.

Many weeks we offered all of our appointments to patients, deferring some of our workforce to strike a balance. The state shifted gears and began directing its inbound supply to high social vulnerability ZIP codes, and with Washtenaw County not on that list our allocation remained small for months. We built outreach programs and populated partner clinics with our volunteer vaccinators. We took vaccine to churches and town halls to make it easier to find. We all predicted manufacturers would ramp up production and built our infrastructure to serve thousands of people, but instead watched helplessly as our clinics sat idle. Vaccine supply just kept running out. Many of our patients who were unable to find vaccine appointments became frustrated and angry. It was understandable, and we felt it too. But I believe every shot we gave counted, and helped us collectively come closer to the end of the pandemic. We helped stop spread, and we protected those most vulnerable.

Meanwhile, we not only kept the hospital running but ramped back up to pre-pandemic capacity. Despite imperfection, we achieved pace — always driven to move fast and not waste a single dose, to reach every member of our community who wanted to get their vaccine, to find the arms of the most vulnerable.

“Sticks in a bundle are unbreakable”

Here we are now in the middle of 2021, and the fight against COVID-19 is not yet over. We’ve administered more than 130,000 shots with a vaccine that is a marvel of science. As of mid-May, 58% of Michiganders had received the protection of the vaccine. Hundreds of COVID patients have been kept alive and out of the hospital thanks to the work of our monoclonal antibody therapeutics team. Persistence.

COVID-19 persists, too, and life can still be quite overwhelming. We know more lives will be lost before this is all over, despite our efforts. It is profoundly humbling. There is a Kenyan proverb that says “sticks in a bundle are unbreakable” — words so perfect to describe what we’ve been through and how we’ve made it this far.

And as always with work this crucial and impactful, we will look back and see decisions made or processes we would change if we had to do it all again. One thing I would not change, however, is the team who came together. It’s been the honor of my career to have been called to action alongside this group of steadfast heroes. What this team accomplished is astonishing! That phone call is one for which I will forever be grateful.