The military has begun vaccinating personnel in Hawaii at Tripler Army Medical Center after the hospital received its first vaccines on Tuesday. The military hospital is one of the Department of Defense’s 16 initial vaccination sites to distribute 43,875 initial vaccines.

The Pfizer vaccine must be transported and stored at subzero temperatures. The military initially chose to send the vaccines out in relatively small shipments, fearing that one small mistake could compromise them.

“One of the keys here was to just test the system,” said Col. Martin Doperak, commander of the hospital at a press conference on Thursday. He said so far none of the vaccines that arrived in Hawaii have gone bad.

After the successful delivery to Tripler, the Department of Defense is more confident about delivering larger volumes and is expected to ramp up deliveries. “DOD is going to be pushing it out a little more broadly over the coming weeks,” Doperak said.

Like in many hospitals around the country, Tripler staff found that many of the Pfizer vials they received contained extra doses.

“That basically is kind of a Christmas present for the whole health care system, we basically just say that we’ve increased the amount that we have by 20%,” Doperak said. 

The first doses are reserved mostly for military medical officers, troops, civilians and contractors that are deemed most likely to encounter people with COVID-19. Staff began inoculations on Wednesday.

The military will then continue through a tiered system picking a mixture of personnel considered to either have jobs critical to national security or a higher risk of infection.

“There are some national defense elements that are considered extremely important, we’re gonna hit those right away. But that is a very small fraction of the overall numbers,” Doperak said. He noted that most active duty personnel tend to be younger and physically fit and have lower risk of serious complications with the disease.

The military has been tight-lipped about its infection rates in Hawaii. Tripler tracks military infections and shares that data with Hawaii’s Department of Health and adds them to the state’s total infection count, but Pentagon officials argue that releasing the number of military cases in the state would jeopardize national security.

President Donald Trump has said repeatedly that he believes the military will play a key role in making the vaccine available to the public. This month President-elect Joe Biden wrote in The Atlantic that “the next secretary of defense will need to immediately quarterback an enormous logistics operation to help distribute COVID-19 vaccines widely and equitably.” 

Doperak said that for now, Hawaii’s medical system seems to be ready to move forward with the vaccines without Tripler’s help.

The Department of Veterans Affairs Pacific Islands Healthcare System also has offices and clinics at Tripler. But the Pacific Island Healthcare System wasn’t among the several VA systems around the country to receive the Pfizer vaccine.

The DOD and the VA share facilities at Tripler, but when it comes to the new vaccines they’re working separately. “When it comes to the vaccine, their logistics system is separate from ours, we do not receive stuff for them, they have told us that they have the ability to store the Moderna at minus 20 themselves,” said Doperak.

Hours after Thursday’s press conference at Tripler, the FDA announced it had approved the Moderna vaccine.

Regardless of what vaccines it receives, the Pacific Islands Healthcare System could face unique logistical challenges transporting, storing and distributing them. The system serves about 58,000 registered veterans throughout all the islands of Hawaii, as well as in American Samoa, Guam and the Northern Mariana Islands.

Doperak said that in the immediate future Tripler will continue to rely on the Pfizer vaccine, so that vaccines like Moderna that are able to be stored at warmer temperatures can go to hospitals and clinics that don’t have ultracold capacities.

“The key is going to be as it becomes more widely available, as many people getting this as possible, because the other key point here in the public health realm is we’re shooting for 70%,” said Doperak. 

Vaccines Are Voluntary For Now

Health experts broadly agree that a vaccination rate of at least 70% is needed to build herd immunity. In Hawaii, only 44% of residents say they’ll take the vaccine when it becomes available according to a November survey from the University of Hawaii’s Public Policy Center.

The U.S. military requires all active duty troops to get flu shots annually, as well as several other vaccinations to ensure the health of the force. But since the current vaccines were approved under emergency use authorization, the COVID-19 vaccinations aren’t mandatory for Department of Defense personnel — at least not yet.

Nevertheless, officials said that service members are enthusiastically volunteering. “We have well over 50% of the folks volunteering to get the vaccine,” said Col. Ingrid Lim, Deputy Commander for Medical Services. “The responses run from ecstatic and excited and can’t wait, to those who are, you know, it’s just another vaccine.”

So far Tripler has seen no serious side effects.

Now that all the military vaccines are on the island and accounted for, Tripler staff have begun distributing the vaccine to other military installations across Oahu. They’re tracking each vial carefully as they transport them to military clinics across the island safely.

“Once you take it out of the freezer, it’s got to be used within five days. So we’re coordinating this very closely, making sure that not a single dose is lost,” he added.