The Department of Veterans Affairs began administering its first doses of the newly approved COVID-19 vaccine on the mainland this week. But veterans in Hawaii will have to wait a bit longer.

The VA recently announced its initial 37 vaccination sites that will be receiving the Pfizer vaccine, the first to be approved by the federal Food and Drug Administration. The sites include several regional systems on the mainland as well as the Caribbean VA Healthcare System in Puerto Rico.

The initial doses are for VA health care workers and veterans in long-term care facilities. But the VA Pacific Islands Healthcare System, which is headquartered in Honolulu, wasn’t on the list.

“The initial vaccine distribution sites were chosen based on criteria including freezer availability and the ability to vaccinate a large volume of people quickly,” Amy Rohlfs, spokeswoman for the VA’s Pacific Islands system, told Civil Beat in an email.

Waialua and Mokuleia with Kaena Point, on right side of photograph.
The VA Pacific Islands Healthcare System is responsible for the care of veterans across Hawaii as well as American Samoa, Guam and the Northern Mariana Islands. Cory Lum/Civil Beat

The Pacific Islands system is unlike other VA health care systems around the country. It spans approximately 2.6 million square miles and is responsible for all U.S. military veterans in Hawaii as well as American Samoa, Guam and the Northern Mariana Islands.

The Pacific Islands system also has few dedicated facilities of its own, with some of its operations at Tripler Army Medical Center in Honolulu. The Pentagon announced last week that Tripler will receive initial doses of the Pfizer vaccine for Department of Defense personnel.

In the Pacific, the VA largely relies on partnerships with other hospitals and clinics in the islands to provide for patients.

Even before the pandemic began the VA has been putting an increasing focus on telemedicine to reach veterans spread across the islands of Hawaii and the Pacific and minimize unnecessary interisland travel. But some procedures — like vaccinations — can’t be done remotely.

Transporting and storing the Pfizer vaccines poses unique logistical challenges. They must be kept at subzero temperatures. Patients also must receive two doses about three weeks apart for the vaccine to work.

In Hawaii, the virus has taken a toll on elderly veterans. An outbreak at the Yukio Okutsu Veterans Home in Hilo killed 26 people, leading to an investigation by Hawaii health officials and the VA that found serious problems in the management of infections.

The state subsequently took over administration of the home from Utah-based Avalon Health Care.

Rohlfs said that while the Pacific Islands system “was not selected for the Pfizer vaccine, we expect that the Moderna vaccine will be authorized soon, and our facility may receive vaccine doses through the VA at that time.”

On Tuesday the FDA released favorable data on the Moderna vaccine, which may be authorized as soon as Friday.

Rohlfs said that any veterans hoping to receive the vaccination through the Pacific Islands Healthcare System need to make sure they’re signed up and registered in the system.

Some 56,000 veterans are registered with Pacific Islands Healthcare System.

“The VA’s ultimate goal is to offer vaccines to all veterans receiving care at the VA and all employees,” Rohlfs said.

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