Vaccinating People in Puerto Rico

A woman gives an educational presentation to Puerto Rico’s healthcare and vaccine providers about COVID-19 vaccination.

Liliana Sanchez-Gonzalez gives an educational presentation to Puerto Rico’s healthcare and vaccine providers.

When Puerto Rico needed help getting people vaccinated against COVID-19, a CDC team rolled up its sleeves and got to work.

The U.S. Caribbean commonwealth has been heavily affected by COVID-19, with more than 100,000 infections and 2,000 deaths  among its 3 million people. As vaccines began to move toward authorization at the end of 2020, the Puerto Rico Department of Health (PRDH) asked for technical assistance to plan a vaccination campaign. Five people from the CDC office in San Juan were given the immense task of getting vaccines into people’s arms to help stop the pandemic.

The Puerto Rico-based team normally studies dengue, a mosquito-borne disease common in the region. Since the beginning of the pandemic, CDC has supported local response efforts with data analysis, epidemiology, laboratory science, and other services.  With this experience, the dengue team was able to quickly turn its focus to getting COVID-19 shots in arms.

The CDC Puerto Rico team was led by Gabriela Paz-Bailey, lead epidemiologist, and included Oscar Padro, IT specialist, Liliana Sanchez-Gonzalez, epidemiologist, Eunice Soto, recruitment specialist, Jeffrey Ramos-Kuilan, logistics specialist, and Jesus Rodriguez, emergency management specialist. They worked hand-in-hand with PRDH and other partners to develop a COVID-19 vaccination implementation plan.

Public health professionals conduct site visits to assess centers vaccination capacities.

Gabriela Paz-Bailey, Angel Rivera, and Alexandra Conde conducted site visits to assess centers vaccination capacities. Each site received recommendations for improvements and quickly implemented them.

The team developed online resources to speed up the process of getting vaccine providers enrolled, helping increase the number of providers from 20 to more than 550.

“PRDH was receiving many calls and emails from providers about how to register, slowing the process considerably,” Oscar says. “We developed new digital tools that improved their workflow, including an online provider registration form.”

Working with the Puerto Rico National Guard, Jeffrey helped develop a vaccine distribution inventory system that shipped vaccines to central hubs, where Guard troops then distributed them to providers. This system provided the most complete island-wide data on total vaccines distributed.

Meanwhile, Eunice identified and enrolled vaccine providers to ensure island-wide coverage and that reached those with greatest need. “Puerto Rico has a solid healthcare infrastructure with experienced vaccine providers,” she says. “Hospitals, federally qualified health centers, and primary care centers were quickly brought up to speed to become the first line of vaccinators. Recruiting non-traditional vaccine providers in rural areas, where fewer vaccine providers were available, was essential to ensure availability across the island.”

In addition, the team trained more than 1,000 healthcare providers and vaccination staff on how COVID-19 vaccines work and their possible side effects. After the CDC team left, PRDH’s Immunization Program experienced trainers like Angel Martinez, Veronica Rodriguez, Ivette Maldonado, and Jesus Alvarado have continued using the established systems to train nearly 20,000 providers in Puerto Rico.

Liliana was tasked with ensuring that providers “had all the training and education resources they needed,” she says. “First, we developed a COVID-19 vaccination website with online training and education materials. The Spanish website quickly became one of the top online resources for information on COVID-19 vaccines. We also developed resources to help providers correctly and safely prepare and administer vaccines and to inform them about allergic reactions, side effects, and situations to avoid when administering COVID-19 vaccines.”

Public health professionals interview a vaccine provider to better understand challenges faced during vaccination.

Eunice Soto interviews a vaccine provider to better understand challenges faced during vaccination.

In a fast-moving environment, when new programs and initiatives are being rolled out, clear and timely communication is essential. The team established weekly “office hours” when the Immunization Program could share strategies, priorities, and newly developed materials, coordinated by Alexandra Conde, the program’s evaluator. Gabriela kept communication flowing between CDC, PRDH leadership, and the Immunization Program, led by Angel Rivera and PRDH physician Iris Cardona as Incident Manager.

“Working hand-in-hand with the dedicated staff from the PRDH was one of the highlights of my deployment,” says Gabriela. “I was impressed by Iris Cardona’s leadership as the incident manager. In a high-stress situation, she was able to keep everyone focused on our main goal of getting shots in people’s arms.”

Other CDC field assignees from Atlanta, including Eddie O’Neill, senior public health advisor, Jenny Concepción-Acevedo, public health advisor, and Milton Martinez, public health advisor, also provided full-time support to PRDH and ensured a smooth transition once the team completed their deployments. Milton Martinez is the CDC assignee to the Immunization Program and has been working non-stop leading operations for vaccine distribution.

The collaboration between CDC and PRDH has supported the successful implementation of the COVID-19 vaccination plan in Puerto Rico. By April, the island had received over 1.5 million vaccine doses, and quickly distributed about 99 percent of those to vaccine providers. The remainder are scheduled to be distributed. To date, more than 702,199 people have received at least one dose of vaccine and nearly 400,000 are fully vaccinated.

Despite multiple challenges, the CDC team and the PRDH Immunization Program’s efforts are already proving effective. Deaths due to COVID-19 continue to fall, including deaths in long-term care facilities.

“Under the leadership of Iris Cardona and Angel Rivera, and the PRDH Immunization Program staff, the CDC field assignees and deployment team facilitated the administration of more than half a million vaccines throughout the island in about three months,” Gabriela says.  

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