The first 100 doses of the Pfizer COVID-19 vaccine arrived Tuesday morning at Lakeside Pharmacy in Antigo.

From the hub in Marshfield, the 20 vials were delivered by the Wisconsin State Patrol in an unmarked car. The vaccine is closely guarded, and the trooper said he could not say if he had stopped elsewhere after leaving Marshfield or if he had other stops with more vials.

“It’s like a puzzle,” said Pat Frey, Lakeside pharmacist. “It’s a puzzle to get it, a puzzle to prepare it for use, and then a puzzle to get it to the right people.”

The vials of vaccine, each containing five to seven doses, are good for up to five days while remaining frozen at temperatures about 15 degrees below zero. Initially, they must be kept frozen at 94 degrees below zero. Once the vials left Marshfield, the 120-hour countdown began.

After being taken from the freezers at Lakeside, the vials rest for about 30 minutes to warm up to room temperature. Then, once a vial is opened, the vaccine must be distributed within six hours. After that, any unused vaccine must be discarded.

Shortly after receiving the vaccines, pharmacists were en route to a few community-based residential facilities (CBRFs) and other medical sites in the community with staff who qualify as Tier 1a employees, the group of people now eligible for the vaccine.

Frey said pharmacy staff visited the CBRFs to distribute the vaccine and make plans to return in a few weeks to administer the required second dose.

Coordinating the vaccinator and the people getting the vaccine is up to the Langlade County Health Department.

“This vaccine is prioritized for health care workers and long-term care residents and staff,” according to a statement from the health department. “We will continue in Phase 1a until the majority of persons in this category get their vaccine. The health care systems in our area have been vaccinating their staff, and pharmacies have been vaccinating staff and residents in skilled nursing homes, with plans to expand to other long-term care staff and residents in the next few weeks.

“We have reached out to health care workers who are not affiliated with a health care system and are ensuring that they are linked to a vaccine provider.”

Pharmacists will follow federal guidelines in administering the vaccine, including the most important rule—don’t waste the vaccine.

If a vial is opened but not used completely, Lakeside employees will be provided the vaccine.

“We’re unique from a stand-alone pharmacy in that we have so many in the store who has contact with customers,” Frey said.

Looking ahead, other groups who will become eligible for the vaccine, as determined by the Centers for Disease Control and Prevention, will be elderly residents, teachers and others.

“When we get to that stage, we’ll have to have appointments to ensure we can go through an entire vial,” Frey said. “We don’t want to open a vial for a 10 a.m. appointment and then not have another until 3 (p.m.). We will have to stagger people a little, because each person should really stay and sit for 15 minutes after the shot. It’s another piece of the puzzle.”

Eligible Phase 1b people have yet to be definitely determined by state officials.

“Currently, Phase 1b includes ‘essential workers’ and those over age 75,” the health department statement reads. “The DHS Vaccine Distribution Subcommittee of the State Disaster Medical Advisory Committee (SDMAC) will define who an essential worker is, prioritize which workers will receive the vaccine in the initial Phase 1b rollout, and provide further age-related guidance.”

Phase 1c would follow. Phase 1c is anticipated to include adults ages 65-74 and individuals aged 18-64 with underlying health conditions.

Pharmacists administering the vaccine were required to learn about the vaccine through an online program.

“All vaccinators need to have a comprehensive vaccination plan in place,” the county health department said. “It is estimated that it will take four to six weeks per phase. Vaccine efforts rest on three equally important tiers: adequate demand, adequate delivery system and adequate supply.”

The federal government decides how much vaccine each state receives. Once per week, state officials ask registered vaccinators how much vaccine they can use for the following week, and then makes decisions on how to allocate it. In mid-December there were 108 agencies registered to give vaccine in Wisconsin. There are now more than 1,000.

Frey said determining how much to request can be confusing. Vaccines and associated supplies are delivered a week after the request is made. The pharmacy received its first order Tuesday, but that is also the deadline day to request more vaccine for next week.