How a bounty of vaccines flooded a small hospital and its nearby college

Reviewed by Emily Henderson, B.Sc.Feb 1 2021

When administrators at Hillsdale College, a conservative liberal-arts school in Michigan, heard its local hospital didn't have a way to store the Pfizer-BioNTech covid vaccine, they offered the use of its science department's ultra-low temperature freezer. The vaccine must be stored at minus 94 degrees Fahrenheit.

With that help, the small hospital — employing about 400 — was able to receive vaccines from the state: 1,950 doses in late December, more than twice what it requested, according to the hospital CEO.

Two weeks later, college faculty, staffers and administrators were among 900 people who received vaccinations at an on-campus clinic run by Hillsdale Hospital, even though college workers were not in the state-recommended priority groups eligible to get the vaccine in Michigan. The clinic was also open to faculty at the local beauty college.

Meanwhile, the number of doses allocated to the public health department of Hillsdale County, home to 46,000, was only 400, leaving the department scrambling to try to vaccinate front-line health workers in the region.

The hospital's willingness to vaccinate Hillsdale College faculty outside of recommended state guidelines following the loan of a refrigerator comes amid growing concern nationally that younger, healthier, more privileged or merely lucky people can "jump the line" while others in the priority groups can't get shots.

The twists and turns of how Hillsdale Hospital got more doses than it could initially give away speaks to the ad hoc, chaotic nature of the vaccine distribution process nationally, in which state, county and local officials complain about not knowing week to week how many doses they will receive to dole out. Some places initially got more than they needed, while others, like the Hillsdale County health department, received far less.

Decisions on who gets a dose often fall to local officials including, as in the case of Hillsdale, the hospital CEO, who first tried to get all front-line health workers vaccinated, then held another clinic for which he pegged eligibility to occupations with exposure to the public, such as pharmacists, hospice workers and educators.

Hillsdale College's staff members were on the list. That was surprising — raising some eyebrows — because the school's leaders have strongly opposed Democratic Gov. Gretchen Whitmer's closure of in-person classes, hosted an in-person graduation in defiance of state mandates against large gatherings and reportedly were prepared to go to court if Michigan extended campus closure rules into this spring. The student newspaper had an opinion piece this fall cautioning against the rush to a vaccine as a threat to liberty and health. The school garnered national attention in September when its Washington, D.C., campus, hosted a conference in Virginia at which then-attorney general William Barr compared covid closure rules to slavery.

It started with the college's freezer

Set amid the rolling hills of south-central Michigan about 90 minutes from Detroit, Hillsdale is a small town whose largest employers are the college, with about 800, and Hillsdale Hospital, the county's only hospital, with 47 beds, along with a 40-bed skilled nursing facility and about 400 full- and part-time employees.

The college held in-person classes for much of the year, requiring masks only in public spaces inside buildings, but professors could request students wear them in class.

As of Thursday, Hillsdale County has recorded more than 3,000 since the pandemic began, with 68 deaths.

Around the time Whitmer closed all campuses to in-person classes in November as cases spiked, there were 76 active cases at the college and 179 people were in contact isolation, the school paper reported.

Hillsdale Hospital had initially requested 800 doses of the Moderna vaccine from the state health department, said Jeremiah J. Hodshire, the hospital's president and CEO.

The Moderna product does not require ultra-cold storage.

Once the hospital secured the use of the college science department freezer, it modified its application, requesting instead the Pfizer product, which comes as 975 doses packed inside special ultra-cold transport containers, Hodshire said.

To officials' surprise — and without explanation — the hospital received two shipments of 975 doses of the Pfizer vaccine, meaning they had lots leftover.

"We were concerned," Hodshire said, and called state officials for an explanation, but ultimately kept them.

Many localities have complained of the unpredictability of these precious shipments from the federal government to the states and on to the localities, with most places getting far less than they need or requested.

What if they gave a vaccine and nobody came?

With a generous supply to dispense, the hospital faced another distribution dilemma. In an area of the country where many people are skeptical about covid, vaccines and government, there wasn't a throng of vaccine takers.

Though the hospital in late December first offered vaccines to its 400 employees, as well as local doctors, dentists, nursing home staffers and their residents, turnout was low. Only about 400 doses were given. Hodshire received his vaccination, he said, after all the workers at his hospital who wanted one received a shot.

There are "a lot of nay-sayers in the community," said Hodshire, who used his weekly podcast and Facebook Live events to assure listeners the vaccines were safe. Every time, he said, "we get people saying, 'You are government agents, you are evil.'"

For the approximately 1,500 doses left, Hodshire arranged a vaccination clinic at a large conference hall at the college — not far from the fridge — and staffed by hospital personnel, along with an assist from the National Guard and volunteers from the small local health department.

He invited optometrists, pharmacists, and K-12 educators. But he also added a group not specifically included in the state priority list for the next phase: higher education employees, including those from the local beauty college — not based on age but, he said, on whether they had direct dealings with students or families. (The state, meanwhile, was about to move to add seniors to its priority list.)

Hodshire pointed to federal guidelines that say groups can overlap to ensure efficient distribution of available vaccine supplies.

More than 200 higher education staff members received shots from that batch of 1,500. No students were vaccinated, a college spokesperson said in an email.

"There was no quid pro quo" for use of the refrigerator, said Hodshire, 45; the goal was to find demand to meet supply.

The college, he said, had made no secret of its intent to revive on-campus classes, "whether the government allowed them to or not." Leaving college staff members to mingle with students on campus and off, without an opportunity for vaccination, "would have been egregious on my part."

The hospital, Hodshire said, shared those plans with the state and received no pushback.

Michigan Department of Health and Human Services spokesperson Lynn Sutfin said in an email that the agency does not collect or approve plans from hospitals about vaccination efforts.

But, she added, "we do not want providers to waste vaccine and would rather they provide vaccine to someone outside of the prioritization groups as opposed to losing doses."

Even after the early January clinic at the college, the hospital had 340 doses left.

So, it set another clinic for late January, offering sign-ups to day care workers, bank employees, clergy and grocery clerks — again, with a requirement that all be involved in public-facing positions.

At the same time, the country's health department was having the opposite experience — struggling with scarce supplies to vaccinate those in the first eligibility group, health care workers. Later in the month, the health department opened eligibility to the state's next priority group, which included other essential workers and seniors, resulting in jammed phone lines and fully booked appointments.

All 400 of its initial allotment of vaccines were from Moderna, because the health department does not have an ultra-cold storage freezer, said the county's health officer Rebecca Burns.

"The hospital hasn't opened [vaccination clinics] to 65 and older seniors," Burns said. "If they were to do so, they would have a huge response."

Moving forward

At the hospital's late January vaccination clinic, 50 health care workers who sat out the first round stepped forward for their shots.

Only then did the facility expand sign-ups to those 65 and up for the remaining 225 slots, which were left after interested clergy, day care and other retail workers signed up.

"They filled within 12 minutes of registration going live," wrote hospital spokesperson Rachel Lott in an email.

For the last full week in January, the county health department learned from the state that it would get 300 more vaccine doses, Burns said. The hospital would get 100 doses, this time of the Moderna vaccine, Hodshire said. It plans to distribute them at a joint clinic with the county health department set for an upcoming weekend.

"Moving forward, we are going to be partnering with them to serve all the eligible populations as we have vaccine available," Lott wrote.