Counties invest heavily in local residents' health and well-being and have been on the front lines of our nation’s response to the coronavirus pandemic. Counties support over 900 hospitals, 824 long-term care facilities and 1,943 local health departments- entities that will play an integral role in the distribution of a COVID-19 vaccine. This toolkit is aimed at providing counties the information and resources needed to plan for and equitably distribute the COVID-19 vaccine at the local level.
Track: COVID Vaccine Administration
- Doses administered per 100k residents
- Doses distributed per 100k residents
- Doses distributed
- People with at least one dose
Background and Resources
About the Vaccines |
COVID-19 Vaccine Tracker
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County Role in Vaccine Distribution |
As gatekeepers of the local health and human service safety net, counties will play an essential role in the development and implementation of vaccination programs. The County Role in Vaccination Program Implementation 1. Leveraging Local Expertise. According to profile data from the National Association of County and City Health Officials (NACCHO), most local health departments provide direct immunization services; 90 percent offer adult immunizations and 88 percent offer childhood immunizations. These departments therefore have a solid foundation of expertise in planning and administering vaccine and immunization programs. Counties must advocate that states leverage this experience and expertise to ensure COVID-19 vaccination planning efforts make best use of established practices and resources for implementation. 2. Increasing Vaccine Confidence. Vaccine confidence is defined as the trust that parents, patients, or providers have in recommended vaccines, the providers administering those vaccines, and the processes and policies that lead to the development, licensure, manufacturing and recommendations for use.[1] County officials and local public health agencies must work directly with individuals in their communities to address vaccine hesitancy, combat vaccine misinformation, and increase vaccine confidence. 3. Advocating for Necessary Resources. A survey conducted in June of 2020 by NACCHO revealed that immunization programs in local health departments were the most impacted by COVID-19 through the redirection of funding and the loss of staff. The findings also suggested that while the majority of local health departments (71%) are prepared to give COVID vaccines, they will need additional resources to do so. [1] National Association of County and City Health Officials (2020). Local public health: an integral partner for increasing vaccine confidence. Retrieved September 22, 2020 from https://www.naccho.org/uploads/full-width-images/factsheet_Local-Public-Health-Increasing-Vaccine-Confidence_july-2020.pdf |
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Priority Populations |
The CDC has convened a group of professional organizations which include the National Institutes of Health (NIH) and the National Academies of Sciences, Engineering, and Medicine (NASEM), to determine which populations should be prioritized for COVID-19 vaccinations and ensure that there is equitable access to COVID-19 vaccination availability across the U.S. The working group will decide on priority populations through the continuous review of evidence on COVID-19 epidemiology and burden as well as COVID-19 vaccine safety, efficacy, evidence, quality and implementation findings. In addition to priority populations, the CDC is encouraging jurisdictions to include a plan to expand vaccine availability beyond priority populations to specific, “critical” populations that jurisdictions are encouraged to consider in their planning efforts:
Key consideration for counties:
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County Communication Plans |
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Vaccine Allocation, Ordering, Distribution & Inventory |
Allocation Each jurisdiction will be allocated a certain amount of the COVID-19 vaccine by the federal government, which will be managed by the jurisdiction’s immunization program. The allotted amount will change over time based on availability and population priority. Each week on Tuesday, states and jurisdictions will be provided allocations that are available to ship the following week.
Ordering Local distribution sites and enrolled providers will order the COVID-19 vaccine by the jurisdiction’s immunization program. The playbook specifies that jurisdictions may use existing IT systems and procedures in place for routine ordering of publicly funded vaccines (e.g., IIS/ExIS upload to CDC’s VTrckS for provider direct order entry). Jurisdictions will also use these systems to communicate with CDC about vaccine supply and allocations. Alongside vaccine allocations there will be ancillary supplies sent to jurisdictions which include needles, syringes, and PPE. States and jurisdictions will order based on their allocated amounts for that week and direct Operation Warp Speed to where shipments of the vaccine should be delivered. Distribution COVID-19 vaccine allotments and ancillary supplies will be provided by the federal government at no cost to vaccination providers. The vaccines will be shipped to provider sites that enrolled in the jurisdiction’s immunization program within 48 hours of order approval. Because of vaccine storage requirements, ancillary supplies will ship separately from the vaccine. The federal government has a contract with McKesson Corp. to be a centralized distributor of Covid-19 vaccines, with the exception of Pfizer’s, which has set up its own distribution network. Inventory The playbook advises that COVID-19 vaccination provider sites will be required to report inventory of COVID-19 vaccines, and jurisdictions will have to ensure this inventory information is submitted with each new order. Vaccines that are authorized under an Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) will vary slightly from product that receive an approval from the FDA, which has implications for the expiration date of the product. Key consideration for counties:
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Vaccine Administration, Documentation & Reporting |
The playbook specifies that each vaccination provider site is required to report certain data elements for each dose administered and within 24 hours of the administration. Required data elements include detailed information about the vaccine administration site, as well as information about the vaccine recipient (see page 53 of the playbook for full list of discreet data elements). While provider sites may use approved Immunization Information Systems (IIS) or other external systems for tracking, all vaccine administration data must be reported to the CDC’s Immunization Data Lake. The CDC recommends that jurisdictions assess the capability of COVID-19 vaccination providers to meet federal and jurisdiction-specific reporting requirements before or upon enrollment, which includes ensuring that sites have trained staff, necessary equipment, and internet access. In addition to reporting vaccine administration, vaccination sites and jurisdictions must implement processes to track first and second vaccine dosages for those vaccines requiring boosters. The information systems being used to track the vaccine administration must also be able to exchange data with other jurisdiction’s systems and/or the CDC ‘s Immunization Data Lake to obtain immunization history, if applicable. Key consideration for counties:
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Policy Priorities & Call to Action |
Counties are critical to any national vaccination effort. In order to be best positioned for success in our efforts to get residents vaccinated we will continue to work with Congress and the administration to obtain the following:
Reach Out to Your Congressional RepresentativeTo assist with our efforts to get direct and flexible aid to counties for vaccines and other COVID-19 mitigation efforts we are asking that you contact your congressional representatives and request their support. |
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Resources |
Partner Organizations
Department of Health and Human Services
Centers for Disease Control and Prevention
Food and Drug Administration |
EXAMPLES OF CORONAVIRUS RELIEF FUNDS (CRF) USES FOR VACCINE DISTRIBUTION
Find more information and examples on county CRF uses here.
Sacramento County, California Population: 1,552,058 CRF allocation: $181,198,725 Plan Overview: Sacramento County plans to allocate $3 million in CRF funds to purchase supplies and resources necessary to effectively distribute a COVID-19 vaccine when it is approved and made publicly available. These expenses include the purchase of “syringes, refrigeration bags, trucks and trailers”. As of October 22, the county has already approved $250,000 in CRF dollars to purchase two trucks and two trailers “to transport supplies to medical points of dispensing sites called MPODs”. The county described these MPOD sites as “pop-up clinics…designed to quickly distribute the vaccine to massive amounts of people”. For more information, click here. |
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Pima County, Arizona Population: 1,047,279 CRF allocation: $87,107,597 Plan Overview: Pima County spent $3.4 million to purchase a 43,500-square-foot warehouse to store PPE and eventually a COVID-19 vaccine. Although CRF dollars were not directly used for the purchase, County Administrator Chuck Huckleberry said “that it was made possible by dollars freed up by the CARES Act and other federal funding”. For more information, click here. |
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Tippecanoe County, Indiana Population: 195,732 CRF allocation: $6,263,207.00 Plan Overview: Tippecanoe County allocated over $120,000 of its CRF sub-allocation from the state to cover expenses related to its COVID-19 vaccine clinic. For more information, click here. |