Alaska

Alaska’s COVID-19 Vaccine ECHO (Extension for Community Healthcare Outcomes) is a partnership with the State and with Alaska Native Tribal Health Consortium (ANTHC) to provide COVID-19 vaccine planning and operation updates. It uses videoconferencing technology to connect a team of interdisciplinary experts with primary care providers, other health services professionals, and community members. These videoconferences create virtual learning communities by connecting Alaska’s COVID-19 experts with specific audiences on specific topics. Additionally, to reach public and consumer audiences, the Vaccine Communication/Education Team will implement a blend of paid, earned, and owned media.

The Alaska Native Tribal Health Consortium (ANTHC) is a non-profit Tribal health organization designed to meet the unique health needs of Tribal people living in Alaska. In partnership with the more than 180,000 Tribal people that we serve and THOs of the Tribal, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction. ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,000 employees offering an array of health services to people around the nation’s largest state.

Alabama

Arizona

Arizona Department of Health Services (ADHS) submitted its Draft Arizona COVID-19 Vaccination Plan but is not as of yet publicly available. According to an update on the ADHS website on October 20th:

To inform this draft plan, ADHS has worked since April with a large and diverse group of stakeholders that includes county and tribal public health, outpatient healthcare providers and associations, inpatient healthcare providers and associations, payors, pharmacy and EMS stakeholders, and state and local emergency management agencies. This partner involvement and feedback is so critical to making sure that Arizona has the best possible plan for vaccine distribution, and also includes the development and implementation of training and exercises to inform the state’s pandemic vaccine response.

The Draft Arizona COVID-19 Vaccination Plan highlights Arizona’s local allocator model, which designates county health departments and tribal health partners as the local authorities responsible for approving vaccine allocations to providers within each jurisdiction. It also focuses on the importance of communication, as the CDC anticipates a vaccine requiring two doses spaced three to four weeks apart.  

The vaccination program will be led by a state advisory committee referred to as the Vaccine and Antiviral Prioritization Advisory Committee which will be comprised of a group of experts from ADHS and its partners.

Source

Arkansas

California

Colorado

Demonstration of proactive communication strategies for second-dose reminders

The Colorado Department of Public Health and Environment’s (CDPHE) will work with local public health agencies (LPHA) to determine where vaccines should go within their jurisdiction. Colorado will analyze the results of an initial COVID-19 Vaccine Provider Interest Survey and coordinate with Local Public Health Agencies (LPHA) to determine the vaccination providers who will be initially enrolled in the COVID-19 Vaccination Program for Phase 1. The state will use the Colorado Immunization Information System (CIIS) to track the data.

Second-dose reminders

Colorado will strongly encourage COVID-19 vaccination providers to schedule a patient’s second-dose appointment when they receive their first dose as patients are more likely to present for a second dose if the appointment is already on their calendar. Whenever possible, second-dose reminders will come directly from the COVID-19 vaccination provider who first immunized the patient as patients are more receptive to receiving messages from trusted and known sources. Proactive scheduling of second-dose appointments can also assist COVID-19 vaccination providers with planning and anticipated inventory needs.

For COVID-19 vaccination providers without existing mechanisms for performing second-dose reminders, Colorado will promote the use of the CIIS which has a reminder/recall report feature and can be run by LPHAs by county level population. This feature also has the capability to reprocess the same reminder/recall run and generate a report of those patients who have become up-to-date since the initial reminder/recall report was generated and those patients who are still not-up-to-date. The state has created a Patient Reminder/Recall training toolkit for clinics which includes training videos, best practices, guidance on reviewing the quality and accuracy of the clinic’s data before running a reminder/recall, and templates for reminder messages. The state also recently invested in a health messaging system (Teletask) that enables them to send automated phone messages, text messages. Lastly, Colorado will have a Public Portal available which provide secure access for patients to have another method by which they can stay on top of their COVID-19 vaccine schedules.

Delaware

The Delaware Division of Public Health submitted an executive summary for its COVID-19 vaccine plan to the Centers for Disease Control and Prevention during the week of October 26th. The plan itself is currently not publicly available.

Source

Florida

While Florida’s COVID-19 Vaccination Plan is not yet publicly available, it has been reviewed and summarized by Tampa Bay’s news station, WTSP. A link to that article and video clip is available for this summary. Florida’s Department of Health is integrating a planning structure based on lessons learned from the H1N1 pandemic, such as by “increasing the inclusion of community partners to provide vaccinators.” All 67 county health departments will be directly involved in vaccination administration. The DOH will be using an “Incident Command Structure” comprised of experts and representatives from the immunization program, epidemiology, EMS, long-term care associations and others. The Department of Health will be coordinating their vaccine efforts with hospitals, pharmacies, correctional facilities, homeless shelters, community-based organizations, long-term care facilities and public safety agencies. The vaccine distribution currently considers the following groups to be priority recipients though it is subject to change at the time a vaccine actually becomes available: health care personnel, essential workers, those with medical conditions placing them at high-risk for COVID-19 complications, and adults who are 65 years of age, or older.

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Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

New Hampshire

While New Hampshire’s full comprehensive COVID-19 vaccination plan is not publicly available, there is some information on it as reported by New Hampshire Public Radio (NHPR) on October 22nd. Lori Shibinette, commissioner of the state Department of Health and Human Services, said that the plan had been submitted to the CDC on October 16th and have already noticed a need to amend the document in light of new information on long-term care testing with vaccinations. New Hampshire is the only state in the nation without an immunization database. This may be a problem if it is not ready by the time a vaccine becomes available, however Shibinette said the state is working to have an immunization database ready by early December and that they have “two or three other options that [they] will use until the registry is up.”

Source

New Jersey

New Mexico

• NMDOH’s Public Health Division manages the public health offices throughout the state 
• The Epidemiology and Response Division is leading surveillance and data analytics

New York

Overall management of New York’s vaccination program will require a Vaccine Central Command Center (VC3) to oversee all aspects of vaccine delivery, administration, and other operational aspects of the program. The VC3 will operate within the existing New York State Incident Command structure following sound emergency response principles, in concert with the ongoing broader pandemic response to ensure that all partners clearly understand each other’s roles and responsibilities. Pandemic vaccination planning, distribution, and monitoring will require close collaboration between state and local public health, external agencies, and community partners. The VC3 will include representatives of state agencies that will be charged with managing all aspects of the COVID-19 vaccine program in close coordination with local public health, healthcare, and community-based organizations.

To administer the vaccine, New York State will rely on an established network of health care providers, including hospitals, LTCFs (nursing homes, adult care facilities (ACFs), assisted living), Federally Qualified Health Centers (FQHCs), Community Health Centers, Rural Health Clinics, private provider offices, local health departments, and other entities that will serve as Vaccination Administration Sites (VAS). In addition, the state will work with commercial and independent pharmacies, businesses, and other organizations to enable on-site vaccination at these sites. Other VASs include schools, colleges and universities, homeless shelters, correction facilities, and sites where target populations gather (i.e., senior centers, social service offices, food pantries, etc.) New York State will plan for quick activation and mobilization of mass vaccination point of dispensing (POD) sites, designed to be operationalized once vaccine availability increases and outpaces provider administration capacity. In addition, New York State will designate mobile vaccination units, similar to the rapid response team testing efforts that have been deployed statewide to help control viral spread and outbreaks to increase access to hard to reach populations including smaller congregate living facilities.

Since the onset of the COVID-19 crisis, New York State has worked in close partnership with local health departments (LHDs) across the state. To support local health departments in the administration of the COVID-19 vaccine, New York State will: advise each LHD regarding storage requirements for vaccines that the LHD may be expected to store and/or administer; ensure they are prepared to fully implement their local mass vaccination plans in accordance with State and Federal guidance; advise on protocols for building public trust in the vaccine, and provide technical and logistical assistance as needed. New York State government, as authorized by the state legislature in statute, has throughout the COVID-19 crisis made uniform and consistent decisions for the entire state regarding public health emergency response, a successful model that has helped New York flatten the curve. To ensure coordinated and efficient statewide distribution and administration, all localities, vaccine recipients and administration entities in New York State will be required to follow the state’s central planning process and guidance for COVID-19 vaccination.

The New York State Immunization Information System (NYSIIS) is a confidential, secure, web-based system that collects and maintains demographic and immunization information in one consolidated record for persons of all ages in New York State (outside of New York City). NYSIIS will be the system for pre-ordering vaccine, ongoing tracking, reporting, and collecting of priority group information. Facilities and providers, including hospitals, nursing homes, adult care facilities, clinics, pharmacies, Federally Qualified Health Centers (FQHCs), and additional public and private providers will be trained and enrolled in NYSIIS.

An online website for New Yorkers seeking information regarding vaccine eligibility and appointment scheduling will be available that offers a vaccine eligibility screening tool and a vaccine administration site locator. Individuals will be able to enter information on the website to see if they meet vaccine eligibility In addition to the support services offered online, a call center will be available for patients and providers to access live support to raise any issues with vaccine access and delivery. A robust data analytics program will track issues that are identified and processed through the call center and online support modules to enable quick action to troubleshoot common issues as they arise. Websites and call centers will be designed to offer support for all New Yorkers including for those with disabilities, non-English speakers, and those with limited language proficiency. New York State will work closely with partners statewide who can assist in ensuring that all public communication is done in a way to ensure that those with health inequities are represented and ensure that access to vaccine is not a barrier for underserved communities. Achieving high rates of vaccination will depend upon a successful and robust public education campaign and properly executed communication strategy. The state will launch an ongoing public education campaign to ensure New Yorkers have the latest, and most accurate, information related to the facts about the vaccine itself, the progress and success of the program and all critical information needed regarding access to vaccination. In addition, engagement with community organizations, localities, tribal nations, and healthcare providers is essential to ensure critical information is distributed reliably to all New Yorkers.

North Carolina

The North Carolina Office of Emergency Medical Services Healthcare Preparedness Program (OEMS HPP) will leverage existing partnerships and develop new ones as needed to ensure successful implementation of the state COVID-19 vaccination plan. Local Health Departments will serve as a conduit of information to their local stakeholders and community regarding vaccination planning and implementation. They will also assist with technical assistance from stakeholders within their county or counties and serve as vaccination sites. North Carolina Division of Public Health will send a representative, as needed, to the SEOC during vaccination operation implementation and be the lead agency for LHD outreach. Other partners will be utilized as needed. Assignment of responsibilities and representatives within each LHD will be determined by each LHD or per respective All-Hazard Plans

The entities responsible for the allocation of the vaccine will be the state of North Carolina allocating to providers, and then the provider will ensure that administration occurs based on priority groups. The distribution role of the state will be to ensure accurate delivery of information provided for each provider and the timely entry of orders. The contract distributor will ensure that vaccines and ancillary supplies are delivered in a timely, temperature-controlled, efficient manner.

NC DPH will conduct bidirectional feedback between LHDs and DHHS Communications to ensure the local perspective is incorporated by leveraging opportunities. NC DPH will provide vetted DHHS Communications messaging to LHDs including: Messages targeted to vulnerable and historically marginalized populations; sharing messaging among LHDs that have been favorably received locally by HMPs. Alerts to LHD patients about flu and COVID-19 vaccine. Messaging via trusted relationships between LHDs and K-12 public schools, institutes of higher education (IHEs), correctional facilities, agricultural and meat-packing businesses. LHDs will work with local emergency management to activate mass vaccination strategies throughout their jurisdictions according to their All-Hazard Plan (AHP). This should include not only clinic-based vaccination, but also community-based, mobile, and non-traditional vaccination sites

The full data, reporting, and performance tracking ecosystem under development includes integration of North Carolina’s COVID-19 vaccine IT systems, including but not limited to immunization information systems (IIS), referred to as the North Carolina Immunization Registry (NCIR), with the CDC’s Vaccine Administration Management System (VAMS) modules, Immunization (IZ) Gateway, Vaccine Tracking System (VTrckS), a potential alternative system, and other COVID-19 data exchanges. As part of this work, data dashboards will be deployed for both internal and external dashboards for analysis and reporting purposes. The dashboards will provide transparent reporting on who is receiving the vaccine, vaccination availability phases, demographics, and more.

North Dakota

COVID-19 vaccination planning falls under the planning section of the Unified Command. After approved, most aspects of this plan fall under the Operations Section, within the Disease Control Branch in the Mass Immunization Group. Provider recruitment will be advertised through various provider associations (North Dakota Medical, Pharmacy, LTC, and Hospital Associations), immunization list serv, and the NDDoH website. Enrollment with the state will be required to receive COVID-19 vaccine; even providers already enrolled as a Vaccines for Children (VFC) Program provider will have to enroll specifically to receive COVID-19 vaccine.

In North Dakota various types of providers are eligible to vaccinate including registered nurses and LPNs, but pharmacy techs in ND are typically not able. Health and Human Services (HHS) recently authorized pharmacists to vaccinate against COVID-19 for individuals 3 and older. Additional detail is expected from CDC regarding priority groups to be vaccinated. The National Academy of Medicine, Engineering and Sciences has finalized a Framework for Equitable Allocation of COVID-19 Vaccine to use as a guide for determining priorities. Nonetheless, North Dakota will have to make decisions regarding how specific doses are allocated.

Vaccine allocation will attempt to distribute vaccine fairly across the state according to the extent that vaccination providers have access to prioritized populations. Priority groups specified by the ACIP and the North Dakota Advisory Committee on COVID-19 Vaccination Ethics will provide recommendations if prioritization among those recommendations are necessary. During Phase 1, large, urban areas will hold mass clinics for outreach to eligible groups (e.g., healthcare workers, essential workers) in addition to supplying vaccine to health systems and long-term care facilities (if targeted by prioritization as expected). If vaccine can be redistributed or transferred, then smaller clinics can be held proximal to high risk populations (e.g., rural health care workers, areas with urban American Indian populations or elderly housing) or carried by vaccinators into homes of the homebound.

A vaccine section was added to the NDDoH COVID-19 website for public communication and updates. The ND COVID-19 hotline will be utilized to answer questions from the public regarding COVID-19 vaccine. In the COVID-19 vaccine enrollment agreement North Dakota will require facilities to post vaccine availability to vaccinefinder.org or a similar vaccine locator website once vaccine is publicly available. Provider enrollment data that is submitted to the CDC twice weekly will also prepopulate vaccinefinder.org with healthcare facility information. A media campaign to promote and educate about COVID-19 vaccination will be developed. It is anticipated that CDC and other partners will also have media campaigns. The joint information system will be used to develop the campaign. As needed, external stakeholders will be consulted regarding communications. The Unified Command Joint Information System can be called upon at any time (24/7) to rapidly disseminate messages through social media, media list serves, etc. This has been exercised throughout the COVID-19 pandemic. All providers must agree to submit the data to NDIIS within 24 hours of administration if they wish to become COVID-19 vaccine providers.

Ohio

The Vaccine Preparedness Office (VPO) consists of ten distinct workstreams to plan and validate vaccine readiness across the entire lifecycle of a vaccine (from ordering, to distribution, administration, funding, and tracking). From the beginning of this pandemic, the Governor’s Office, the Ohio Department of Health, the Emergency Management Agency, and partner departments have been working collaboratively, in partnership with Ohio’s 113 local health departments and local government officials, to prepare and protect Ohioans. Meetings between officials with these organizations occur regularly to align efforts, identify gaps and provide resources. A coordination committee, comprised of local points of contact for all health districts, will be created to streamline communication and logistical coordination between each district and the state.

Ohio plans to begin with the vaccination of high-risk health care workers and first responders during this phase. For the estimation and locating of critical populations, the population was segmented on a county-by-county level using data from medical claims, Bureau of Labor Statistics, U.S. Census, and CMS COVID-19 nursing home data. Ohio, with support from third-parties, has prepared a robust vaccine deployment analytical tool. One of the tool’s capabilities is the ability to select specific critical population groups and size and locate them based on publicly available census, medical claims, labor, and school district and university enrollment data.

Having created a comprehensive criteria list for a potential candidate, the team will create and manage a reference list of all potential providers in the state. These providers could include, but are not limited to: local departments of health, healthcare systems, pharmacies (independent, large chains, grocery stores), long-term care facilities, community health centers (Federally Qualified Health Centers and Regional Health Centers), emergency medical services (EMS), correctional facilities, behavioral health and rehabilitation centers and Ohio Department of Health Internal Constituents (e.g., VFC Program, Perinatal Hepatitis B Program). The state will proactively reach out to these groups through a communication campaign to facilitate registration.

For data collection, Ohio will use the existing IIS system (ImpactSIIS) and connect to the IZ Gateway via Connect and Share. Providers will be responsible for reporting to Ohio’s ImpactSIIS. Providers will be required to send data each 24-hour period. Ohio is still determining what metrics are most appropriate to be posted on a public-facing website.

Oklahoma

The Commissioner of Health is the leader of a centralized public health agency which covers 75 of the 77 counties in Oklahoma. The majority of the Core Team have been critical members of the COVID-19 response in Oklahoma and have established a strong working relationship. Continual communication will occur between the Immunization Division and providers to ensure all requirements or potential complications are addressed. The Vaccination Program Team will ensure state officials stay briefed on vaccine program metrics of success including vaccine uptake, supplies, throughput, and tracking. Local public health officials participate in coordination calls twice weekly related to all COVID-19 related response priorities. Local health departments will continue to keep stakeholders and the general public informed. The program will be engaged with pharmacies, correctional facilities, homeless shelters, community-based organizations, and others.

Healthcare staff working in Long Term Care and Assisted Living Facilities will be the first priority. Vaccine supply for these staff will be initially provided by the state allocation, especially during instances of very limited supply. Later in Phase I and subject to implementation of federal Pharmacy Partners Plan, the majority of Oklahoma’s Medicare Certified LTC/ALFs will come from federal allotments directly provided by national pharmacy agreements. The COVID Vaccine Team will work with the facilities not certified by Medicare to determine the best way to distribute/administer vaccine to their employees. These staff will be vaccinated though closed pods and strike teams via direct shipments to LHDs (the term LHD includes also THD, OCCHD)

Oklahoma began creating a potential pandemic provider list in January 2020 as a required activity under Core grant. Providers were recruited through the Oklahoma Heath Advisory Network (OK-HAN), which reached approximately 5,000 healthcare providers throughout Oklahoma. Vaccines for Children providers were reached through the Immunization Field Consultants (IFCs). Over 515 pandemic providers including LHDs, RHCs, FQHCs, hospitals and others enrolled with Immunization Service before CDC released its provider enrollment forms. The Vaccine Coordinator and Immunization Nurse are leading the provider enrollment effort and have reached out to 70 LHDs. The LHDs (including also THD and OCCHD) will be part of vaccine administration to all populations in phase 1. For phase 1, Local County Health Departments will be used to administer state allocated vaccine to LTC and public health staff through closed PODs and will work with partners to coordinate vaccine to tribally ran LTC and public health programs. Later, the Department of Health will reach out to large hospitals to administer vaccine to their Health Care workers providing direct in-patient care to COVID patients.

COVID-19 vaccine administrations will be collected through a combination of Oklahoma State Immunization Information System (OSIIS), and the Vaccine Administration Management System (VAMS). COVID vaccine reports will be generated through Enhanced OSIIS and SAS software will be used to look at vaccine coverage, inventory, and administrations. These reports will be used to monitor vaccine inventory, administrations, vaccine coverage for high priority and high-risk groups to help ensure maximum COVID vaccine coverage of the Oklahoma population. Oklahoma will use a GIS map for planning of COVID 19 vaccine distribution and administration. Some components of the map will be shared with the public such as COVID Vaccine providers and locations and availability of clinics. Attention and consideration are being given to the level of information being made publicly available, as security of the vaccine at the recipient facility must be ensured.

Objectives for communication include creating awareness of the first phase of distribution to phase 1 populations, developing an awareness and activation campaign that will provide Oklahomans within the phase 1 priority list the information they need to make a decision about getting vaccinated, and arming providers and partners across the state with key information that will allow them to inform and guide Oklahomans as they prepare to receive the vaccine. Oklahoma State Communications team will be working closely with the Oklahoma and Tulsa Health Departments, tribal PIOs, hospital associations to ensure messaging consistency, clarity and accuracy of information being shared from the CDC and the federal government through OSDH to the rest of the state.

Oregon

The Oregon Health Authority (OHA) regulates or administers many of the state's health care programs, such as those administered through the Public Health Division (PHD), as well as Oregon’s Medicaid program, the Oregon Health Plan (OHP). The Oregon Immunization Program is responsible for facilitating the delivery of immunizations. The OIP Vaccine Planning Unit has been formed to coordinate the planning and implementation of COVID-19 vaccine distribution in Oregon. The public health system in Oregon is a partnership between the Oregon Health Authority and local public health authorities. There are structures and processes in place to guide the coordination of public health efforts within counties and statewide. Coordination between state and local authorities to plan the allocation and distribution of the COVID-19 vaccine will follow these established processes. Oregon is building clear communication pathways to facilitate cooperative planning with counties, engage county partners to establish clear roles and responsibilities for counties and the state, and clarify allocation processes to ensure consistent COVID-19 vaccine usage throughout the state.

Oregon intends to leverage existing relationships with currently enrolled Vaccines for Children (VFC) and public access providers, to enroll providers to receive and administer the COVID-19 vaccine. They will also engage Local Public Health Authorities to assist in recruitment, and partner with the Oregon Association of Hospitals and Health Systems, the Academy of Family Physicians, community-based organizations who work with critical populations, the Coalition for Community Health Clinics and Oregon Primary Care Association to advise us on prioritizing enrollment. Finally, Oregon will partner with Coordinated Care Organizations (CCOs), which are contracted by OHA to provide health services for Medicaid members

All providers, current and new, will submit records of all doses administered to Oregon’s Immunization Information System (IIS), ALERT IIS, within 24 hours of administration. Oregon’s communication objectives include providing information to the public about planning, policy, operations using crisis and emergency risk communication principles: Be first. Communications will be proactive and timely. Being first is always balanced by the accuracy needed to maintain credibility, and to be right and respectful in our approach. The state will also ensure messaging and communications are culturally responsive and linguistically accessible. The communication will educate the public about the development, authorization, distribution, and execution of COVID-19 vaccines and that situations are continually evolving. OHA will track several metrics and publish them on the immunization program and COVID-19 website.

Pennsylvania

While the full plan is not publicly available yet, Pennsylvania’s Department of Health has released and executive summary of it. The distribution will use existing agreements with pharmacies to aid in the distribution of the vaccine when it becomes available. During the first phase of vaccination distribution, the DOH will focus its efforts on Healthcare Personnel, First Responders, Critical Workers and individuals with high-risk conditions. The department will utilize a three-phased recruiting and enrollment approach for vaccination providers. Phase 1 is currently under way and focuses on hospitals, Federally Qualified Health Centers, County and Municipal Health Departments, and DOH State Health Centers. Phases 2 and 3 will be expanded to existing Vaccines for Children (VFC) and non VFC providers and pharmacies throughout the commonwealth.

Clear communication is a key function to ensure the public is educated on the COVID-19 vaccine. The Office of Communications will be responsible for utilizing multiple mechanisms to provide vaccination updates to the public. It is anticipated that DOH will use press releases, news briefings, the department website and social media to ensure public confidence in the safety and efficacy of COVID-19 vaccines.

DOH will utilize the CDC COVID-19 Vaccination Response Dashboard to estimate critical population categories, implement data into the administration of vaccine and record COVID19 vaccine administration data. Metrics will be shared via DOH’s existing COVID-19 Data Dashboard on the department’s public website.

Summary

South Carolina

The State has established a Unified Command Group (UCG) to coordinate and unify response functions. It has also established Emergency Support Functions (ESFs) with state agencies and volunteer organizations to support response and recovery operations. County Emergency Management will maintain communication with the State Emergency Operation Center (SEOC). Counties will provide disaster situational updates and forward requests for assistance as necessary to the SEOC.

DHEC is closely monitoring guidance put forth by the CDC's Advisory Committee on Immunization Practices (ACIP), the National Institutes of Health, and the National Academies of Sciences, Engineering, and Medicine (NASEM), and other sources regarding identified populations of focus for COVID-19 vaccination. DHEC will recruit and enroll COVID-19 vaccination providers through ICS Immunizations Branch. They will assemble a pandemic provider enrollment and management team to execute the administrative and outreach functions needed. The lead of this team will be responsible for communicating provider enrollment data to the CDC twice weekly.

DHEC will require vaccination providers enrolled in the COVID-19 Vaccination program in Phase 1 to utilize the VAMS tool for vaccine administration documentation and reporting. For phases 2 and 3, DHEC will require documentation and reporting through a combination of VAMS and the state's immunization information system, SIMON. The DHEC's Immunizations Branch will monitor all planned mobile clinics' reporting status, ensuring that providers fully report their data via VAMS (phase 1 and 2) or the IIS mass vaccination module (phase 2). The DHEC VAMS Coordinator and IIS team will monitor provider reporting via VAMS or the IIS in phases 2 and 3.

Efforts are underway to help keep the public informed on the COVID-19 vaccine. This includes incorporating educational messaging into agency talking points, news releases, and social media copy. The JIC has currently targeted communications efforts at reaching the general population, state and local leaders, and key stakeholders and partners. The JIC will tailor communications to address the initial populations' specific needs identified to be impacted by each phase of the program's role. To support this, the agency is currently working collaboratively with members of the Vaccine Task Force.

Vaccine Plan - Draft

South Dakota

As of October 27th, the full COVID-19 vaccination plan for South Dakota has been submitted according to a report by The Dickinson Press, however the full comprehensive document has not yet been made available to the public. There are not many certain details about what the plan contains. The South Dakota Department of Health officials are currently working on responding to feedback and recommendations made by the CDC on their initially submitted draft.

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Tennessee

The initial TDH COVID-19 Vaccination Program Planning Team included members of the Vaccine Preventable Diseases and Immunization Program team and the Office of Emergency Preparedness. TDH has convened a Pandemic Vaccine Planning Stakeholder group which meets every two weeks and is leveraged to help inform allocation decisions, define priority populations, and identify gaps in knowledge. The group is comprised of more than 28 different offices, agencies, and departments representing public health, rural health, refugee and other minority populations, legislators, experts in bioethics, medical societies, communications experts, health care coalitions, emergency management, and others. Tennessee is a hybrid state where 89 of its 95 counties report to the State and six metros are independent from the State. Tennessee contracts with these six counties (Shelby, Madison, Davidson, Sullivan, Knox, and Hamilton) to conduct public health activities. Coordination between the State and local authorities occurs through numerous channels, including partnering agencies, medical societies, health care coalitions, and emergency management agencies, in addition to multiple opportunities for partners to participate in calls and webinars (bi-weekly COVID-19 update webinar for clinicians, bi-weekly calls between TDH and metro, regional and local health departments, monthly calls with Tennessee Hospital Association, long term care facilities, and others, bi-weekly press conferences that include the Commissioner of Health, and others).

Ten percent of the State’s allocation of COVID-19 vaccines will be reserved by the State for use in targeted areas with high Social Vulnerability Index (SVI) values. Five percent of the State’s allocation of COVID-19 vaccines will be distributed equitably among all 95 counties. Eighty-five percent of the State’s allocation of COVID-19 vaccines will be distributed among all 95 counties based upon their populations. TDH plans to use Geographic Information System (GIS) mapping and Tiberius functionality to locate/map all critical populations. The state will recruit/enroll all hospitals as vaccine providers and will then start onboarding local and regional pharmacy partners not already working through CDC. The State will also be deploying vaccination strike teams across the state that will be able to conduct on-site vaccination events for targeted populations that may not have ready access to another vaccine provider. Once hospitals and pharmacies are onboarded, they will begin focusing on large employers, urgent care clinics, and community providers that will be able to reach additional individuals within these priority populations.

Tennessee will use the Tennessee Immunization Information System (TennIIS) to collect COVID19 vaccine doses administered by providers. The satellite, temporary and off-site clinics will use TennIIS’ Mass Immunization Module to document COVID-19 vaccine administration at the time of the mass vaccination event. All public health clinics have been trained on TennIIS’ Mass Immunization Module and will be using this module during this fall’s flu mass vaccination events and during the Fight Flu TN event. This will prepare public health users for documenting COVID-19 vaccine administration later this year. Publicly-reported vaccination program metrics may mimic the current format used to report COVID-19 metrics on the THD public website.

Texas

The Texas Department of State Health Services (DSHS) will utilize an internal COVID-19 vaccine planning and coordination team gathered from across the agency, including the Immunization Program. DSHS is collaborating with the Texas Division of Emergency Management (TDEM) and the Texas Emergency Management Council (TEMC) to identify targeted populations and logistical requirements for providing them COVID-19 vaccine. TDEM works closely with local jurisdictions, state agencies, and federal partners to ensure Texas becomes more resilient for future disasters. The TEMC includes 39 state agencies and nonprofit emergency assistance organizations.

Texas will use a combination of publicly available datasets, data provided by CDC, and data from other state agencies, state regulatory boards and private partners to: identify, estimate numbers of, and locate vulnerable and frontline populations via mapping. Critical populations will likely include healthcare personnel likely to be exposed to or treat people with COVID-19, people at increased risk for severe illness from COVID-19, including those with underlying medical conditions and people 65 years of age and older, and other vulnerable, frontline workers.

Texas will implement a statewide integrated communications/outreach/engagement plan. The plan is tiered for providers (recruitment, vaccine administration), the public (information, call to action) and stakeholders (outreach, support and feedback). Key audiences are as follows: healthcare providers; community-based public health partners and coalitions; local and regional health entities; city, regional and statewide elected officials and administrators; municipal departments/agencies; vulnerable and frontline audiences identified by the CDC; and the public. An emphasis will be placed on targeting media outlets favored by the following audiences: vulnerable and frontline workers; people at increased risk for severe illness or death; people at increased risk of acquiring or transmitting COVID-19; and people with limited access to vaccination services.

Texas will use ImmTrac2 as the official repository of data because this will be the basis for the data reported to the CDC and used for their analysis. DSHS will ensure that all the necessary protections are in place for the data in transit and at rest. Due to Texas’s laws governing the Texas Immunization Registry, no individual data will be shared via the CDC Immunization Gateway. Providers must report doses used in ImmTrac2 and complete the reporting process within the VAOS system to keep information on their inventory up to date. This includes reporting doses wasted and transferred. Reporting must be completed within 24 hours of usage, waste, or transfer. Texas will track and monitor progress on providers, vaccine ordering and distribution, and vaccination coverage by county from lmmTrac2.

Utah

The Utah Health Department revealed their COVID-19 vaccination plan on October 21st according to a report by The Salt Lake Tribune. The full plan document does not appear to be publicly available online yet. Utah’s Legislature’s Health and Human Services Interim Committee were informed that the first doses will go to those who staff emergency departments, urgent care facilities, COVID-19 units and long-term care facilities, as well as to those health care workers who have preexisting health conditions.

Rick Lakin, immunization program manager for the Utah Department of Health, noted that in the final phase of vaccine distribution the health department will begin monitoring vaccine uptake “through population data.”

“This will allow us to look at populations within the state of Utah that have low vaccination rates and we maybe want to improve [that] coverage,” he said. “We’ll work with our local health departments to ensure that we can reach out to those vulnerable populations that have not received their vaccine at this point yet.”

Source

Vermont

Virginia

Washington

West Virginia

Wisconsin

COVID-19 Vaccination Plan - Draft
Source: Wisconsin Department of Health Services (DHS); October 2020

Wyoming

Background

About Operation Warp Speed

Operation Warp Speed (OWS) is a multi-agency federal partnership led by the Department of Health and Human Services (HHS), that has been tasked with organizing efforts to accelerate the development, manufacturing, and distribution of COVID-19 vaccines and other countermeasures including diagnostics and therapeutics. The goal of this initiative, as outlined by HHS, is to “deliver 300 million doses of a safe, effective vaccine for COVID-19 by January 2021”.

Vaccine Development

The Departments of Health and Human Services (HHS) and Defense (DoD) have announced billions of dollars toward the development of six vaccine candidates: BioNTech SE/Pfizer, Moderna, AstraZeneca/Oxford, Janssen Pharmaceuticals, Novavax, and Sanofi/GlaxoSmithKline. Congress has allocated roughly $10 billion to this effort through supplemental appropriations in previously passed COVID-19 relief bills including the CARES Act.

As of today, Moderna, BioNTech/Pfizer, and AstraZeneca/Oxford have already begun Phase III clinical trials for their respective vaccine candidates, the final stage of clinical development. The other three companies will follow by the end of the year. Following the completion of Phase III trials, vaccine candidates will have to undergo approval by the Food and Drug Administration (FDA).

Federal Vaccine Distribution Plan

HHS and OWS are seeking to finalize planning for production and distribution of the vaccine as early as possible so that they may begin distribution immediately following FDA approval and authorization.

On September 16, 2020 HHS announced its COVID-19 vaccine distribution plan. The plan was developed in coordination with the Centers for Disease Control and Prevention (CDC) and the Department of Defense (DoD). The agencies released the plan in the form of a brief report to Congress outlining a strategic overview of the plan, and an interim playbook for state, tribal, territorial and local public health programs to begin operationalizing a vaccination response to COVID-19 within their respective jurisdictions.

The plan outlines four main tenets:

• Stakeholder engagement and communication with the public to improve vaccine confidence and uptake.
• Immediate distribution upon FDA approval (within 24 hours).
• Safe administration and availability of administration supplies.
• Data monitoring through IT tracking systems.

While many elements of the strategy are still in process pending the outcome of Phase III trials and the timeline for FDA approval, CDC’s jurisdictional playbook serves as a framework that outlines many preliminary steps states and localities-- especially counties, can be taking now to prepare for vaccine distribution.

The playbook is particularly geared towards CDC Immunization and Vaccines for Children Cooperative Agreement funding awardees. The CDC will distribute federal funding for vaccine preparedness to the 64 jurisdictions with existing cooperative agreements under this program. The agency is also requiring the awardees to submit detailed vaccine distribution plans to their CDC project officers no later than October 16, 2020.

COVID-19 Vaccination Program Planning Basics

The playbook outlines the following guidance to assist jurisdictions in operationalizing and launching a COVID-19 Vaccination Program.

Use of Planning Assumptions & Adaptation

The playbook emphasizes the importance of “full situational awareness” when planning a vaccine distribution program, which involves balancing the information we have on hand, versus what is not yet known about the vaccine; such as the type of vaccine that will be available, how much of it will be available, and what the efficacy will be. The resource includes an appendix of planning assumptions, which should be taken into consideration during early planning efforts.

In addition to planning assumptions, the playbook encourages the adaptation of previous vaccination response plans such as those for H1N1, the seasonal flu and childhood immunization programs.

Following the development of a plan, the playbook encourages the use of tabletop exercises to identify weaknesses, especially for plans involving multiple levels of government and cross sectoral partners.

Development of Internal Planning and Coordination Teams.

The playbook recommends the formation of an internal planning and coordination teams to provide thoughtful insight and expertise from a wide array of state and local jurisdictions. Such jurisdictions may include, but are not limited to:

• Immunization and preparedness professionals
• Legal professionals
• Media and public affairs professionals
• Clinical experts in isolated population fields (e.g. aging, HIV/AIDS, or rural health) 
• Local public health jurisdictions

Development of External Implementation Committees.

In addition to the formation of an internal planning committee, the CDC recommends that jurisdictions leverage external partnerships through the formation of COVID-19 Vaccination Program implementation committees. The members of this committee should represent key COVID-19 vaccination providers for critical population groups, (outlined on page X of this analysis).

Many of the examples provided by the CDC of stakeholders to be included in external implementation committees are county owned or operated, including:

• Emergency management agencies
• Local health departments
• Health systems & hospitals (including critical access hospitals for rural areas, in-patient psychiatric facilities)
• Community Health Centers
• Rural Health Clinics (RHCs)
• Long-term care facilities, nursing homes, skilled nursing facilities
• Correctional facilities

*Please see playbook for full list of suggested stakeholders.

State & Local Coordination

As states work with counties and other sectors of local government around the planning of a COVID-19 vaccination program plan, the CDC playbook emphasizes the importance of aligning areas of responsibility and specific to maximize resources, quality and efficiency of the program and avoid the duplication of efforts.

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

Critical 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:

• Critical Infrastructure workforce: frontline healthcare personnel, vaccinators, school nurses EMS personal etc.
• People at increased risk for severe COVID-19 illness: nursing home and skilled nursing facility residents, people with underlying medical conditions, people aged 65+
• People at increased risk of acquiring or transmitting COVID: racial and ethnic minorities, tribal communities, people incarcerated or detained in correctional facilities, people experiencing homelessness or living in shelters, colleges or universities, people living or working in congregate settings
• People with limited access to routine vaccination services: people in rural communities, individuals with disabilities, the uninsured and underinsured. 

Key consideration for counties:

• Counties officials are trusted public servants in their communities, with the ability to leverage existing partnerships with a variety of stakeholders to rapidly disseminate information through a range of channels.
• County officials should leverage stakeholder partnerships to help identify and communicate with critical populations to ensure equitable vaccine distribution.

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.

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.

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.

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:

• Determine the entity in your jurisdiction responsible for managing vaccine allotments and orders.
• Ensure that eligible vaccine provider sites in your county (local health departments, clinics, community health centers, etc.) are enrolled in your state’s immunization program so that they may receive vaccine allotments.
• Take inventory of existing IT systems used for publicly funded vaccines and ensure all local vaccine provider sites have access to these systems for vaccine ordering and inventory purposes.

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:

• Assess the vaccine provider site’s ability (staff capacity, necessary equipment, and internet access) to adhere to CDC’s data reporting requirements. Report resource needs to your jurisdiction project manager. 

Take Action

The CDC is suggesting that states and local jurisdictions use the playbook to develop their COVID-19 vaccination plans. The plans must be submitted to CDC through the corresponding project officer assigned to each of the 64 jurisdictional awardees of the Immunization and Vaccines for Children Cooperative Agreement by October 16, 2020. See Appendix B for the complete list of the 64 jurisdictions and the corresponding project officers.

Timeline

Key next steps for counties:

• Reach out to your state’s CDC Jurisdiction Project Officer for Vaccine Development to ensure that your county expertise and resource needs are reflected in jurisdictional plans.

• Contact your Representative and Senators to request that Congress provide direct and flexible COVID-19 funding for state and local governments to assist with the acquisition of supplies and resources for vaccine distribution.

Resources

Federal Funding & Mandates for Vaccine Development and Distribution

Partner Organizations

• Local Public Health: An Integral Partner for Increasing Vaccine Confidence (NACCHO)
• NACCHO Infographic: The Impact of COVID-19 Response on Local Health Department Immunization Programs
• Preliminary Framework for Equitable Allocation of COVID-19 Vaccine (NASEM)

Department of Health and Human Services

• Fact Sheet: Explaining Operation Warp Speed
• From the Factory to the Frontlines: The Operation Warp Speed Strategy for Distributing a COVID-19 Vaccine

Centers for Disease Control and Prevention

• COVID-19 Vaccination Program Interim Playbook for Jurisdiction Operations
• Vaccine Storage and Handling Toolkit
• Vaccination Guidance During a Pandemic
• Frequently Asked Questions about COVID-19 Vaccination
• Ensuring the Safety of COVID-19 Vaccines
• How CDC Is Making COVID-19 Vaccine Recommendations
• 8 Things to Know about Vaccine Planning

Food and Drug Administration

• Development and Licensure of Vaccines to Prevent COVID-19
• Emergency Use Authorizations (EUAs)

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.

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. 

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.