Plan — VDH Plan for Equitable Distribution of COVID-19 Vaccine (January 4, 2021)

Summary

The Virginia Department of Health, Division of Immunization, Office of Epidemiology, dated this plan for equitable distribution of COVID-19 vaccine January 4, 2021. It says Item 299 I of the 2020 Appropriation Act required the department to convene a work group. Its background traces a unified command system set up in March 2020, a Vaccine Unit formed in June 2020, and a COVID-19 Vaccine Advisory Workgroup established in August 2020. It says the FDA granted emergency use authorization to Pfizer-BioNTech on December 11, 2020, and to Moderna on December 18, 2020. It lists challenges including varying cold-chain requirements and the need for socially distanced vaccination practices.

Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used

Cite this document

“Plan — VDH Plan for Equitable Distribution of COVID-19 Vaccine (January 4, 2021).” Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2021-rd24-50db718c50/, SHA-256 4fe61673c6a2377c6e496045876f7f38e1d92ab54f1f307bf28a7df10c53cb86.

Full text

VDH Plan for Equitable Distribution of COVID-19 Vaccine
Division of Immunization, Office of Epidemiology
Virginia Department of Health
January 4, 2021
VDH Plan for Equitable Distribution of COVID-19 Vaccine – January 2021

Introduction
During Special Session I of the 2020 General Assembly, Item 299 I of the 2020 Appropriation
Act required the Virginia Department of Health (VDH) to convene a work group to (i) evaluate
the methods by which vaccines and other medications necessary to treat or prevent the spread of
COVID-19 are made available to the public, (ii) identify and develop a plan to implement
specific actions necessary to ensure such vaccines and other medications are equitably
distributed in the Commonwealth to ensure all residents of the Commonwealth are able to access
such vaccines and other medications, and (iii) make recommendations for any statutory,
regulatory, or budgetary actions necessary to implement such plan. The bill requires that the
work group include the Commonwealth's Chief Diversity, Equity, and Inclusion Officer and
representatives of the Office of Health Equity at VDH, the Department of Emergency
Management, and such other stakeholders as the department shall deem appropriate and which
may be an existing work group or other entity previously convened for a related purpose. Finally,
the bill requires VDH to make an initial report on its activities and any findings to the Chairs of
the House Committee on Health, Welfare and Institutions and the Senate Committee on
Education and Health by December 1, 2020, and shall report monthly thereafter.

Background
In March 2020, the Commonwealth of Virginia established a unified command system to
manage the state-level response to COVID-19. In June 2020, the Vaccine Unit was formed under
the Public Health Surveillance and Guidance Workgroup to conduct planning and coordination
of COVID-19 vaccination. In August 2020, the Vaccine Unit established a COVID-19 Vaccine
Advisory Workgroup, made up of a diverse group of stakeholders, to provide ongoing input
regarding vaccination planning and communications using a health equity lens. This past fall,
VDH developed Virginia’s COVID-19 vaccination plan, which was exercised with partner state
agencies. This plan continues to be updated in collaboration with local health districts, the
Virginia Emergency Support Team, and the COVID-19 Vaccine Advisory Workgroup as more
information becomes available. The most current information, including the plan, is available at
https://www.vdh.virginia.gov/immunization/covid19vaccine/.

Findings
COVID-19 Vaccines Available in the United States
As of December 31, 2020, the U.S. Food and Drug Administration (FDA) had issued emergency
use authorizations (EUAs) for two COVID-19 vaccines. Pfizer-BioNTech submitted its
application, including trial data, to the FDA requesting emergency use authorization (EUA) on
November 20, 2020 and the FDA granted the EUA on December 11, 2020. On November 30,
2020 Moderna submitted its application, including trial data, to the FDA requesting EUA on and
the FDA granted it on December 18, 2020.
Vaccine Allocation
The Centers of Disease Control and Prevention’s (CDC) Advisory Committee on Immunization
Practices (ACIP) and the National Academies of Sciences, Engineering, and Medicine have
published guidance on populations of focus for COVID-19 vaccination and equitable access to
COVID-19 vaccination in the United States. ACIP reviews evidence on COVID-19

2
VDH Plan for Equitable Distribution of COVID-19 Vaccine – January 2021

epidemiology and burden, as well as COVID-19 vaccine safety, vaccine efficacy, evidence
quality, and implementation issues, to inform recommendations for COVID-19 vaccination
policy.

ACIP voted on December 1, 2020 to formally recommend that COVID-19 vaccine be distributed
during Phase 1 in three timeframes: Phase 1a, 1b, and 1c. ACIP recommended that during Phase
1a, COVID-19 vaccine be allocated to healthcare personnel (HCP) and long-term care facility
(LTCF) residents. ACIP recommended that among LTCF groups, vaccine first be allocated to
skilled nursing facilities, then to assisted living facilities, then to residential care communities,
then to intermediate care facilities for individuals with developmental disabilities, and then to
state veterans homes.

ACIP ethical principles for allocating initial supplies of COVID-19 vaccine, namely to maximize
benefits and minimize harms, promote justice, and mitigate health inequities, support this
decision. LTCF residents, because of their age, high rates of underlying medical conditions, and
congregate living situation, are at high risk for infection and severe illness from COVID-19. As
of November 15, 2020, approximately 500,000 COVID-19 cases and 70,000 associated deaths
had been reported among residents of skilled nursing facilities in the United States. As of
December 1, 2020, approximately 245,000 COVID-19 cases and 858 COVID-19-associated
deaths had been reported among U.S. HCP. Early protection of HCP is critical to preserve
capacity to care for patients with COVID-19 and other illnesses.

In response, the Virginia Disaster Medical Advisory Committee (VDMAC) and the Virginia
Unified Command voted to adopt ACIP recommendations in Virginia. The Virginia Disaster
Medical Advisory Committee (VDMAC) provided guidance on how to prioritize vaccine within
subgroups of healthcare providers. However, they stressed the importance of not missing
opportunities to vaccinate HCP out of strict adherence to prioritized groupings, with the goal of
administering vaccine in Virginia as quickly as possible. Vaccine is being allocated to HCP who
are public/patient facing and not able to perform their duties remotely. The Virginia Department
of Health (VDH) estimates that there are more than 500,000 HCP and LTCF residents in
Virginia.

On December 20, 2020, the Centers for Disease and Prevention Advisory Committee on
Immunization Practices (ACIP) recommended that in Phase 1b nationally, vaccine should be
offered to people ≥75 years of age and to frontline essential workers (non–health care workers).
In Phase 1c, vaccine should be offered to people 65–74 years of age, people 16–64 years of age
with high-risk medical conditions, and essential workers not recommended for vaccination in
Phase 1b.

The Virginia Unified Command will issue guidance during the first week of January on
Virginia’s allocation groups for Phase 1b and 1c. The Virginia Unified Command is considering

3
VDH Plan for Equitable Distribution of COVID-19 Vaccine – January 2021

recommendations from the VDMAC. The Virginia COVID-19 Vaccine Advisory Workgroup
provided comments to VDMAC to consider in making its recommendations.

Vaccine Distribution

The majority of LTCF residents and staff in Virginia elected to receive vaccinations from CVS
and Walgreens’ teams onsite through CDC’s Federal LTCF Pharmacy Partnership. VDH notified
CDC on December 10, 2020 that it was activating Part A of the contract as of December 14,
2020 and allocated Pfizer vaccine for that purpose.

The first shipment of vaccines from Pfizer-BioNTech were received in Virginia on December 14,
2020. The Pfizer-BioNTech vaccine requires ultracold storage (negative 70 degrees Celsius) and
was distributed to geographically diverse health care systems with ultracold storage capacity.
They were provided for HCP. Healthcare systems and local health departments are now holding
vaccination clinics, utilizing both Pfizer and Moderna vaccine, for healthcare personnel across
the state. Local health districts are developing plans to ensure opportunities for non-hospital
healthcare personnel to get a COVID-19 vaccine. Together with healthcare systems, they are
making plans to hold vaccination clinics for providers in their areas. Local health districts are
reaching out to practices to engage them in this process. Opportunities for vaccination will
continue to increase.

CVS and Walgreens began onsite vaccination in skilled nursing facilities on December 28, 2020.
Part B of the CDC’s Federal LTCF Pharmacy Partnership provides for vaccination in assisted
living facilities, continuing care retirement communities, personal care homes, residential care,
adult family home, adult foster home, intellectual or developmental disabilities, HUD 202, and
Veteran's homes. On December 31, 2020, VDH notified CDC that it was activating Part B of the
contract as of January 4, 2021 and allocated Pfizer vaccine doses for that purpose. CVS and
Walgreens will begin to contact facilities to schedule clinics. VDH anticipates that vaccination
will begin in mid-January in facilities covered by Part B.

Virginia expects future COVID-19 vaccines to be allocated to the Commonwealth by the federal
government on a weekly basis. The amount of vaccine and the timing of when Virginia will
receive it will depend on the capabilities of the manufacturers to produce the vaccine safely.
When first doses are shipped, the U.S. Government sets aside doses for second dose allocation.
They are allocated at the appropriate interval in addition to vaccine allocated for people to
receive their first dose.

VDH established a dashboard on its website to keep people apprised of the number of vaccine
doses distributed in Virginia and the number of doses administered. It is updated daily. As of
December 31, 2020 a total of 388,100 doses of COVID-19 vaccine had been distributed from the
two manufacturers to 110 sites in Virginia, including healthcare facilities and local health

4
VDH Plan for Equitable Distribution of COVID-19 Vaccine – January 2021

departments, and 64,882 people had been reported to VDH as receiving a vaccination. The
number of doses of vaccine administered shown on the vaccine dashboard will always lag behind
the actual number of doses administered. Providers must record vaccinations into the Virginia
Immunization Information System (VIIS), and there is a delay between the recording and
availability of this information. VIIS is a confidential, secure registry containing vaccine
information provided by participating providers to individuals of all ages.

Statutory, Regulatory, or Budgetary Actions
The COVID-19 vaccine landscape is complex and evolving. These complexities include the
likely need for a two-dose series; vaccine products not being interchangeable; varying
presentations and efficacy and adverse event profiles in different populations; varying cold-chain
requirements; unknown ability to administer to children and pregnant women; the need for
socially distanced vaccination practices; communication and education; and distrust of public
health among some high-risk groups. In order to ensure a successful mass vaccination campaign
once vaccines become available, VDH will require funding to support the purchase of equipment
and ancillary supplies and also will require funding for information management staffing;
support for local health districts; warehousing and shipping; and a statewide communications
campaign. The Governor has included language in his budget to support expected COVID-19
vaccine expenditures through June 2022.

Conclusions
The COVID-19 vaccination response is complex and will continue to evolve. VDH continues to
update its planning on new information and expects continued adaptation as new vaccines are
introduced and other considerations arise. VDH will continue to publish new information on its
external COVID-19 vaccine website as it becomes available.

File and source

File: 2021-RD24.pdf
Size: 408,613 bytes
SHA-256: 4fe61673c6a2377c6e496045876f7f38e1d92ab54f1f307bf28a7df10c53cb86
Our copy: 2021-RD24.pdf
Original: No public link identified.