Crucial Elements in Jurisdiction COVID-19 Vaccine Planning
Planning for COVID-19 vaccine when available is causing state and local health departments a lot of angst these days. COVID-19 vaccine planning, normal routine vaccine administration and the impending onslaught of influenza have been heralded as the triple threat for jurisdictions to combat in the coming months… and they are very focused on these threats, though in many different ways. Regardless of the approach, there seem to be a number of different elements for any jurisdiction to consider. These include:
- Pre-registration: Obtaining an indication of interest from provider organizations in regard to administering COVID-19 vaccine when available. The interesting thing about pre-registration during the pandemic is the need to expand beyond the usual providers within a jurisdiction to include other non-traditional healthcare professionals who do not typically vaccinate children or adults, but who may be called upon once a vaccine is available. These may include specialists such as dermatologists, mental health specialists, OB/GYN, etc.
There are several ways of capturing a provider organization’s interest in COVID-19 vaccine administration that include leveraging survey data from Redcap, Survey Monkey or other survey tools. A key consideration in collecting this data is storing the response as to whether the vaccine would be administered during Phase 1 to critical workers and high risk populations or in Phase 2 to the general population. This response will determine the priority for onboarding these providers down the road.
- IIS Enrollment: Creating a provider organization profile and obtaining a signed Centers for Disease Control and Prevention (CDC) COVID-19 vaccine provider agreement. Jurisdictions expected the COVID-19 enrollment process to be similar to current registration processes for the Immunization Information System (IIS), but CDC is requiring use of a seven-page document with the need for the provider organization information, as well as data specific to the individual healthcare professionals affiliated with the organization, and storage capabilities and specificity for each organization. This is essential as the COVID-19 vaccines have defined storage needs and shelf lives that must be strictly adhered to for efficacy and safety of the vaccine and the recipient.
There are several options for gathering this information as several vendors scrambled to develop online fillable versions of the new CDC COVID-19 provider agreement. HLN developed an online Vaccine Provider Agreement System (VPAS) application for the New York City Citywide Immunization Registry (CIR) that can be used by other jurisdictions. VPAS allows for controlled access to the application for multiple users and electronic signatures of required individuals. Invitations with custom generated URLs and tokens can be electronically triggered to colleagues with requests for contributions to the agreement data. VPAS data can be uploaded to the CDC based on the CDC-specified format or exported for subsequent importing to the local IIS.
- Onboarding: Most IIS have defined onboarding processes for routine vaccinating providers and have taken the time to fully test them to ensure data quality and conformance with national standards. These processes allow for electronic reporting via HL7 messages of vaccine doses administered and support automated inventory decrementing to yield available doses on hand. With non-traditional healthcare providers administering COVID-19, these onboarding and reporting processes may not be as familiar or even supported by their internal systems. Therefore, it will be up to the jurisdiction’s Immunization Program to communicate and train these new sites. Given the timing of the COVID-19 vaccine being available, there may be a need to refine or streamline these processes to onboard new vaccinators easily and quickly. Training has become a significant component to COVID-19 vaccine planning. The CDC is providing materials and resources to assist jurisdictions with training on the Vaccine Administration Management System (VAMS) they are developing for jurisdictions that choose to use it.
- Ordering/allocating vaccine: Ordering is another crucial element to the COVID-19 planning, with many questions being asked in terms of who will be responsible for ordering the vaccine, distributing and allocating it. A key question is to where the vaccine will be shipped, as this is a significant part of the planning given that most of the COVID vaccines will require specialized storage and handling.
The current plan is to have all ordering of the COVID-19 vaccine done in CDC’s Vaccine Tracking System (VTrckS), which leverages the system that most provider organizations and healthcare professionals are familiar with, would require the least amount of training and would be integrated to allow for the ordering and upload of vaccine from the jurisdictions’ IIS directly into this system.
The distinction between VAMS and VTrckS is that VTrckS is the main system for IIS to request vaccine and track its distribution and allocation. The VAMS application will focus on the administration of the vaccine to consider who will provide the dose, when and where it will be administered, and how the data will flow once the dose is given.
- Mass vaccination clinics: It is anticipated that the initial supply of COVID-19 vaccine will be limited; to be administered to critical workforce and high-risk populations in Phase 1 as recommended by the Advisory Committee on Immunization Practices (ACIP). It is also envisioned that the supply would increase over several months to allow for vaccinations to the general population as Phase 2. While jurisdictions await these critical recommendations, they are planning for the administration of the vaccine to these targeted populations, either in Phase 1 or Phase 2 through a variety of methods. These include, onsite at Assisted Living and Long Term Care Facilities, in closed points of dispensing (PODs) specifically to invited persons such as employees or first responders, or in a drive-by mobile clinic at a local health department.
Regardless of the method, the process remains as: recipients need to register for the clinic, schedule an appointment, complete a questionnaire and/or consent form, receive the vaccine dose and certificate of administration, and the vaccine administration to be reported in near real time to the CDC. Jurisdictions are considering leveraging CDC VAMS, their existing IIS, another tool such as PrepMod or Azova Vaxigo to manage this end-to-end process or perhaps use a hybrid approach with certain tools used for various steps in the process.
- Reporting: Another element in the COVID-19 vaccine planning is CDC’s requirement for reporting. Jurisdictions will submit information about the provider organizations and participating healthcare professionals who enrolled in item #2 above twice a week. In addition, once vaccinations begin for COVID-19, jurisdictions will be expected to report the vaccine doses administered through mobile clinics, closed PODs or any other method in as near real time as possible. Many jurisdictions are grappling with the reporting requirements for primarily two reasons: first, their IIS collects this data, though may not be capable of reporting the data in real time to the CDC according to recently-released specifications, and second, that there may be jurisdictional rules or regulations that prevent the sharing of this data with anyone without disclosure to the patient.
Planning for COVID-19 vaccine is the primary focus of so many individuals and organizations in preparation of ensuring that all people can safely receive the vaccine when it is available. With information coming out on a daily basis and jurisdictions making decisions with information they have at any certain time, the public health community is working toward a plan that works for them and their residents.