COVID-19 vaccine implementation Nancy Messonnier, MD 8/18/2020 For more information: www.cdc.gov/COVID19
Complex and evolving landscape for COVID-19 vaccine ▪ One vs. two dose series ▪ Products not interchangeable ▪ Varying presentations ▪ Vaccine efficacy and adverse event profile in different populations ▪ Varying cold-chain requirements ▪ Use in children and pregnant women ▪ Need for socially distanced vaccination practices ▪ Communication and education ▪ Some high-risk groups for COVID-19 may distrust public health 8/18/20
Multiple Critical Components to Vaccine Implementation Communication and Stakeholder Guidance (state, local, special populations, private sector partners, public) Prioritizing Distribution Vaccine Allocation Safety, Effectiveness, Administration population (MFR – Dist- State) Recovery of Vaccine Uptake, Second dose Supply - Monitor, Track, Report Data Vaccine Uptake, Use, and Coverage ADE and Vaccine Effectiveness Monitoring and Reporting Regulatory Considerations Public health impact relies on rapid, efficient, and high uptake of complete vaccine series, with focus on high-risk groups 8/18/20
Illustrative scenario for planning purposes; will be adapted based on the clinical / manufacturing information on all OWS candidates and vaccine prioritization Distribution will Adjust as volume of vaccine doses increases, moving from targeted to broader populations reached (phased approach) Continued Vaccination, Limited Doses Available Large Number of Doses Available Shift to Routine Strategy Max Volume Doses available per month (baseline as of 07/16) Illustrative ramp-down, not doses based on OWS decisions or available candidate projections (per month) ~660M cumulative doses available Trials only • Constrained supply • Likely sufficient supply to meet demand • Likely excess supply • Highly targeted administration required to achieve • Supply increases access • Broad administration network for Key • Broad administration network required coverage in priority populations increased access factors including surge capacity • Expand beyond initial populations • Administer through commercial and private • Tightly focus administration • Open vaccination sector partners (pharmacies, doctors offices, Likely • Administer vaccine in closed settings (places of • Administer through commercial and clinics) work, other vaccination sites) specific to priority private partners admin • Administer through public health sites (mobile • Maintain PH sites where required populations clinics, FQHCs, targeted communities) strategies 8/18/20
Key Flow of material Overview of Distribution and Administration Administration sites Pharmacy LTC Providers Select commercial partners and federal Home Health entities receive allocations Contracted OWS Indian Health Services Manufacturers Partner Depots Other federal entity sites Distributor Public Health Clinics/FQHCs Hospitals Kitting Ancillary Supplies States & PPE receive Doctor’s Office allocations Mobile Vaccination Mass Vaccination OWS coordination 8/18/20
Key Flow of material End to end data infrastructure Flow of data Pharmacy LTC Providers Home Health Indian Health Services Partner systems or Jurisdiction IISs Other federal entity Distributor sites systems Public Health Clinics/FQHCs Hospitals Orders Doctor’s Office Inventory OWS coordination Mobile Vx Allocations Mass Vx Reporting Orders SAP Inventory CDC CDC Storefront IZ Data Lake End to End IT (Analysis) Administration data Infrastructure VTrckS IZ Gateway 8/18/20
To distribute and administer COVID-19 vaccine, we will leverage many partners to ensure success Leveraging public health expertise …and contributions from our private and assets from all-of- USG… partners Federal State Local Distribution Administration Guidance & best practices 8/18/20
This page does not represent prioritization decisions; simply represents sample of target populations DRAFT Draft Concept of Operations for select target populations Populations are not comprehensive; additional populations to be added Target population Vaccination Sites Critical Infrastructure Health care and Community support services Occupational health setting, Pharmacies, Other settings Homeland and national security Occupational health setting, Pharmacies, Other settings Other critical infrastructure Occupational health setting, Pharmacies, Other settings People at Increased Risk of Severe Illness Elderly (65 years & older) Doctor's offices, Pharmacies, Other settings Nursing home / Assisted living facility residents Facilities health services, Mobile vaccination units Communities of color (Black, Hispanic) Doctor’s offices, PODs, Other settings Tribal populations IHS facilities, Tribal health units, Other settings People with underlying medical conditions Doctor’s Offices, Pharmacies, Other settings People Living in Congregate Settings People who are incarcerated/detained Correctional facility health services, Pharmacies, ICE Health Service Corps; BOP for federal facilities People experiencing homelessness PODs, Mobile vaccination units, Health clinics serving population People attending university or college Student health clinics, PODs, Other settings Populations With Limited Access to Vaccine People living in rural jurisdictions FQHCs, Mobile clinics, Other settings Individuals with disabilities Home health organizations, Mobile clinics, Other settings 8/18/20
In the face of health crises or emergencies, communication, community engagement, and cultural competency are critical This research suggests that efforts should prioritize targeted messaging, community engagement and support, and culturally competent interventions to promote equitable acceptance and uptake of adult immunizations. Targeted Messaging Community Engagement Cultural Competency Epidemics do not increase Sustained community Health care staff and first vaccine acceptance in racial or engagement is key in identifying responders should provide ethnic minorities, meaning the education and support culturally competent messaging targeted communication from required to implement health and care — and include minority trusted messengers remains efforts — especially in groups in planning — to necessary — especially when a communities that face instability encourage equitable vaccine is new, data on safety with basic needs, such as engagement and outcomes in a or risks is limited, and negative employment, food, shelter, and pandemic response (Hutchins, 2009). informal messaging occurs (CDC, clean water (Hutchins, 2009). 2015). 8/18/20
8/18/20
CDC’s strategic framework for strengthening vaccine confidence and preventing outbreaks of vaccine preventable diseases. Strategy: Protect communities at risk from under-vaccination ✓ Protect Leverage immunization data to find and respond to communities at risk ✓ Work with trusted local partners to reach at-risk communities before outbreaks communities ✓ Ensure vaccines are available, affordable, and easy-to-get in every community Strategy: Get providers and parents effective information resources ✓ Expand resources for health care professionals to help them have effective vaccine Empower conversations with parents families ✓ Work with partners to start conversations before the first vaccine appointment ✓ Help providers foster a culture of immunization in their practices Strategy: Stop misinformation from eroding public trust in vaccines ✓ Work with local partners and trusted messengers to improve confidence in vaccines among key, at-risk groups Stop myths ✓ Establish partnerships to contain the spread of misinformation ✓ Educate key new stakeholders (e.g., state policy makers) about vaccines 8/18/20
Stakeholder Engagement and Strategies Engagement ▪ A complex network is necessary for successful implementation of a national COVID-19 vaccine distribution program • Support local, state and regional planning Traditional Public Health Immunization • Promote vaccine to general public and special populations Authorities Partners • Ensure vaccine equity and access Strategies ▪ Provide routine and timely updates on vaccine planning ▪ Build national network to amplify messaging and outreach to Commercial Federal Partners Partners increase trust, acceptance, and uptake of vaccine ▪ Engage in dialogue with new and existing partners to understand key considerations and needs for special populations ▪ Stand up specific stakeholder groups for communities of color Special Populations
Microplanning with jurisdictions for COVID-19 vaccination response began last week Objectives of program Key facts • Accelerate state, local, tribal readiness for a • Five jurisdictions: 1 – North Dakota (on site) large-scale vaccination campaign • Better inform OWS's understanding of – FL (on site) 2 – CA, MN, PHI (virtual) jurisdiction plans & technical assistance needs • Provide technical assistance to jurisdictions • Multi-agency microplanning teams, including 3 – CDC on their COVID-19 vaccine planning process • Develop model plans to be shared with all – DOD 4 – IHS jurisdictions prior to COVID-19 vaccine release • Build on expanded influenza vaccination 5 campaign planning work 8/18/20
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