Brief COVID-19 Vaccination: Data, Distribution and a Developing Workforce

The COVID-19 vaccination campaign was the largest vaccination campaign in U.S. history and states played a critical role in making the vaccine available to residents. The initiative posed unprecedented challenges for federal and state governments, which mobilized to allocate vaccines to eligible populations. Legislative and executive leaders at all levels enacted measures to balance vaccinating communities quickly and equitably. As the nation moves into a new phase of COVID-19 response, lawmakers may consider the continued use of pandemic vaccination policies and how to adapt those policies to guard against new waves of COVID-19 and future pandemics.

Federal Action

The COVID-19 vaccination campaign was the largest vaccination campaign in U.S. history and states played a critical role in making the vaccine available to residents. The initiative posed unprecedented challenges for federal and state governments, which mobilized to allocate vaccines to eligible populations. Legislative and executive leaders at all levels enacted measures to balance vaccinating communities quickly and equitably. As the nation moves into a new phase of COVID-19 response, lawmakers may consider the continued use of pandemic vaccination policies and how to adapt those policies to guard against new waves of COVID-19 and future pandemics.

To support states in their vaccine distribution efforts, the CDC released operational guidance and a companion document as an annex for jurisdictions related to logistical and equity considerations. The guidance also includes information about public health challenges exacerbated by the COVID-19 pandemic, such as maintaining routine childhood and influenza vaccination rates.

On Aug. 19, 2020, the Department of Health and Human Services (HHS) issued an amendment under the Public Readiness and Emergency Preparedness Act authorizing vaccinations by pharmacists. The amendment authorized state-licensed pharmacists and pharmacy interns to order and administer COVID-19 and routine vaccines recommended by the CDC.

State Action

Since the end of 2020, state lawmakers implemented policies to expand the vaccinating workforce, address vaccine reporting and achieve equitable vaccine distribution. These efforts continued into 2022 and addressed COVID-19 cases and deaths in the short term and built vaccination infrastructure for new variants and future pandemics in the long term.

Vaccine Workforce

Expanding the vaccinating workforce allowed many states to increase the number of vaccines administered and their overall capacity, reducing the pressure on mass vaccination sites, physicians’ offices and other traditional vaccination settings. While pharmacists were the most common provider to receive vaccination authority, states utilized many provider types to bolster their COVID-19 vaccination workforce.

California AB 1064 granted pharmacists authority to independently initiate and administer any COVID-19 vaccine approved or authorized by the Food and Drug Administration (FDA), as well as vaccines on the CDC’s recommended immunization schedules. Similarly, Ohio HB 6 amended existing vaccination authority for pharmacists. The bill authorized pharmacists to administer the COVID-19 and influenza vaccines to children between 7 and 13 years old without a prescription.

In 2021 and 2022, state legislatures granted COVID-19 vaccine authority to other providers, including optometrists (Illinois and New Jersey), podiatrists (South Carolina), dentists (Wisconsin) and cardiac/emergency technicians (Georgia). State legislatures can also work with the executive branch to ensure compliance with state and federal requirements for COVID-19 vaccination. In 2022, Kentucky SB 25 approved and extended an emergency administrative regulation to ensure pharmacists’ compliance with federal COVID-19 vaccination training regulations.

Vaccine Reporting

Amid the push to vaccinate eligible Americans against COVID-19, vaccine data collection emerged as a tool for state legislators to measure state vaccination progress and any gaps in the response. States addressed COVID-19 vaccine documentation in immunization information systems (IIS) and other systems for vaccine tracking and reporting.

Georgia HB 80 appropriated funds to replace and modernize the public health surveillance system to improve pandemic response and future epidemiologic surveillance capacity. The bill appropriated additional funds to implement the new vaccine management system.

Virginia HB 2061 required health care providers that administer immunizations to participate in the Virginia Immunization Information System (VIIS) and report patient immunization history and information to the system. Under previous law, participation in VIIS was optional.

In 2022, Washington enacted legislation requiring the department of health to report to the legislature on vaccine distribution efforts as well as fiscal aspects of those efforts. Illinois enacted legislation requiring nursing homes to report COVID-19 vaccination and other pandemic data to the state.

Vaccine Equity

States prioritized equitable COVID-19 vaccine access relative to race, ethnicity, geography and medically underserved communities.

Maryland HB 588 directed the Maryland Department of Health (MDH) to equitably allocate COVID-19 resources and vaccines across all partners and vaccine sites. The bill requires vaccine distribution to account for the disproportionate impact of the pandemic on underserved and minority communities. It also required MDH to collaborate with and fund trusted community-based organizations with a history of working in zip codes with the highest levels of COVID-19 infection rates.

Texas SR 469 required the Department of State Health Services to report on disparities in the distribution of or access to COVID-19 immunizations and vaccine hesitancy rates based on an individual’s race, gender, socioeconomic status and geographic location.

In a special session on COVID-19 measures, Kentucky enacted SB 2, which requires the Cabinet for Health and Family Services to develop a plan to increase the distribution of COVID-19 vaccines to primary care providers. The legislation cited CDC recommendations that indicate access through primary care providers can help address disparities in vaccination. The bill required the cabinet to provide technical assistance and support to those providers regarding public confidence in vaccines and vaccine access.

In 2022, Massachusetts enacted legislation requiring a detailed COVID-19 vaccination equity plan.

As state legislators work to keep COVID-19 cases down and manage the pandemic, the policies above provide options for the present as well as insight for the future.

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services as part of a financial assistance award totaling $300,000 with 100% funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. government.