closeup image of elderly patient receiving vaccination in her arm

National Framework, State Plans Emerging for COVID-19 Vaccine Allocation

By Tahra Johnson and Aileena Roberts | Nov. 20, 2020 | State Legislatures Magazine

A COVID-19 vaccine is not available to the public yet, but two vaccines are about 95% effective, based on stage 3 trials. A vaccine could be available to some people as soon as the end of this calendar year. The federal government, states and local jurisdictions are doing a lot of legwork to prepare for the allocation and distribution of the vaccine(s).

The Advisory Committee on Immunization Practices (ACIP), a group within the Centers for Disease Control and Prevention, is helping inform evidence-based approaches to COVID-19 vaccination policy, including an initial vaccine prioritization strategy. While the end goal is to offer vaccines to the entire U.S. population, identifying priority groups is a key part of planning for states. 

In early October, a committee convened by the National Academy of Medicine (NAM) released a draft Framework for Equitable Allocation of COVID-19 Vaccine in the United States and abroad. The committee’s findings may help inform ACIP’s deliberations related to vaccine priority groups and strategies to ensure equity in vaccination. The framework is more than 200 pages, but you can quickly understand its major elements in this one-pager and the outline below.

The framework’s authors, national and global experts in health policy and immunization, considered several factors in prioritizing who may receive the vaccine first: risk of acquiring infection, risk of severe morbidity and mortality, negative societal impact and risk of transmitting infection to others.

The framework breaks down the allocation of the future COVID-19 vaccine into four phases: 

  • Phase 1a—High-risk health workers and first responders.
  • Phase 1b—People with significant comorbid conditions (defined as having two or more) and older adults in congregate or overcrowded settings.
  • Phase 2—K-12 teachers and school staff and child care workers; critical workers in high-risk settings; people with moderate comorbid conditions; residents and staff of homeless shelters or group homes; incarcerated/detained people and staff; and all older adults.
  • Phase 3—Young adults, children and workers in industries important to the functioning of society.
  • Phase 4—All other individuals residing in the United States who are interested in receiving the vaccine for personal protection.

The Centers for Disease Control and Prevention (CDC) released its own considerations for state vaccination plans (page 51), which contain many of the same recommendations as the NAM framework, including that first consideration be given to health care personnel, adults with underlying conditions and those age 65 and older.

In addition, the CDC recommendations prioritize critical populations, the rate of current spread in a particular area, and vaccine production and availability in an area. The CDC suggests that jurisdictions should anticipate that allocations will change based on supply and demand of the vaccine, as well as the risk of infection in a community, and that they should plan for high-demand and low-demand vaccine scenarios.

State, Territory Plans

States and territories submitted their allocation and distribution plans to the CDC in mid-October, and the agency compiled the executive summaries. Lawmakers can work with their state health agencies to identify policies that may remove barriers and streamline access to the COVID-19 vaccine in their states. 

For instance, New York state’s COVID-19 vaccination program (executive summary) took into account multiple scenarios on vaccine availability. Much like the NAM framework, New York’s planned vaccine distribution is dependent on risk in a certain geographical area, and the elderly and those at health risk would receive the vaccine first. The state also laid out measures for vaccine safety and distribution and for the establishment of a vaccine central command center.

 New Mexico’s COVID-19 vaccine administration plan (executive summary) makes similar prioritizations and would be administered to the following high-risk groups first: health care workers, first responders, nursing home residents and staff, and those working in prisons and homeless shelters. Older adult residents with underlying health conditions also receive higher preference for receiving the vaccine than the general population. Local pharmacies, hospitals and health clinics around the state will coordinate with the department of health to administer the vaccine. 

South Dakota’s interim COVID-19 vaccination plan (executive summary), much like New Mexico’s, designated groups of people into certain phases. Among those in the first phase: health care personnel, essential workers, the elderly, ethnic and racial minority groups, tribal groups, and those working in prisons or homeless shelters. The plan also dictates vaccine storage and handling and creates a team of immunization and vaccine leads.

A variety of steps and challenges lie ahead for states. The U.S. Department of Health and Human Services will distribute funding across jurisdictions to support these efforts, though the exact amount is pending. At minimum, states will need to have distribution plans, adequate vaccine storage and administration, data tracking, and consistent and tailored messaging.

Tahra Johnson is a program director and Aileena Roberts is an intern in NCSL’s Health Program.

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) 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.

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