closeup image showing vials of covid-19 vaccine

State Legislatures Inject Momentum Into COVID-19 Vaccination Efforts

By Tahra Johnson and Aileena Roberts | Jan. 18, 2021 | State Legislatures Magazine

The federal government, states and local jurisdictions worked overtime during the holidays to coordinate the distribution of the Pfizer and Moderna COVID-19 vaccines. In late December, Congress passed the COVID-19 Emergency Supplemental Appropriations and allocated $4.5 billion for direct grants to states, localities and territories for the distribution and administration of the vaccines.

Approximately 31 million doses of the Pfizer and Moderna vaccines have been distributed since their approval by the Food and Drug Administration. Both vaccines require two doses to provide immunity. About 11 million people have received their first dose and about 1.6 million people have received a second dose.

The time off during the holiday season for those administering vaccines increased lags in reporting and complicated distribution. Despite those setbacks and the staffing issues state health officials have encountered in rolling out the vaccines, health departments continue testing and contact tracing in attempts to reduce transmissions.

‘When Is It My Turn to Get the Vaccine?’

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) provides recommendations for who should receive the COVID-19 vaccine while doses are limited, taking into consideration the vaccine’s physical effects on different age groups, ethnicities and people with underlying medical conditions. The ACIP recommended prioritizing residents in long-term care facilities and health care personnel for the initial vaccines and proposed guidance on prioritizing front-line and essential workers. Most states are following the ACIP’s guidance, though many have diverged from it, especially after the initial phase, in priority group designation and timeline.

One commonality between the state plans is that health care workers, long-term care residents, teachers and other child care workers are among the first to be prioritized for the vaccine. The National Academy for State Health Policy (NASHP) released a guide describing how each state defines its phases and prioritizes essential workers. Generally, most states and federal guidance include first responders, firefighters, police officers, teachers, child care workers and other education-related personnel in Phase 1B or 1C. Some states and counties have moved forward to Phase 1B while others will do so following Phase 1A’s completion. Vaccine allocation will change based on supply and demand, as well as the risk of infection in a community. States should plan for high-demand and low-demand vaccine scenarios.

Above: Proposed vaccination phases, from a presentation at the ACIP meeting Dec. 20, 2020.

Legislative Involvement

Several state vaccination plans include legislators or legislative staff, or both, in a priority phase. At least eight states include members of the legislature in a priority phase in their initial draft plans. Arkansas includes executive and legislative branch employees in phase 1B. Colorado includes essential officials from the executive, legislative and judicial branches of state government in phase 1B. In Iowa, stakeholders are working on plans to vaccinate legislative staff necessary for the continuity of government and prioritizing them under phase 1B. Though few explicitly mention legislators and legislative staff, states may include them under the definition of government employees, key government leaders or essential employees.

In fact, some legislators have even begun receiving vaccinations. Representative Kyle Mullica (D), who is an emergency room nurse, was the first state lawmaker to receive the vaccine in Colorado. Ohio Representative Beth Liston (D), a physician treating patients with COVID-19, received the vaccine last month. Eleven legislative leaders in Kentucky received the vaccine in the state’s Capitol rotunda with the goal of highlighting bipartisan support for the safety of the vaccine.   

Legislators are leading efforts in a variety of ways. The Connecticut governor’s COVID-19 Vaccine Advisory Group includes legislative caucus chairs along with other state and local leaders, health care providers and scientific subject matter experts. Among the 50 states that released their vaccine allocation plans, more than 15 plans mentioned ways in which state policymakers can work together to increase widespread distribution of the vaccine. At least 10 states, including Alabama, Delaware, New Jersey and Tennessee, are relying on state lawmakers to challenge disinformation on the vaccines or participate in a public communications plan, or both, according to state plans.  

Streamlining Access

State policymakers have been identifying policies that may remove barriers and streamline access to the COVID-19 vaccine. It is safe to say that vaccine policy is shaping up to be a hot item in legislatures. So far, at least 15 states introduced more than 30 bills in this year’s legislative sessions. The bills relate to restricting vaccine mandates, such as prohibiting immunizations requirements for employees; authorizing pharmacists and other health care workers to administer the vaccine; supporting public awareness campaigns; and outlining certain components of distribution.

Several states—including California, Minnesota, New Hampshire and New York—enacted legislation expanding pharmacists’ authority to administer vaccines in 2020. North Carolina SB 704 includes a process for authorizing pharmacists to administer a vaccine through a statewide standing order. Others are considering legislation to expand the authority of other health care professionals, including dentists, optometrists and licensed pharmacy technicians, to contribute to mass vaccination efforts.

States also enacted legislation last year related to vaccine distribution. Massachusetts passed HB 5164, which reallocated money to the state health department for distribution and allocation of the vaccine to make it more equitable to the public. Virginia enacted HB 5005 to convene a working group with the Commonwealth’s Chief Diversity, Equity and Inclusion Officer to evaluate methods to stop the spread of the coronavirus and ensure even distribution of the vaccine. NCSL is tracking this evolving situation and all legislation related to the COVID-19 vaccine.

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

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