Framework for Equitable Allocation of COVID-19 Vaccine (2020) / Chapter Skim
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5 Administering and Implementing an Effective and Equitable National COVID-19 Vaccination Program
5 Administering and Implementing an Effective and Equitable National COVID-19 Vaccination Program
Pages 157-174
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health departments and their partners are operating. As plans for program implementation are developed in different jurisdictions, the foundational principles and criteria for determining an equitable allocation framework laid out earlier in this report need to be taken into account.
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, the Association of State and Territorial Health Officials, and the National Association of County & City Health Officials (Logan Circle Policy Group, 2010)
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CDC may also develop communications and educational materials for use by stakeholders to address vaccine confidence concerns and increase vaccine demand, including strategies to reach underserved and hard-to-reach populations. COVID-19 Vaccine Distribution In Chapter 3, the committee suggested that, in the interest of speed and workability, federal allocation of COVID-19 vaccine to states could be made based on these jurisdictions' population size -- after which the committee's allocation framework would be applicable.
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. According to current plans from CDC shared with STLT partners, distribution of vaccines by jurisdictions will be allowed while maintaining the cold chain; however, CDC indicated that 2 More information about distribution, tracking, and monitoring within CDC's Pandemic Vaccine Program is available from https://www.cdc.gov/flu/pdf/pandemic-resources/pandemicinfluenza-vaccine-distribution-9p-508.pdf (accessed September 7, 2020)
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Dedicated efforts should focus on ensuring equitable distribution across tribal nations and territories. For instance, administration of the COVID-19 vaccine must include consultation and coordination with Indian country in order to fulfill the federal trust responsibility of providing health care services to American Indians and Alaska Natives.4 The Indian Health Service (IHS)
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To facilitate vaccination programs at the local level, CDC's National Center for Immunization and Respiratory Diseases has funded immunization program managers in 64 state, territorial, and local sites. This Center could be the coordinating point for gathering federal government input and assisting local programs.
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A rigorous vaccine safety monitoring program will need to be in place, with an emphasis on rapid and transparent review of information on adverse events following immunization, defined as health problems or conditions that occur after vaccination that could be caused by the vaccine or purely occurring by chance, unrelated to vaccination. The system should build on existing systems, including lessons learned from the H1N1 vaccination campaign and CDC's plans for monitoring vaccine safety in emergencies (Iskander and Broder, 2008)
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ADDRESSING COST AND FINANCING BARRIERS In this section, the committee calls attention to the key gaps in the cost and financing of COVID-19 vaccine administration. These gaps must be addressed to ensure equitable allocation.
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. Furthermore, the ACA requirements do not apply to many health insurance products, including recently promoted short-term plans, health care sharing ministry plans, grandfathered health plans, and Farm Bureau plans.
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Therefore, making the vaccine easy to access by offering vaccination clinics at schools, workplaces, and other locations in the community that people frequent can be as important as zero cost sharing in driving down cost barriers and mitigating inequities. Even if cost sharing is zero, providers still incur costs of vaccination.
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Therefore, federal funding to execute on these priorities would allow for a more rapid easing of social distancing than would be possible if the allocation of vaccines were restricted exclusively to states and individuals with the funds for vaccine administration. ENGAGING COMMUNITIES IN LOCAL COVID-19 VACCINATION PLANS STLT Implementation Requires Community Engagement To ensure equity, STLT authorities will need to collaborate closely and foster community partnerships to create and develop local COVID-19
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To that end, strong partnerships need to be developed urgently with community-based organizations and other community partners in order to build effective vaccine delivery systems that are convenient for the people they are intended to reach. Role of Community-Based Organizations in Vaccine Administration Community-based organizations, the so-called "boots on the ground," often have deeper insights about the people and families they serve than do many public health program managers serving in primarily administrative roles.
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Furthermore, many workers, especially in the building trades, have health insurance coverage through joint union–management insurance plans, and some workers get their health care through clinics run by unions or joint union–management plans. IMPORTANCE OF COMMUNICATION Public communication from the federal to the local level about the national COVID-19 vaccination program must be timely, consistent, and accurate in order to foster public trust, encourage participation, and manage expectations.
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CONCLUDING REMARKS An effective and equitable national COVID-19 vaccination program must be framed by an overarching commitment to the principles on which the committee's allocation framework is founded: maximum benefit, equal concern, mitigation of health inequities, fairness, transparency, and evidence-based. However, the mere establishment of foundational principles does not guarantee equitable allocation: equitable allocation must be supported by equitable distribution and administration.
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• Establish a robust and comprehensive surveillance system to moni tor, detect, and respond to identified problems, gaps, inequities, and barriers. Monitoring should encompass equitable vaccine allocation and distribution, vaccine delivery, adverse events following immuni zation, promotion and communication, and uptake and coverage.
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Require health insurance providers and self-insured employ ers to waive co-pays and deductibles for vaccine administration based on a reasonable nationally determined administrative rate set by the Centers for Medicare & Medicaid Services for all providers, irrespective of site of care or network participation status. • reach uninsured individuals, provide federal support and funding To for mass vaccination clinics and for reimbursement for providers serving uninsured directly.
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2015. Coverage of certain preventive services under the Affordable Care Act.
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