A high-level overview of the COVID-19 vaccination plans of the states of Kentucky, Louisiana, and Maine is provided below. Please note that only the links provided by the KFF site to the plans released by authorities in Louisiana and Maine worked properly. The link for Kentucky’s plan leads to a page that reads “Page Not Found.” Nonetheless, additional research was conducted to find the latest draft issued by the state.
- Local and regional distribution for the COVID-19 vaccine will be handled by the Kentucky Department for Public Health (KDPH) and Kentucky Emergency Management (KYEM). Part of the official Kentucky Medical Countermeasures Plan will be utilized to help support the state’s vaccine distribution operations.
- Although vaccine distribution could be handled centrally, it may be extended to additional vaccination providers and healthcare organizations that are able to offer pandemic vaccinations to any targeted cohorts. The state plans to distribute the vaccine directly to vaccination providers, such as a physician’s office, or to designated depots managed by administration sites, such as chain drug stores, for secondary distribution.
- Those providers must enroll into the Kentucky Immunization Registry (KYIR) and ensure they can receive, store, administer, and track vaccine administration. The enrollees will place their vaccine orders through Kentucky’s immunizations program, and the orders are shipped to them via a centralized vaccine distributor.
- For the target groups in Phase 1, the KDPH plans to order from weekly allocations to be distributed by the centralized distributor to any designated location. It anticipates that the COVID-19 vaccine will be transported from the distributor/manufacturer directly to target groups included in Phase 1. According to the Kentucky vaccine draft, the vaccine will be supplied according to “the phased target structure through those methods deemed most appropriate by state and local authorities.”
- The KDPH will permit the local transportation of vaccines in certain circumstances “if adherence to cold chain and tracking requirements are maintained.” Furthermore, It may take advantage of regional distribution nodes for Phase 3 and 4 allocation to the general public.
- State and local public health, safety, and emergency management authorities in Kentucky will play major roles in guaranteeing the correct and safe handling and storage of the COVID-19 vaccine. Providers will be required to handle and store vaccinations within the approved temperature ranges, and the approved storage units must monitor temperatures throughout the day via a digital data logging thermometer.
- Vaccination providers and jurisdictions will be accountable for maintaining the quality of the vaccine upon its arrival at a designated location, and the KDPH will reduce chances for disruptions in the cold chain. The KDPH has attained the necessary resources to help in following cold chain requirements, and it has entered into a partnership in case there is a need to extend ultra-low cold storage capacity.
- Due to the rather limited ultra-low cold storage capacity, the KDPH plans to install regional storage nodes to properly store and ship the vaccine.
- The state of Kentucky will consider guidelines for storage and handling of the COVID-19 vaccine listed in the CDC’s Vaccine Storage and Handling Toolkit. Nevertheless, it will review different resources for this matter.
Prioritization/Hierarchy of Who Receives Vaccine
- The KDPH’s Vaccine Allocatin Committee will review target populations recommended by the U.S. CDC for vaccine allocation prioritization. However, it is willing to make necessary adjustments depending on “the evolving epidemiology of COVID-19” and will observe national recommendations for alterations that may come up. It plans to implement a phased allocation plan that consists of four phases.
- For now, Phase 1a will involve high-risk health workers and first responders, while Phase 1b will cover individuals with underlying and comorbid conditions that place them at a greatly higher risk, along with older adults residing in overcrowded and congregate settings.
- Phase 2 will involve vaccinations for K-12 school teachers/staff members and child care workers, essential workers in high-risk settings, individuals with underlying and comorbid conditions that place them at a moderately higher risk, individuals in group homes for disabilities or homeless shelters, people and staff in jails, detention centers, or prisons and, and older adults not covered in Phase 1.
- Phase 3 will cover young adults, children, and employees in industries essential to society’s functioning that are at a greater risk of exposure and not covered in Phase 1 or 2.
- Finally, Phase 4 will involve vaccinations for everyone else not included in Phase 1, 2, or 3.
Data & Reporting
- Providers of the COVID-19 vaccine in the state must submit relevant information to the Kentucky Immunization Registry (KYIR) and record every instance of a vaccine dose being administered. Alternatively, they can use the Vaccine Administration Management System (VAMS) apparatus provided by the CDC, which permits information to be sent electronically to KYIR through the Immunization Gateway.
- Vaccine providers must have the capacity to provider real-time reporting and documentation for vaccine administration, and off-site clinics will be given various services, such as cellular cradle point devices and Wi-Fi hotspots, to ensure they can participate. These providers need to upload documentation within 24 hours in order to satisfy reporting requirements established by the CDC.
- Provider-level data will be monitored by the KDPH to assure that every administered vaccine dose is completely reported and documented every 24 hours. Internal reports gathered from KYIR will be utilized by KYIR Data Quality Analyst and on-boarders to monitor the timeliness of data submission and data quality.
- Furthermore, KYIR will assist the KDPH in developing coverage reports, which will be used by the Immunization Branch to monitor vaccine uptake and identify pockets of need.
- Vaccination planning for the state of Kentucky is coordinated between community partners, Local Health Departments (LHDs) external agencies, and Kentucky Department for Public Health (KDPH). As such, there is what is referred to as “a shared governance health structure” where LHDs and KDPH play major roles in assuring that the COVID-19 vaccination campaign is a success.
- The KDPH’s Vaccine Allocation Committee consists of community partners and external groups and ensures equitable access to the COVID-19 vaccination.
- The state has the Kentucky Immunization Registry, which allows the KDPH to monitor vaccine waste, inventory, usage, and ordering. It also gives providers the capability of generating patient reminders for a second vaccine dose.
- According to the vaccination plan draft issued by the state, the “Kentucky Health Information Exchange (KHIE) automates the reporting of immunizations directly to the KYIR in support of eligible hospitals (EHs), critical access hospitals (CAHs) and eligible providers (EPs) for all stages of Meaningful Use of electronic health record technology.”
- The KDPH, in collaboration with the Kentucky State Police, is responsible for security of the vaccine at the state level. Local law enforcement agencies and the LHD are responsible for security operations at the local level, but KSP may supplement local security operations if need be.
- Local law enforcement agencies must secure fixed facilities taking part in vaccine distribution, including dispensing sites and regional storage nodes. These agencies are expected to partner with county officials and LHDs in planning for this security responsibility.
- The Kentucky Transporation Cabinet (KYTC), KDPH, KSP, and KYEM may organize transportation security via the SHOC and supply escorts for transport automobiles to health care facilities or sites.
- The vaccine will be distributed to priority groups using the Louisiana COVID-19 Dose Allocation Tool, which permits distribution using percentages based on guidance from the CDC and the Advisory Committee on Immunization Practices. It will be distributed in phases (using terminology from the Louisiana Department of Health (LDH) Health Standards), and the Office of Public Health (OPH) will use “evidence to maximize societal benefit” via diminishing mortality and morbidity due to the transmission of the disease.
- The vaccine distribution vendor for the CDC, McKesson, will distribute it to sites in Louisiana with orders that have been approved by the Immunization Program.
- Providers at POD locations will only be approved to carry the vaccine if they have cold chain capacity, which is determined through the completion of the Redistribution and COVID-19 Provider Enrollment Form, along with a supplemental questionnaire from the OPH Immunization Program.
- Vaccination providers enrolled by Louisiana will use the state’s Immunization Information Network (LINKS), a network that integrates with the Vaccine Tracking System (VTrckS) from the CDC, to order the COVID-19 vaccine.
- Detailed data on the storage and handling of the vaccine is available in the following documents: 1) Appendix 8: Louisiana’s Comprehensive Point of Dispensing Plan for COVID-19 Vaccine, and 2) Appendix 9: Louisiana’s Plan to Securely Order, Distribute, Receive, Store and Transport COVID-19 Vaccine.
- The state has determined that healthcare providers are obligated to maintain the quality of the vaccine the moment it arrives at their location. Staffers are required to undergo training from the CDC related to the storage and handling of the COVID-19 vaccine and will also be provided with Just-In-Time Training (JITT) by the state.
- Vaccines are to be transported to off-site, temporary, or satellite clinic, where they will be properly stored by designated staff, who will receive the same storage training as those working for healthcare providers, to sustain the correct temperature throughout the day.
- In some scenarios, the vaccine may be shipped to a location in order to limit possible disruptions within the cold chain. The state’s Immunization Program will offer support to entities involved in redistribution to assure cold-chain procedures are applied.
Prioritization/Hierarchy of Who Receives Vaccine
- The state’s COVID-19 Vaccination Action Collaborative (VAC) Prioritization-Allocation Work Group has identified critical populations for the distribution of the vaccine. During the decision-making process, its primary goals regarding prioritization is the protection of citizens that are needed to combat the virus, people with the highest risk, and workers that are vital to sustaining societal function. Hierarchy will be divided into three total phases.
- In Phase 1A, prioritization is to be given to hospital personnel and congregate care setting personnel.
- Phase 1B prioritization involves emergency medical services personnel, urgent care facility personnel, non-public type primary care, law enforcement and firefighters, and individuals 65 and up that have existing health issues, among others.
- Phase 2 prioritization involves daycare and K-12 school personnel, food distributors, postal workers, adults aged 18-64 that have existing health concerns, and incarcerated adults, among others.
- Finally, Phase 3 will involve vaccination for the general public.
Data & Reporting
- LINKS will be utilized to log any doses that are administered by vaccinators/providers, who can access the network at any point in time. Providers are obligated to enter this information into the network within 12 hours of the administration of the vaccine. Data provided by vaccinators/providers is to be supervised via daily immunization reports for every location.
- Vaccine information is to be gathered through LINKS, which will also generate COVID-19 vaccination coverage reports, and provided to the CDC using the IZ Gateway and following HL7 procedures. In case this is not possible, the data will be compiled into a CSV file and provided to the CDC through the SFTP site. Coverage reports are to be utilized to monitor and track the state’s vaccination rate and identify pockets of need (PON).
- LINKS is capable of recording variables such as: administration date, administration address, administration location, dose number, IIS vaccination event ID, MVX, CVX, IIS recipient ID, lot number, recipient personal details (e.g., name, sex, DOB, and address), sending organization, vaccine route of administration, vaccine administrating site, vaccine administering provider suffix, and vaccine expiration date.
- Additionally, LINKS captures all data related to patient vaccination and can be used to monitor the number of doses a patient receives and when they receive the vaccine, along with where and when doses were given.
- The Louisiana Department of Health (LDH) Office of Public Health (OPH) serves as the leading government agency for the state’s response to severe respiratory pathogens and pandemic influenza. It collaborates with private, state, and local agencies to supply educational opportunities that guarantee preparedness for a pandemic. According to the organizational chart provided on page 14, the LDH’s Incident Commander leads the agency’s Emergency Operations Center, and its Deputy IC, EOC Manager, and Safety Officer all report to them.
- Meanwhile, the State Health Officer maintains the authority to declare and stop a public health emergency, along with controlling subsequent actions. Other governing agencies involved include the Governor’s Office of Homeland Security and Emergency Preparedness (GOHSEP).
- Technological collaborations have “resulted in all FQHC reporting vaccinations into LINKS” (FQHC stands for Federally Qualified Health Clinics). Meanwhile, work is being conducted with Rural Health Clinics for the interface of LINKS.
- Lousiana’s State SNS Plan contains the mechanisms needed to ensure positive control of the state’s emergency assets such as vaccines. If the OPH cannot offer proper security for the vaccine, “Security during vaccine storage, transport and distribution will be coordinated with GOHSEP’s EOC.”
- LINKS has endured considerable security assessments to guarantee the network maintains the capability of securely documenting all vaccinations, while solely approved and designated vaccine providers can log into LINKS and order the vaccine (orders are approved by the Immunization Program).
- McKesson and the manufacturer of the vaccine are responsible for distribution security, and Louisiana will deploy contracted GOSHEP vehicles, ambulances, and unmarked vehicles for redistribution. Designated staff members will sign for the vaccine upon arrival at an administration destination.
- When the vaccine arrives at its designated location in the state, it will be taken to a secure area to be evaluated for deficiencies, and then secured within a locked storage area that can only be accessed by trained designated staff.
- Each vaccine storage units in Regional Offices and the Immunization Program are locked and central units are supervised every day for 24 hours.
- Local PODs in the state must employ a minimum of one armed security officer, and the COVID-19 vaccine is to be stored in a secure area at the administration location and watched by a staff member or security guard.
- To receive the vaccine, providers are required to enroll in the Maine Immunization Program (MIP) and create standard cold storage units. Prior to placing an order, the Immunization Information System (IIS) requires them to deploy proper storage units for the vaccine and that the units have up-to-date and in-range temperatures.
- The Maine IIS and MIP and staff members will use the Pandemic Allocation functionality to designate providers as being eligible to order the vaccine. This apparatus enables staff to approve, reject, or alter orders at a program level or individually based on total vaccine allocation volumes provided by the U.S. CDC. The state plans to use the Tiberius Platforms to help it plan, distribute, and allocate the COVID-19 vaccine, as it enables them to plan provider-level orders using a selection of distribution scenarios.
- Staff members from the Maine IIS will verify orders from designated locations according to current vaccine inventory and demand. Moreover, providers must modify their vaccine requirements “within the IIS which delineates the age cohorts and insurance status of the populations the organization serves to assist in assigning vaccine allocations.”
- Maine has listed 468 potential vaccine providers within the state. Potential vaccine providers in Maine include hospitals, doctor offices, clinics, state health departments, city health departments, open PDOs, workplaces, chain pharmacies, supermarket pharmacies, mass merchant pharmacies, and independent pharmacies.
- All distribution locations will be required to adhere to cold chain requirements in regard to vaccine storage. Vaccine storage units at these locations must maintain the proper temperatures mentioned in the COVID-19 Vaccination Program Agreements. Reviews will be conducted to analyze the storage capacity for ultra-frozen, frozen, and refrigerated vaccines.
- Vaccination program sites in the state must enroll in the designated Maine IIS, IIS, along with finishing the COVID-19 Vaccine Educational Training. They must routinely monitor vaccine temperatures, and those that have ultra-cold vaccine must ensure that their digital data logger is capable of recording temperatures of -60 and -80 degrees.
- At individual provider locations, VFC providers must record the temperature of storage units each day, while providers at off-site clinics have to record temperatures “under the Mass Vaccination Module in IIS“, while complying with the CDC’s recommended handling and storage procedures.
Prioritization/Hierarchy of Who Receives Vaccine
- Maine will use a phased approach for its vaccination efforts, focusing its attention on healthcare personnel and other critical populations, including citizens with various conditions that increases their risk to severe illness from COVID-19. Specific conditions are listed on page 21 and include Asthma, Cystic Fibrosis, Immunocomprimised State, Immune Deficiencies, HIV, Neurological conditions, pregnancy, Type 1 Diabetes, Liver Disease, Obesity, Cancer, heart conditions, etc.
- The state of Maine relied upon its Health System COVID Planning Survey to identify the volume of people in healthcare systems that may be prioritized in the event of limited vaccine availability. Results from the survey revealed that 53% of personnel at hospitals throughout the state should be prioritized in Phase 1A.
- For Phase 2 and 3, the state intends to employ a broad approach for vaccination efforts in rural and populated regions.
Data & Reporting
- Maine will use the IIS to record vaccine doses that are supplied by providers. These providers can use a variety of means to report doses, such as real-time HL7 interface using their EMR or through direct entry for the IIS. The could also use Mass Vaccination quick entry or upload data via a CSV/flat file.
- The IZ gateway’s Share and Connect components will be used by the IIS to gather doses provided from direct ship locations, as well as other jurisdictions. Administration data will be transmitted by the IIS through the SOAP web service interface.
- Staff for the IIS and MIP will routinely run SQL and IIS reports in order to compare doses administered to the order volume, to gauge activity, and compare administration dates to study the timeliness of reporting.
- Coverage assessment reports will be crafted by the IIS, who employs a data analyst epidemiologist to study information and offer reports. Currently, the MIP is evaluating Insight Analytics so that the IIS can use its own datamart to supply robust geographical maps containing drill downs and multi-dimensional filtering.
- The Maine CDC is the public health agency of the state, and it provides an assortment of public health services and programs. Programs within the Maine CDC have received modifications to their practices to help with the response to the COVID-19 outbreak. Maine CDC’s internal “Crisis Team” consists of the District Public Health Liaisons, Maine Immunization Program, Public Health Emergency Preparedness, and Public Health Nursing, which serve as significant players for the state’s vaccination plan.
- The Maine Department of Health and Human Services, or DHHS, along with other major departments (e.g., Education and Corrections departments), is assisting the Maine CDC with its COVID-19 vaccine plan and its implementation.
- The state’s Governor and her leadership team are conducting the primary operational and policy decisions. Also, the Maine Immunization Program, which will act as the leader for the state’s vaccination response, partners with community members and health practitioners to provide vaccines, vaccine-preventable disease tracking, and outbreak control.
- The technology infrastructure consists of the state’s electronic immunization information system, otherwise referred to as IIS. The state intends to connect it to the IZ Gateway, which is a national platform from the U.S. CDC that facilitates the sharing of information related to vaccine administration between states.
- Maine’s Public Health Emergency Preparedness Program (PHEP) is accountable for the COVID-19 vaccine’s security during the vaccine management process.