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Even though the US is still in the midst of the COVID-19 pandemic, plans are already underway to create and distribute a safe and effective vaccine for the virus. What is evident is that once the vaccine is ready, there will be challenges in its swift and equitable distribution across the country. The large-scale vaccination distribution effort is set to ensure that as soon as the vaccine becomes available, citizens will begin to receive it through their state, territorial, and local governments. These findings discuss the distribution efforts in North Carolina, North Dakota, and Ohio.

COVID-19 Plans for North Carolina

Distribution

  • Providers serving open-priority groups will receive additional sub-allocations of the vaccine.
  • Amounts allocated to individual providers will be loaded from NCIR to VTrckS.
  • As soon as an order is approved by CDC, distribution will begin. Vaccines will be shipped from the manufacturer in ultra-cold storage coolers packed with dry ice, so jurisdictions do not have to purchase ultra-cold storage equipment just yet.
  • Ancillary supply kits and their diluents will be shipped separately from the vaccines but to arrive at the same time or before the vaccine.
  • Vaccines will be distributed mainly to commercial, private section partners, and the public sector as required. The CDC will oversee distribution contracts. The state and its contract distributors will ensure that the vaccine reaches providers in a timely manner.

Storage

Prioritization

  • The authorities have already indicated that all North Carolinians will have equal access to the vaccines.
  • North Carolina will follow guidelines from the CDC’s Advisory Committee on Immunization Practices (ACIP), the National Academy of Medicine, John Hopkins University, and the World Health Organization.
  • The state has considered prioritizing itself to release limited quantities of a vaccine requiring ultra-cold chain storage, release more significant quantities of a vaccine requiring standard storage, or release both vaccines at the same time.
  • The state has examined further the prioritization possibility of releasing a vaccine that requires ultra-cold chain storage and which caters for 100-1000 doses per facility. However, the state’s advisory committee notes that this prioritization scenario can be adapted to the other two scenarios if necessary.
  • Priority will be given to healthcare workers and medical first responders (approximately 161,000 individuals), followed by residents in long-term care settings (approximately 951,000 individuals).
  • Next will be those at risk of high exposure and transmission to others (up to 1.57 million people), workers in critical industries (at least 767,000 people), followed by the remaining population.

Data & Reporting

Governance

Technology Infrastructure

Security

COVID-19 Plans for North Dakota

Distribution

  • Distribution is expected to be fair across the state based on the access which providers will have to prioritized populations.
  • Vaccines will be distributed to providers based on their population estimates for the target populations, the dosages allocate to the state, package quantities, and ability to accept the minimum shipment.
  • Orders in 100 dose increments or 1,000 dose increments for ultra-low cold chain vaccines will be ordered and sent to CDC’s ordering system and then distribute through McKesson.
  • Vaccines not sent in 100 dose increments will be ordered through CDC’s ordering system and then delivered to the NDDoH Emergency Preparedness warehouse for distribution.
  • Vaccines allocated to providers will be tracked cumulatively, and allocations will be base on administered and inventoried dosages.
  • The NDDoH Division of Immunization (Mass Immunization Group) will try to provide the same vaccine to providers at all times.
  • Distribution will be done based on a three-phase system. Phase 1 will include mass clinics for outreach to eligible groups. Phase 2 will involve distribution to large urban areas once the vaccine becomes widely available. Phase 3 will focus on private health care providers and pharmacies as demand for the vaccine declines.
  • Routes will not be longer than 12 hours to ensure the vaccines stay cold.

Storage

Prioritization

Data & Reporting

  • Data estimates on priority groups will be obtained from statewide data sources and from healthcare facilities when they enroll for the vaccine. The estimates will be vetted based on county census data and known sources of data.
  • The state will use the Tiberius platform to collect this data in order to make effective allocation decisions.
  • Provider information will be manually updated in NDIIS in the vaccine module. When changes are made to the module, they will be automatically uploaded to the CDC ordering system called Vaccine Tracking System (VTrckS).
  • Facilities will be expected to post the availability of the vaccine on vaccinefinder.org or a similar vaccine locator website once the vaccine is publicly available.

Governance

Technology Infrastructure

Security

  • All vaccines being transferred from one provider to another must be inventoried and approved by the NDDoH Division of Immunization (Mass Immunization Group) before the transfer.
  • North Dakota will comply with the data use agreement (DUA) for documenting and using patient-level data.

COVID-19 Plans for Ohio

Distribution

  • The CDC’s Social Vulnerability Index will be used to assess vaccine administration during and after distribution.
  • The state will ensure that the vaccine is distributed equitably to all people, especially to racial and ethnic minorities.
  • Registered providers will receive direct shipment of the vaccine. Contracted transportation vendors will deliver the vaccine.
  • All vaccine-ordering and distribution processes will be transparent, ensuring that the total incoming shipment is appropriately distributed to providers based on estimated target population, health equity, social vulnerability, the current epidemiological landscape, and the current level of immunity.
  • Every dosage received will be accounted for, ensuring minimal loss or expiry. To achieve this, all providers will be expected to demonstrate the availability of cold-chain storage.
  • Allocation for the vaccine will be done through a central VPO allocation algorithm and the state will order on behalf of providers whose information will be in VTrckS.

Storage

Prioritization

  • The first beneficiaries of the vaccine in Phase 1 will be high-risk healthcare workers and first responders.
  • Next will be the older adults living in crowded settings as well as those with underlying health conditions.
  • Phase 2 will cater to critical risk workers, teachers and school staff, all older adults not included in Phase 1, people living in homeless shelters and group homes, people and staff in jails and prisons, and people of all ages with underlying conditions.
  • In Phase 3, all children young adults, and workers in critical industries will be vaccinated.
  • In the final phase, all other people living in Ohio who did not have access to the vaccine in previous phases will be catered to.

Data & Reporting

  • The state will use the Immunization (IZ) Gateway to share data and information. It will also use the Connect and Share functions of the Gateway to disseminate information.
  • The state will ensure that all healthcare systems and hospitals are digitalized to ensure effective vaccine registration.
  • Providers will be responsible for reporting to Ohio’s ImpactSIIS and they will be expected to send data every 24 hours. On its part, the Ohio Department of Health Immunization Program and ImpactSIIS team will check for updates from providers on a daily basis.
  • The state will provide required data reports to CDC and the federal government.

Governance

Technology Infrastructure

  • The state has already prepared a vaccine deployment analytical tool that will help the team to select critical population groups and then to filter and allocate them based on need.
  • The state will use the current IIS system (ImpactSIIS) and use it to connect to the IZ Gateway via Connect and Share. This will ensure that the vaccine is distributed effectively and based on priority, particularly in the early days when vaccine availability will still be limited.
  • Ohio is considering using VAMS to increase patient registration and scheduling.
  • Providers will receive administration and IT training, and the state will facilitate CDC, VTrckS, and ImpactSIIS enrollment to avoid delays.

Security

GLENN TREVOR
Glenn is the Lead Operations Research Analyst at The Digital Momentum with experience in research, statistical data analysis and interview techniques. A holder of degree in Economics. A true specialist in quantitative and qualitative research.

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