COVID-19 Vaccination Plans: South Carolina, South Dakota, Tennessee

South Carolina will make vaccines available to enrolled providers that serve critical populations during Phase 1. Vaccine distribution in South Dakota will be according to “SD COVID-19 Vaccine Allocation Guidance“. The COVID-19 vaccination plans of South Carolina, South Dakota and Tennessee have been outlined below.

South Carolina

Distribution

• In Phase 1, COVID-19 vaccine allocation is limited, therefore, South Carolina will make the vaccines available to enrolled providers that serve critical populations. Collected population estimates will be used to establish the proportion of COVID-19 vaccine doses received at each site. Selected sites will reach healthcare and essential workers as well as people at high risk of severe illness, as these are the target populations.
• The number of available doses will be used to determine allocation to enrolled providers. The state’s “COVID-19 Vaccine Advisory Committee” will give recommendations concerning “Phase 1-A and Phase 1-B subset populations.”
• During times of limited supply, in Phase 1-A and Phase 1-B, distribution is aided by an algorithm that accounts for the following:
  • The number of recipients that can be vaccinated at a site
  • The handling and storage capacity of a site
  •  Geographic location of a site
  •  Amount and timing of the state’s allocations
  •  Demand for second doses 
  •  The amount required for the second dose in Phase 1-A

Storage

• It will be a requirement for providers to follow the forthcoming guidelines for vaccine storage and handling in the “CDC Vaccine Storage and Handling Toolkit Addendum for the COVID-19 vaccine”.
• The DHEC Enrollment Team verifies that providers’ storage and temperature monitoring equipment are reliable upon enrollment. It is required that storage unit temperatures are documented as stated in the Vaccine Storage and Handling Toolkit Addendum for COVID-19 Vaccine. Before a new order is approved, this documentation should be submitted and reviewed by the DHEC between the time a vaccine is received and the time a new order is requested.

Prioritization / hierarchy of who receives vaccine

• The following resources are being used as guidance by DHEC to determine the crucial populations for COVID-19 vaccination:
  • “CDC’s Advisory Committee on Immunization Practices (ACIP)”
  • National Institutes of Health
  • National Academies of Sciences, Engineering, and Medicine (NASEM)
  • “The Panel Study of Income Dynamics (PSID)”, which has “data on SNAP usage and income”
  • “The DHEC ICS Data and Intelligence Branch population heat maps of populations 65 and older with co-morbidities”
  • “DHEC-produced GIS maps of healthcare facility distribution, including hospitals and long-term care facilities, which includes the number of licensed beds”
  • “The National Academies of Sciences, Engineering, Medicine (NASEM) Framework for Equitable Allocation of COVID-19 Vaccine (2020)”
  • “CDC’s Social Vulnerability Index, which accounts for natural and human-caused disasters and disease outbreaks”
  • SC HealthViz, which has country-specific data on different variables, like those who are “full benefits Medicaid enrolled,” “Living in Poverty,” “No HS Diploma (age 25+)”, “Rural, Unemployed and Uninsured.”
• If the vaccine supply is not sufficient, the Vaccine Advisory Committee will recommend sub-prioritization for the following:
  • Phase 1-A: People, both paid and unpaid, who work in healthcare environments, can expose infectious materials or patients, and can’t work from home.
  • Phase 1-B: Essential workers who cannot socially distance at work, and people at high risk for severe COVID-19 illness such as those aged 65 and above.

Data & Reporting

• In Phase 1, enrolled vaccination providers will be required to use the VAMS tool to document and report vaccine administration. For Phase 2 and 3, they will be required to use VAMS and SIMON, the state’s immunization information system, depending on whether they are mobile or fixed clinic settings, and how well SIMON can comply with data reporting elements. 
• SIMON has capabilities to report vaccine coverage by geographic region, down to the zip code. Reports will be automatically generated every week and sent to “the Immunization Branch director and Regional Clinic Coordinators” for review.

Governance

• South Carolina has established a Unified Command Group (UCG) to coordinate and unify planning, logistics, operations and finance. This group will consist of:
  • “Director, SC Department of Health and Environmental Control (DHEC)”
  • “Director, SC Emergency Management Division (SCEMD)”
  • “The Adjutant General” 
  • “The SC State Epidemiologist” 
• Members of the UCG oversee the Vaccination Task Force, which sets out agency and partner roles, as well as coordination efforts and action items with regard to COVID-19 vaccination. Working groups under the task force are as follows:
  • “Logistics: DHEC (Lead), SCEMD (Support), SC National Guard (Support)”
  • “Planning: DHEC (Lead), SCEMD (Support), SC National Guard (Support), SC Hospital Association (Support)”
  • “Finance: DHEC (Lead), SCEMD (Support), SC National Guard (Support)”
  •  “Communications: DHEC (Lead), SCEMD (Support), SC National Guard (Support)”
• There is a Vaccine Advisory Committee convened by DHEC to assist in formulating recommendations for equitable distribution of vaccines. 

• “DHEC Immunization Division of the Bureau of Communicable Disease Prevention and Control” oversees immunization services in all county health departments in the state’s 46 counties, coordinates immunization with the “providers enrolled in the Vaccines For Children program“, and ensures availability of vaccines for high-risk populations. 
• The ICS Immunization Branch of DHEC leads the COVID-19 Vaccine Internal Planning Team, and includes agency staff from the Bureaus of “Population Health, Informatics, and Data Analytics”, “Communicable Disease Prevention and Control”, and Public Health Preparedness.
• The SC Emergency Operation Plan (SCEOP) has a framework for how the state’s agencies carry out “all-hazards emergency response and recovery. “
• “The Outreach and Engagement Unit in DHEC’s ICS” will carry out a “COVID-19 response needs assessment” for the State and federal recognized tribal partners.
• “DHEC’s Vulnerable Populations Coordinator” will look at the plans of federal-tribal partners to receive vaccines through the Indian Health Service (IHS) organization and the plans of state-tribal partners; and establish technical assistance requirements. 

Technology Infrastructure

• The state uses WebIZ, an “immunization information system (IIS) commercial off-the-shelf solution”. This IIS is also called “Statewide Immunization Online Network (SIMON)” and facilitates “bi-directional Health Level 7 messaging” between itself and providers’ electronic health record systems.

Security

• The South Carolina Law Enforcement Division will provide the required security at vaccine distribution sites and during delivery.

South Dakota

Distribution

• Vaccine distribution will be according to “SD COVID-19 Vaccine Allocation Guidance” which includes vaccine amounts available, current target population, vaccinator numbers, level of infection in the states and requirements for second doses. Distribution to regions will be done after evaluating target population data. 
• Further vaccine sub-allocation will be according to COVID-19 regional spread, county incidence rates, size of priority populations and equitable geographic distribution. Providers and regions that reach the aforementioned interval for second doses will be given priority. 

Storage

• The cold storage conditions for individual providers will be reviewed to determine if they have sufficient capacity and suitable conditions to store vaccines.
• Providers will be required to train with the “SDDOH Immunization Education Coordinator” on topics including “appropriate storage units, temperature monitoring and documentation, vaccine receiving, placement, inventory control, transfer and transport, emergency relocation, and protocols for vaccines exposed to abnormal temperatures.” They are also required to reference obligations in the “CDC Vaccine Storage and Handling Toolkit.” 

Prioritization / hierarchy of who receives vaccine

• The critical population for the vaccine includes:
  • Residents of long-term care facilities
  • Those with underlying medical conditions that are risk factors for severe COVID-19 illness
  • People aged 65 and above 
  •  Racial and ethnic minorities 
  •  Tribal communities 
  • Those who are detained or incarcerated in correctional facilities
  • Healthcare personnel and other essential workers 
  •  Homeless people or those living in shelters
  • Those who work and live in other congregate settings 
  • Those who attend universities, colleges and schools 
  •  Rural communities 
  •  Disabled people 
  • The under-insured or uninsured 

Data & Reporting

• SDDOH will use SDIIS to collect data on vaccine doses administered from providers. Administered doses automatically be entered into the SDIIS through a bi-directional interface, or manually entered for providers without a bi-directional interface.
• The SDIIS will report all the required information to CDC through the Immunization Gateway Connect component, and Immunization Coverage Reports will be generated based on predetermined parameters. 

Governance

• The South Dakota Department of Health (SDDOH) is the state’s public health agency that serves state residents. In June 2020, the department changed its structure in response to COVID-19. 
• The new structure includes Executive Management, Public Health Laboratory, SD State Epidemiologist, “Public Health Preparedness and Response”, and the “Office of Disease Prevention Services“, among others.
• The department also established a “COVID-19 Mass Vaccination Planning and Coordination Team“, including a “Vaccination Team Lead and backup“, “Public Health Protection and Response“, a state pharmacist, Correctional Health, Community Health, SDIIS Coordinator, and Office of Licensure and Certification. In addition, there are several internal committee members. 

Technology Infrastructure

• The immunization registry team will liaise with the IIS contracted provider and the Bureau of Information and Technology (BIT) department to monitor IIS performance. Priority will be given to any identified system issues and these issues will be worked on by the BIT, IIS contractor and the registry team.

Security

• The BIT will prioritize required code changes for security scanning.

Tennessee

Distribution

• Vaccine supply will be restricted during Phase 1-A allocation, so vaccination priority will be given to first responders and front line healthcare workers. Initial vaccine distribution will be to hospitals with intensive care units and emergency departments. Geographic areas in CDC’s Social Vulnerability Index or any other index showing higher risk of disease burden or outcome severity will also be prioritized. 
• Local pharmacies will also be onboarded in preparation for vaccination of more individuals in Phases 1-B and 1-C.

Storage

• Vaccines will be distributed to providers based on storage capacity and approval for vaccine storage.
• Storage units will be assessed by “Tennessee’s VFC Coordinators and Epidemiologists” to ensure they meet the minimum requirements outlined in the “CDC Storage and Handling Toolkit”. 

Prioritization / hierarchy of who receives vaccine

• Critical populations include:
  • Healthcare workers and other essential workers 
  • Residents of long-term care facilities  
  • Those with underlying medical conditions that are risk factors for severe COVID-19 illness
  • People aged 65 and above 
  •  Racial and ethnic minorities 
  •  Tribal communities 
  • Those who are detained or incarcerated in correctional facilities
  •  Homeless people or those living in shelters
  • Those who work and live in other congregate settings 
  •  Rural communities 
  •  Disabled people 
  • The under-insured or uninsured 
• The state will categorize critical populations further by giving priority to people with co morbid situations or those at high risk for poor COVID-19 outcomes 

Data & Reporting

• The state will use the Tennessee Immunization Information System (TennIIS) to collect data on vaccine doses administered by providers. The information will be sent to CDC via the IZ Gateway.  
• Every weekday, TennIIS will generate a report and dashboard with data from COVID providers such as patient demographics and facility information.

Governance

• The Tennessee Department of Health COVID-19 Vaccination Program Planning Team includes members of the “Vaccine Preventable Diseases and Immunization Program team”, members of the Office of Emergency Preparedness, leadership of Community Health Services, a representative of the COVID-19 EP Response team and the “TDH Office of Communications and Media Relations”.  
• The “Pandemic Vaccine Planning Stakeholder group” convened by TDH includes over 28 “offices, agencies, and departments representing public health, rural health, refugee and other minority populations, legislators, experts in bioethics, medical societies, communications experts, health care coalitions and emergency management,” among others. The Governor’s office and Unified Command Group (UCG) carry out public communications and campaigns regarding vaccination.
• The internal team is led by the “TDH Vaccine-Preventable Diseases and Immunization Program (VPDIP)” and the TDH Emergency Preparedness Program, and its other members include the “TDH Office of Communications and Media Relations” and the TDH Office of Community Health.
• The external team is led by the “TDH Vaccine-Preventable Diseases and Immunization Program” and the TDH Emergency Preparedness Program.

Technology Infrastructure

• The Tennessee Immunization Information System (TennIIS) used to collect vaccine data is a Software as a Service (SAAS) platform maintained by STC health. It has over 13,500 users in more than 5,700 facilities.
• During Phase 1-A allocation, the Mass Immunization Module by TennIIS will be used by providers who lack an electronic interface between TennIIS and their Electronic Health Record systems. When the vaccine is more widely available, the providers who lack the electronic interface will use TennIIS’ iWeb Module. 

Security

• The “Data Use Agreement between TDH and CDC” will require review and approval by TDH Legal, Security and IT before data is shared with CDC.