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Questions about financing, allocation, supply chain, communication and information requirements
Federal / state cooperation essential for distributing Covid-19 vaccine safely and effectively
Questions were sent from Republican and Democratic governors from across the country
The National Governors Association, chaired by Governor Andrew M. Cuomo, today sent a list of questions to the Trump administration for clarity on how to effectively distribute and administer a COVID-19 vaccine. The distribution and implementation of the vaccine is a massive enterprise that cannot be managed without significant logistical coordination, planning and financial assistance between states and the federal government. The list of issues – submitted by Republican and Democratic governors across the country – covers funding for vaccine administration, allocation and supply chain, as well as communication and information requirements.
“The National Governors Association, of which I chair, sent a letter to the President of the United States last week. We asked to meet with the President to discuss how this is supposed to work between the federal government and the states,” the governor said. Cuomo. “We are now releasing a collection of questions from governors across the country, Democratic and Republican, and saying to the White House: how should this work? We need to answer these questions before the vaccine is available so we are ready to go and no one gets caught flat-footed when it’s time to vaccinate people. “
The list of NGA issues collected from the country’s governors is available below:
Funding for vaccine administration
- Will funds be allocated to states to assist with the distribution of the vaccine and other vaccine efforts?
- Without additional government and local funding to implement COVID-19 vaccine plans, we will be hampered in what we can achieve. When can we expect more definitive information on resources related to this answer?
- What are the plans for any federal contracts and / or additional funding to support “boots on the ground” for level 2 and above vaccination?
- How are vaccine administration costs covered for uninsured persons?
- Will the federal government set guidelines for allowable vaccine administration costs for those with health insurance (whether it is state insurance, Medicaid, Medicare, CHIP, or another state-funded health insurance)?
- How is funding / reimbursement for vaccines handled?
- We understand that the vaccine was originally supplied free of charge, as it was remdesivir. However, states now have to pay for belt dams in the commercial market. How long will the federal government commit to delivering the vaccine to states at no cost?
Allocation and supply chain
- How is the vaccine distributed to states? What formula will be used?
- How is the vaccine distributed? What mechanism will the federal government use?
- Can the administration provide more guidance on what priority requirements are required for vaccine release, and to what extent will states have room to maneuver these decisions?
- Are further amendments to the PREP Act expected in addition to permits for pharmacists and trainees to administer vaccines?
- How does the CDC plan to manage vaccine distribution to federal entities such as federal prisons, VAs, and other federal organizations? Will these entities receive a vaccine supply directly from the CDC, or will states administer it?
- Similarly, when can states expect guidance from the federal government on the responsibility of states to vaccinate federal employees (e.g., who vaccinates the National Guard, USPS employees, the FBI, etc.)?
- How will tribal supremacy be respected? The CDC sent a template asking how many vaccine doses should be sent to each IHS / tribal health facility rather than asking states where each tribe wants their vaccine doses sent (which may be one of these facilities, a DOH public health office) , a private provider with whom they would like to enter into a contract, etc.)
- What will be the national strategy for vaccine prioritization when supply is short?
- How will handling supplies (ie needles, syringes, alcohol pads, tape aids, etc.) work?
- Will there be additional guidance documents on handling ultra-cold vaccine (ie thawing, storage after thawing, reconstitution, etc.?
- We are aware of the concern that there is already a shortage of dry ice, which is used to store ultra-cold storage vaccines during clinical trials.
- If true, does this deficiency affect plans for shipping ultra-cold storage vaccine using dry ice and containers that can store the vaccine for up to a week?
- If there is a shortage of dry ice, does this change the guideline to states not to buy extra ultra-cold storage freezers?
- We also need guidance on redistribution of ultra-cold storage vaccines. If they come in 1,000 dose shipments as specified by the federal government, we will probably need to redistribute them further in our rural areas. What will the guidelines be for doing so without compromising on the vaccine?
- How long will the product be viable outside the original packaging in which the 1,000 doses are sent? Can / will smaller packaging also be delivered in the shipment?
- What will the federal guidance be about under-prioritization among the original priority groups, since at first there will not be enough vaccine for even health workers as a group?
Communication and information requirements
- There has been some indication that large pharmacy chains and possibly interstate health systems will register directly with the federal government. We need the specific details, as many of them also reach out to the states. This affects our targeted enrollment of these stakeholders on board as Covid-19 vaccine providers. When can we expect a clarification of which stakeholders will enter into a contract with the federal government?
- Will there be a coordinated multi-state process for monitoring vaccination effects (side effects, lack of immune response, etc.) to ensure that early warning signs are identified as soon as possible?
- Will the federal government provide up-to-date / real-time information on tribal nations joining the CDC for direct mail, as opposed to enrolling through the state?
- Can the administration provide more information on long-term care facilities? Specifically, do they plan to mandate vaccines in nursing homes through the CMS? For example. Will the use of vaccines be linked to continued Medicaid funding? If so, when will such requirements take effect?
- Will the federal government require states to report personally identifiable COVID vaccine data? We are concerned that this could create a lack of trust and deter people from being vaccinated.
- What is the role of the state in security surveillance after people have been vaccinated?
- How many states use VAMS as their immunization information system (IIS)?
- Will states share their micro-prioritization within Phase 1b?
- What communication / message material has been developed?
- How will complex scientific data be transmitted and shared publicly? What type of teaching material and in what languages will be developed?
- What information is publicly shared about each approved vaccine? How is transparency ensured?
- The CDC plans to require reporting to IIS within 24 hours of administering the vaccine. We know for influenza vaccine that there is a dramatic delay in data coming in – how will reporting COVID-19 vaccine data be different?
Contact the governor’s press office