COVID-19 Vaccine Administration Preparedness

On September 16, the CDC released the COVID-19 Vaccination Program Interim Playbook for Jurisdiction Operations. This document lays out some fairly realistic expectations of jurisdictions (mostly states) in their distribution, administration, and tracking of COVID-19 vaccinations. That said, even though there continue to be many unknowns about the vaccines to be utilized, dosages, timetable of availability, and how and where vaccines will be delivered to states, there are reasonable assumptions that could be made and high probability strategies identified, which the CDC failed to do. Instead, as is a hallmark of many poor managers, they provided a punch list of considerably detailed demands but not the very essential information and parameters needed to support good planning. Information is everything.

Garbage in/garbage out is a pretty simple concept of utilizing poor or lacking information to inform a process, which will result in similar outputs. After reviewing New York State’s COVID-19 Vaccination Plan, that concept is fully demonstrated. Most sections of New York State’s plan are vague at best, saying what they will do but not how they will do it. They do identify some roles and responsibilities, but without delineating the boundaries between functionaries. For example: they will utilize pharmacies, local health departments, and state-run facilities, among others, to accomplish public vaccination. This is a solid and expected strategy, but the responsibilities for each are poorly defined for their own operations, much less how they will or won’t work together. Many concepts in the plan are vague at best, and even lacking more defined federal guidance, should have better detail. A big component of vaccination will be community delivery through local health departments, yet this is barely acknowledged. I would have expected this plan to provide guidance and outline preparedness requirements for local health departments, even if they were communicated separately. I acknowledge this is intended to be a strategic level plan, but it doesn’t seem to even consistently provide that measure of detail. I’m left with a lot of questions. And while it may be petty, the document itself is poorly written and published – I expect better from state government.

I’ve not looked at the plans of other states, but if this is indicative of the general state of things, the term ‘shit show’ is the phrase that comes to mind. While we will no doubt improve, there is a long way to go and I think jurisdictions will find themselves in a bind, being poorly prepared when they receive notice of an imminent delivery of vaccines with no detailed plan or assigned resources to get the job done. If anything, we have had plenty of time to prepare for vaccination efforts. There are clearly failures at all levels. While communication between and among federal, state, and local jurisdictions has certainly taken place beyond these documents, the standards and measures need to be more apparent.

We need to do better and be better. Reflecting a bit on the piece I wrote yesterday, we need to be thorough and imaginative in our preparedness efforts without excluding possibilities. Local jurisdictions must be prepared to support vaccinations in their communities. As I’ve written before, most health departments simply don’t have the capacity to do this. Jurisdictions need to engage with their health departments for the best guidance possible and work from that. An 80% solution now is better than a 20% solution later. As with any disaster, local communities are the first stakeholder and the last.

What are you seeing from your states? What do you think is missing in our overall efforts?

© 2020 Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC®

4 thoughts on “COVID-19 Vaccine Administration Preparedness

  1. well here’s the Vax plan from my state: https://www.mass.gov/doc/massachusetts-interim-draft-plan/download. A couple of problems I see right away: 1) they expect in phase 1 an availability of 20-60k doses. That’s a huge range (I assume dictated by limited information from the industry & from DC), and they don’t mention the possibility that I’ve heard that an effective vax will require 2 doses/patient. It’d also be helpful if the plan showed some knowledge of how many HCPs and how many hi-risk pt’s there are to vax in that phase; that 20-60k doses may not be enough, and we’d have to make an ethical choice between HCPs & hi-risk pt’s. In 2014 a MA gov survey showed 68,xxx nurses all working direct care for some # of hrs/wk.

    2) Hard to see why they have an undefined phase 2 before getting to a phase 3 of sufficient availability.

    Other than that I see more detail than you describe in the NYS plan.

      1. Y we have that problem here. So much of our covid response & general disaster planning, including my hotbutton issue of triage, has been secret for a dozen years. When i suggested that the Boston transit system place hand sanitizers at all the fareboxes they declined b/c of lack of $, but have also refused to say who made that decision. & that’s the word from my “Cradle of Democracy.”

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