Thousands of health care workers rolled up their sleeves and received the first round of coronavirus vaccines on Dec. 14, including in Southeastern Pennsylvania and South Jersey.
Pennsylvania will receive an initial shipment of more than 110,000 doses of the vaccine, with the first ones given to health workers, first responders and residents and staff in nursing homes and other congregate settings.
But who gets it next?
Phase 1: Potentially Limited Doses Available
Phase 1 vaccine administration applies when initial doses of vaccine first become available and are expected to be in limited supply (potentially very limited supply initially) compared to demand. Focus should be on the target populations advised by CDC to include:
- Those most essential in sustaining the ongoing COVID-19 response
- Those at greatest risk of severe illness and death, and their caregivers
- Those most essential to maintaining core societal functions
- Healthcare personnel likely to be exposed to or treat people with COVID-19; and
- Other essential workers
Populations considered for Phase 1 include select populations from the following categories:
- Healthcare Personnel
- First Responders
- Critical Workers
- People with high-risk conditions (defined further down on the page)
Phase 1A: As instructed by CDC, Pennsylvania is planning for very small initial allocations of vaccine when product first becomes available. The CDC's Advisory Committee on Immunization Practices (ACIP) has recommended 1) health care personnel and 2) residents of long-term care facilities (LTCFs) be offered vaccination in Phase 1A of the COVID-19 vaccination program. Pennsylvania is adopting these recommendations.
The DOH recognizes the sub-prioritization approach recommended by ACIP, because initial vaccine allocation is expected to be scarce compared to the number of health care personnel in the state who would require vaccination, and there is expected to be a constrained supply environment for some months. In addition to the sub-prioritization endorsed by ACIP, DOH is including additional sub-prioritization categories to better inform providers to ensure ethical allocation of scarce vaccine.
Initial allocation of vaccine in Phase 1A will be distributed to hospitals, which will be responsible for vaccinating health care personnel, and the Pharmacy Partnership for Long-Term Care Program, which will be responsible for vaccinating residents and health care personnel who work in long-term care facilities. Hospitals should use the appendix 8 tool.
Healthcare Personnel: Phase 1A:
“Health care personnel” are defined by ACIP as paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials. These health care personnel may include, but are not limited to; emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, direct support professionals, clinical personnel in school settings or correctional facilities, contractual staff not employed by the health care facility, and persons (e.g., clerical, dietary, environmental services, laundry, security, maintenance, engineering and facilities management, administrative, billing, and volunteer personnel) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted among from health care personnel and patients. “Healthcare settings” refers to the CDC definition of the places where healthcare is delivered and includes, but is not limited to; acute care facilities, long term care facilities, inpatient rehabilitation facilities, nursing home and assisted living facilities, home health care, vehicles where health care is delivered (e.g., mobile clinics), and outpatient facilities, such as dialysis centers, physician offices, adult day facilities and others.
Sub-prioritization of Healthcare Personnel: Phase 1A:
ACIP recommends that health care personnel be prioritized in the earliest phases of COVID-19 vaccination. However, if there is initially insufficient supply to cover all health care personnel, ACIP recommends further sub-prioritization. As such, “COVID-19 facing health care personnel,” should be prioritized. The Department is defining “COVID-19 facing health care personnel” as health care personnel who:
- Have direct patient contact (within 6 feet) and are unable to telework. This includes individuals who provide services to patients or patients’ family members, or who handle infectious materials; AND
- Are personnel without a known infection in the prior 90 days (but serologic testing is not recommended); AND
- Are personnel who work the majority of the time in a “COVID-19 facing unit.” A COVID-19 facing unit is an area of a health care facility that is expected to care for individuals with COVID-19. This includes emergency departments, intensive care units, inpatient medical or surgical floors in acute care facilities, emergency medical services units, outpatient respiratory care clinics, and urgent care centers.
Long-term care facilities (LTCFs): Phase 1A:
“Long-term care facilities” are defined by ACIP as facilities that provide a spectrum of medical and non-medical services to frail or older adults unable to reside independently in the community. In Pennsylvania, facilities that may serve frail or older adults in a residential setting include; Skilled Nursing Facilities, Personal Care Homes, Assisted Living Facilities, Private Intermediate Care Facilities for Individuals with Developmental Disabilities, Community Group Homes, Residential Treatment Facilities for Adults, Long-term Structured Residences, State Veterans Homes, State Centers, private psychiatric hospitals, and State Hospitals.
Sub-prioritization of LTCFs: Phase 1A
ACIP recommends that LTCF residents be prioritized in the earliest phases of COVID-19 vaccination. LTCF staff are considered healthcare personnel. However, in settings where initial vaccine is insufficient to vaccinate residents of all LTCFs, ACIP recommends further sub-prioritization.
- Skilled Nursing Facilities should be prioritized among LTCFs as they provide care to the most medically vulnerable residents.
- After skilled nursing facilities have been vaccinated, the remaining LTCFs should be prioritized by licensure type based on factors related to COVID-19 infection risk.
Phase 1B: As instructed by CDC, Pennsylvania is planning for limited but expanding supply of vaccine where people at higher risk and critical workers may receive initial doses. Critical workers will be identified through ACIP recommendations and the advisement of the Vaccine Crisis Committee.
“Critical workers” and “essential workers” refers to the ACIP’s definition that can be found here and is based off of the Cybersecurity & Infrastructure Security Agency’s guidance. This includes workers who are essential to continue critical infrastructure and maintain the services and functions Americans depend on daily and workers who cannot perform their duties remotely and must work in close proximity to others.
First Responders: Phase 1B: On scene, cannot work remotely or maintain social distancing.
- Law enforcement (Personnel with direct public contact and possible COVID exposure)
- Fire/rescue personnel (Personnel with direct public contact and possible COVID exposure)
- PA National Guard responders not included otherwise in Phase 1a (Personnel with direct public contact and possible COVID exposure)
- Older Adult Protective Services, Adult Protective Services, Child Protective Services (Personnel with direct public contact and possible COVID exposure)
Critical Workers: Phase 1B: Essential business personnel who cannot work remotely or maintain social distancing.
- Critical Manufacturing Sector, which include: people who manufacture medical supplies, PPE, pharmaceuticals, vaccines; and people who manufacture other essential products
- Emergency Services Sector, which include: field workers with direct public exposure, volunteer response organization field personnel and supportive housing field personnel
- Energy Sector, which include: people who conduct home/business visits for electrical assessments and repairs, gas supply assessments and repairs; and oil refinery workers, others in petrochemical processing and distribution
- Food and Agriculture Sector, which include: meat processing and other food processing facility workers
- Workers serving people in congregate settings not otherwise included in Phase 1A, including: Correctional facilities/juvenile justice facilities, homeless shelters, domestic violence/rape crisis shelters, Office of Children, Youth, and Families Child Residential Facilities
- Nuclear Reactors, Materials, and Waste Sector, which include: onsite technical personnel, emergency responders
- Transportation Systems Sector, which include: Drivers of high occupancy vehicles (more than 6) or drivers participating in medically necessary services, TSA workers, airport/train security and Medical Assistance Transportation Program Drivers
- Water and Wastewater Systems Sector, which include: field workers making assessments and repairs in the community, wastewater treatment facilities technicians and emergency responders
- Education, which include: teachers, school staff working directly with students
- Employees caring for children or adults in Early Childhood and Adult Day Programs, which include: Child Care, Part Day School Age Programs, Home Visiting Programs, Early Intervention staff not otherwise included in 1A, Early Childhood programs including Head Start, Pre-K, and Family Center; and Adult Day Programs
- Other high-risk services/activities, which include: environmental cleaning of patient care areas, laboratory processing of COVID-19 specimens, mortuary care for deceased COVID persons
High Risk Conditions: Phase 1B: People with high risk conditions leading to more severe disease and poor outcomes if infected with COVID-19
- Underlying Medical Conditions including: Cancer, Chronic kidney disease, COPD (chronic obstructive pulmonary disease), Immunocompromised state (weakened immune system) from solid organ transplant, Obesity (body mass index [BMI] of 30 kg/m²or higher but less than 40), Severe obesity (BMI of 40 kg/m² or higher), Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies, Sickle cell disease, Type 2 diabetes mellitus, Smoking and Pregnancy
- Age associated high risk (People age 65 years and older)
- Residents of congregate settings and individuals receiving home and community-based services not otherwise specified as a LTCF, including: Behavioral Health/Rehabilitation Facilities, Community Residential Rehabilitation Services, Correctional Facilities/Juvenile Justice Facilities, Domestic Violence Shelters, Homeless, Intensive or Partial Treatment Programs, Office of Developmental Programs Home and Community-Based Services, Office of Long-Term Living Home and Community-Based Services and Office of Children, Youth and Families Child Residential Facilities
Phase 2: Large Number of Doses Available, Supply Likely to Meet Demand: Focus on ensuring access to vaccine for members of Phase 1 critical populations who were not yet vaccinated as well as for the general population; expand provider network.
- Those involved in broader health provision
- Those who face greater barriers to access care if they become seriously ill
- Those contributing to maintenance of core societal functions
- Those whose living or working conditions give them elevated risk of infection, even if they have lesser or unknown risk of severe illness and death
Populations considered for Phase 2 include select people from the following categories: critical workers, people with high-risk conditions and people with vaccine access challenges.
Critical Workers: Phase 2: Essential business personnel who cannot work remotely or maintain social distancing not considered in Phase 1. Also, people who interact directly with the public. “Critical workers” and “essential workers” refers to the ACIP’s definition that can be found here and is based off of the Cybersecurity & Infrastructure Security Agency’s guidance. This includes workers who are essential to continue critical infrastructure and maintain the services and functions Americans depend on daily and workers who cannot perform their duties remotely and must work in close proximity to others.
High Risk Conditions: Phase 2: Expanded health conditions as per CDC guidance and additional age category and additional residents of congregate settings such as:
- Underlying health conditions who might be at high risk
- Asthma (moderate-to-severe)
- Cerebrovascular disease (affects blood vessels and blood supply to the brain)
- Cystic fibrosis
- Hypertension or high blood pressure
- Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
- Neurologic conditions, such as dementia
- Liver disease
- Pulmonary fibrosis (having damaged or scarred lung tissues)
- Overweight (BMI of 25 kg/m² and higher, but less than 30 kg/m²)
- Intellectual or neurological disabilities
- Type 1 diabetes mellitus age-associated higher risk
- People age 40 - 64 years
- Residents of a congregate setting
- College dormitories
- Military barracks
- Boarding schools
- Summer camps
Phase 3: Likely Sufficient Supply, Slowing Demand
Focus on remainder of all Phase 1 and Phase 2 populations, expand to general population, complete vaccine series
General Population: Phase 3:
All persons of any age not previously vaccinated
Vaccine Access Challenges: Phase 3: The DOH will partner with professional member organizations for hospitals, including Public Health Management Corporation (PHMC), Hospital and Health system Association of Pennsylvania (HAP), and Pennsylvania Association of Community Health Centers (PA ACHC) and CMHDs. A letter will be drafted to notify the organizations and their members to inform them of the upcoming COVID-19 vaccination efforts in accordance to CDC guidelines through group prioritizations. Shortly thereafter of this notification, guidance in completing the provider agreement will be distributed to all eligible hospitals, Federally Qualified Health Centers (FQHCs) and CMHDs. In addition, the DOH will engage the pharmacies as needed to assist with LTCF vaccinations. The DOH has identified a potential workflow with needed resources for onboarding potential COVID-19 providers for Phase 1 of the COVID-19 vaccination campaign.
- Reach out to HAP and PA ACHC to inform them of upcoming correspondence as related to provider agreements and enrollment
- Draft high-level correspondence to HAP and PA ACHC
- Determine how DOH will receive and process the completed provider agreements: Create an email resource account to receive the completed provider user agreements. The short-term solution for processing provider agreements in Phase 1 will be entering into a form developed in Microsoft Access which is a virtual spreadsheet. DOH will develop a long-term solution that will improve the efficiency of processing provider agreements.
- Establish a toll free line to support providers in addressing any questions they encounter
- The DOH is obtaining a current listing of all hospitals, FQHCs and CMHDs (excluding Philadelphia) to compare to those currently enrolled and actively reporting to the Pennsylvania Statewide Immunization Information System (PA-SIIS) in order to identify those facilities that have not adopted the PA-SIIS. The focus will then lie on the training of those facilities that have not adopted the PA-SIIS.
You can read the Department of Health’s entire vaccine plan by clicking here.