Vaccination Implementation Strategies to Consider for Populations Recommended to Receive Initial Doses of COVID-19 Vaccine (Persons included in Phases 1a-1c)

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The Advisory Committee on Immunization Practices (ACIP) recommends that once vaccination is underway in the initial phase (Phase 1a) of the COVID-19 vaccination program, which includes healthcare personnel and residents of long-term care facilities, planning should begin for subsequent phases, including Phase 1b (frontline essential workers and individuals 75 years of age and older) and Phase 1c (other essential workers, persons 65–74 years of age, and individuals 16–64 years of age with underlying medical conditions). The following guide is intended to assist state, tribal, local, or territorial (STLT) immunization programs and other immunization partners in planning for vaccination of these populations. Using various strategies, some with commonality across groups, and others unique for specific populations. Using various strategies, some with commonality across groups, and others unique for specific populations, can be considered to reach these populations for COVID-19 vaccination. CDC’s COVID-19 Vaccination Program Interim Playbook for Jurisdictionspdf icon has additional operational considerations to consider for COVID-19 vaccination planning.

Provider Recruitment and Enrollment
  • Communicate vaccination provider requirements and enrollment procedures widely throughout jurisdiction, especially to providers serving these populations.
  • Identify whether employers have existing occupational health or vaccination service providers that can vaccinate essential workforce and enroll those providers in the COVID-19 vaccination program.
  • Map locations of enrolled providers and their capacity to administer vaccinations, considering the unique storage requirements for COVID-19 vaccines.
  • Actively encourage and enroll vaccination providers, including providers from racial and ethnic minority populations, especially those serving priority populations in the following settings, such as:
    • Hospitals
    • Long-term care facilities (LTCFs)
    • Employers/occupational health clinics
    • Pharmacies
    • Health departments
    • Health clinics (including federally qualified health centers, community health centers, and tribal centers)
    • Physician offices, including subspecialty medical providers treating individuals with underlying medical conditions that put them at increased risk for severe illness from the virus that causes COVID-19
    • Home healthcare providers
    • College/university health services/clinics
    • Correctional/detention facilities
    • Community vaccinators and other partners with mobile vaccination clinic services
    • Emergency medical services
    • Federal agencies
    • Points of dispensing (PODs) with vaccination services
  • Population-specific considerations
    • Healthcare personnel (HCP)
      • Special consideration should be given to enrolling HCP in smaller facilities who are not part of larger healthcare systems.
    • LTCF residents
      • Many LTCFs are enrolled in CDC’s Pharmacy Partnership for Long-term Care (LTC) Program. Special consideration should be given to enrolling providers, such as providers on staff in these facilities, to reach LTCF residents living in facilities not enrolled in this program.
    • Essential workers
      • Essential workers work in a wide variety of settings and cannot always be reached in one central location. Special consideration should be given to enrolling providers in areas where a large number of essential workers live or work.
    • Individuals ≥65 years of age
      • Individuals in this population may have limited mobility, and many need prescription medications. Special consideration should be given to enrolling providers who work in mobile clinics which would provide access for those with limited mobility, as well as those who work in pharmacies, where individuals in this population might be frequenting for prescription refills.
    • Individuals 16–64 years of age with underlying medical conditions
      • Many individuals in this population see subspecialty medical providers and need routine treatment and prescription medication. Special consideration should be given to enrolling providers to reach individuals in this population (e.g., subspecialty medical providers, dialysis centers, pharmacies).
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Enumerating, Prioritizing, and Locating Populations
  • Use CDC’s considerations for sub-prioritization of groups recommended to be vaccinated in Phase 1b and Phase 1c. In settings where the vaccine supply is insufficient to vaccinate all essential workers (frontline or other essential workers), sub-prioritization of vaccine doses might be necessary.
  • Enumerate the population size within each population.
    • Partner agencies and organizations may be helpful in determining accurate estimates of these population groups, such as the jurisdiction’s emergency management agency, labor department, chamber of commerce, business healthcare coalitions, and chronic disease/nutrition programs.
  • Map distribution of these populations or the facilities/locations where they live or work.
  • Use mapping tools to identify areas with health disparities (e.g., Social Vulnerability Index, Mapping Medicare Disparities Toolexternal icon, government-sponsored dashboards).
  • Compile and maintain critical points of contact for reaching these populations—for example:
    • Healthcare systems
    • LTCFs, including assisted living and intermediate care facilities
    • Group homes for older adults and adult day care settings
    • Large retail pharmacies
    • Small independent pharmacies serving rural areas
    • Employers of essential workers
    • Emergency medical services organizations
    • Treatment centers for persons with high-risk medical conditions (e.g., dialysis centers)
    • Professional medical subspecialty societies whose members care for patients in these priority groups
    • Home healthcare providers
    • Correctional/detention facilities
    • School system superintendents
    • College and university presidents
  • Population-specific considerations:
    • Healthcare personnel (HCP)
      • Include HCP who are not working in large health systems, such as those with home health agencies, occupational health clinics, and school/student health centers.
    • LTCF residents
      • Include smaller facilities that may not be enrolled in CDC’s Pharmacy Partnership program.
    • Essential workers
    • Individuals ≥65 years of age
      • Include populations that may be homebound or have other access issues by engaging home health agencies and community nurses who serve these populations.
    • Individuals 16–64 years of age with underlying medical conditions
      • Include populations that may be homebound or have other access issues by engaging home health agencies and community nurses who serve these populations, as well as specialty treatment centers (e.g., dialysis centers).
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Vaccine Administration
  • Ensure enrolled vaccination providers are following recommended practices for safe delivery of COVID-19 vaccine.
  • Encourage vaccination providers to schedule clinic visits to prevent congregation of individuals, limited only to persons who may be pre-identified to be vaccinated at that time.
  • Encourage using risk-specific vaccination options/events (e.g., events specifically and only for people ≥75 years of age/closed PODs).
  • Encourage establishment of institutional standing orderspdf iconexternal icon where possible.
  • Encourage vaccination at intake for people living in congregate settings (e.g., group homes, homeless shelters, LTCFs, correctional/detention centers)
  • Engage community members from these populations in planning, including leadership and stakeholders who work with these populations.
  • Engage trusted sources to educate these populations about vaccine recommendations and availability, familiarize partners with available communication materials and assets, and address vaccine hesitancy—for example:
    • Professional organizations, state licensure boards, and healthcare coalitions
    • Employers of essential workers
    • Union representatives
    • Specific health advocacy organization serving these populations
    • Social workers
    • Faith leaders
    • Leaders of community-based organizations
  • Ensure vaccination clinics are available during different times of day to accommodate varying shifts and schedules. Designate clinics that may be closed to outside groups where employers and leadership can refer patients for advance scheduling using systems such as VAMS.
  • Develop and conduct mobile clinics in multiple locations at non-traditional sites, such as:
    • Small health clinics not enrolled as vaccination providers
    • Group homes for people with disabilities and their caretakers
    • LTCFs
    • Correctional/detention facilities
    • Employers
    • Schools
    • College/university parking lots, gyms, dining halls, faculty buildings, and residence halls
    • Faith-based organizations
    • Public libraries, public parks
    • Emergency medical services organizations
  • Partner with groups that can perform mobile vaccination services (e.g., pharmacies, visiting nurse associations).
  • Ensure that providers are aware of requirements to report certain adverse events following COVID-19 vaccination to the federal Vaccine Adverse Event Reporting System (VAERS)external icon.
  • Ensure that vaccination clinics have capability to address hypersensitivity reactions.
  • Population-specific considerations:
    • Healthcare personnel (HCP)
      • For HCP working in smaller facilities that might not have their own vaccination clinics, be sure they can connect with nearby pharmacies for vaccination or are invited to participate in vaccination clinics serving staff at larger facilities.
    • LTCF residents
      • For smaller facilities that may not be enrolled in CDC’s Pharmacy Partnership program, enlist a mobile clinic to visit the facility to vaccinate residents.
    • Essential workers
      • Engage occupational health clinics in these sectors, where appropriate, for closed points of dispensing (PODs). Use mobile clinics for essential workers who do not have access to occupational health services.
    • Individuals ≥65 years of age
      • Have this population use VaccineFinderexternal icon, CDC’s online system for showing COVID-19 vaccine availability and locations across the United States, to find a COVID-19 vaccination location near them. If access is an issue, engage home health agencies/mobile vaccination services.
    • Individuals 16–64 years of age with underlying medical conditions
      • Have this population use VaccineFinderexternal icon, CDC’s online system for showing COVID-19 vaccine availability and locations across the United States, to find a COVID-19 vaccination location near them. If access is an issue, engage home health agencies/mobile vaccination services.
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Second-Dose Reminders
  • Use a variety of methods to provide second-dose reminders to recipients and/or medical proxies about the correct timing and vaccine type for their second dose of COVID-19 vaccine, including:
    • Vaccination record cards
    • Electronic health records/patient portals
    • Text messaging
    • Phone calls
    • Email
    • Mail
    • Peer navigators/mentors
    • CDC’s VaxText and V-Safe (Both systems offer COVID-19 vaccination second-dose reminders)
  • For people living in institutions who are moved after receipt of the first dose, link them to vaccination providers in the community or send a reminder to the receiving facility.
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Documentation and Reporting
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Provider/Administrator Communications
  • Educate healthcare providers throughout jurisdiction about recommendations to vaccinate these populations and, if not an enrolled provider, where to refer patients for free vaccination.
  • Educate nonclinical facility administrators about recommendations to vaccinate these populations, such as:
    • Employer human resources staff
    • Correctional/detention facility wardens, leadership, and health services
    • Emergency medical services organizations
  • Ensure providers have information to counsel patients on vaccine recommendations, including relevant contraindications or potential lower efficacy in certain groups.
  • For people in institutions, train providers to ensure transfer of vaccination records to receiving facilities or request vaccination records from previous facilities.
  • Message directly to caretakers or medical proxies to encourage vaccine uptake.
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Communications
  • Educate partners on currently available communication resources and where they are located.
  • Develop or adapt to the local context diverse communication materials on vaccine recommendations and where people in these groups can get vaccinated, such as:
    • Newspaper (print and online) advertisements
    • Online/social media advertisements, including on advocacy organization websites
    • Mail/postcards
    • Population-specific communications (e.g., employer communications, trade magazines, senior-focused publications, or other communications)
    • Educational videos
  • Ensure all communication materials are culturally and linguistically appropriate, including messaging with American Sign Language, large print, and braille.
  • Create or adapt low literacy messages, including those for people with intellectual disabilities.
  • Ensure all messaging complies with Americans with Disabilities Act (ADA) regulations.
  • Population-specific considerations:
    • Healthcare personnel (HCP)
      • Share Vaccinate with Confidence Give HCP educational materials to help them feel confident in their decision to receive COVID-19 vaccine and to make strong vaccine recommendations for their patients.
      • Find a vaccination champion for each unit/floor/division. Have champions and other staff wear buttons showing they’ve been vaccinated to promote vaccine confidence among staff and patients.
    • LTCF residents
    • Essential workers
      • Allow for workers to ask questions and discuss concerns about the vaccine process, including workplace policies to support workers needing time away from work if they are experiencing any expected post-vaccine side effects.
      • Have leadership in the occupational field be role models by highlighting stories and pictures of upper management being vaccinated. Individuals ≥65 years of age
      • Engage organizations, such as AARP, in promoting vaccination in this population with materials showing images of older adults that highlight the benefits of vaccination.
    • Individuals 16–64 years of age with underlying medical conditions
      • Ensure that subspecialty medical professionals (e.g., cardiologists, pulmonologists) and the specialist care team (including chemotherapy clinics, dialysis centers, etc.) are familiar with the Vaccinate with Confidence framework to address patient questions/concerns about vaccination. Identify vaccination champions in these settings.
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Page last reviewed: December 23, 2020
Content source: National Center for Immunization and Respiratory Diseases