BUILDING HEALTH CENTER CAPACITY TO SUPPORT MASS COVID-19 VACCINATION CLINICS

President Biden’s recent announcement launching the first phase of the Federally Qualified Health Center Program for COVID-19 Vaccination underscores the central and essential role health centers are playing to ensure underserved communities across the country are getting the COVID-19 vaccine.  In order to expand and sustain their capacity to conduct mass COVID-19 vaccination efforts for several months, many health centers are focusing on several core components to ensure their vaccine efforts operate efficiently and effectively to reach their primarily underserved, and often marginalized, communities. In this issue we explore two of these core components:  • Securing and training supplemental staff and volunteers, and • Logistical and operations planning Expanding and Training the COVID-19 Immunization Workforce “We cannot fight this pandemic alone… Our strength is in our numbers.” Ronda Arline, MSN, Director of Nursing Albany Area Primary Health Care  Mass COVID-19 vaccination clinics take more people and resources to operate than health centers often have available. The use of volunteers can enable health centers to utilize staff on a rotating basis to oversee and manage key vaccination clinic stations. As you look to create a volunteer pool, consider reaching out to: • Retired health care providers • Local and neighboring county health departments, private practice providers, and larger health system organizations •  Trusted community leaders and their organizations  •  Emergency medical technicians and paramedics Everyone involved in a COVID-19 vaccination clinic, regardless of their years of experience administering vaccinations or role they play in the vaccination clinic, needs to be familiar with the specific COVID-19 vaccine products; guidance for vaccine storage, handling, preparation, and administration; and patient data collection and software to upload the data correctly into online immunization information systems (IIS), electronic medical records, and other software systems. To ensure all staff and volunteers are properly trained: • Access CDC COVID-19 Training Materials and Resources for active and retired health care providers, and clinic support and operations staff and require each staff/volunteer to complete their appropriate trainings  • Conduct additional onsite training specific to each staff/volunteer role and station prior to the clinic’s opening • Utilize health center staff to provide ongoing oversight of and guidance to all volunteers  • Closely monitor staff and volunteers who are entering patient data as it is critical that the data be entered correctly and completely

LOGISTICAL AND OPERATIONS PLANNING

Health centers are finding that logistical and operations planning and execution of mass COVID-19 vaccination clinics are often requiring an “all hands on deck from multiple departments” approach. This is needed to ensure these offsite vaccination clinics are organized, and operate efficiently and effectively in administering the vaccines.  As your health center plans and executes its mass COVID-19 vaccination clinics, consider these tips from Appalachian Mountain Community Health Center. Their COVID-19 Vaccination Clinic Logistics and Operations Checklist reflects learnings from executing recent mass COVID-19 drive-thru and offsite vaccination clinics:  • Review CDC requirements for vaccine administration  • Have station/team leads to serve as: procuring and monitoring vaccine supplies (such as your pharmacist), volunteer coordinator, operations coordinator, information and technology needs and data collection, etc. • Send staff and volunteers educational materials, specific to their roles (varies state to state) prior to their clinic participation • Plan the clinic flow from entrance to exit, maintaining safe distancing • Make patient education handouts in advance: COVID-19 vaccine consent (CDC provides a template), Emergency Use Authorization for your vaccine product, Vaccine Adverse Event Reporting System form, side effects handout • Plan for enough supplies – gloves, sanitizer, sharps containers, gauze, Band-Aids, trash receptacles, etc. • Try to make a schedule and get vaccine recipients into slots, based on number of available vaccinators, and pre-load their information into the COVID-19 Vaccine Management System if possible • Arrange for qualified staff at each station:   Greeting Check-in Registration/Consent assistance, required handouts/vaccine cards to recipients Vaccinators Post-Vaccine observation Chair sanitizing (after each person) Staff to monitor vaccine supply and pre-draw syringes • Create staff shifts if numbers allow. Recommend one person to be the overall supervisor. • Breakfast and Lunch! For detailed guidance, see CDC Guide for Planning Satellite and Off-site Vaccination Clinics under Monthly Resources.

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MULTI-STATE QUALITY IMPROVEMENT EFFORT

Preliminary Data Highlights Begin to Explore Who Among the Health Center Patient Population Are Affected By COVID-19

NACHC and its partners in the CDC COVID-19 Multi-State Quality Improvement Project are continuing its efforts to extract and analyze preliminary data from community health centers across our six multi-state PCA and HCCN partners. This quality improvement research and evaluation effort is assessing data in five areas:  • Testing: distribution over time and the patient population • Positivity rates: stratified by age, race and time • Predictors of COVID-19 diagnosis/SARS-CoV-2 infection • Rate of influenza and COVID-19 vaccinations provided and received by health center patients • Pandemic Impact on health center operations: virtual care, volume, patient distribution  Additional questions of interest include the impact of social determinants of health (SDOH), comorbidities, utilization of services by COVID-19 positive patients, and outcomes of these patients including post-COVID-19 syndromes. Preliminary Findings NACHC’s informatics data team is currently analyzing the first set of patient data records from January - December 2020. Preliminary insights extracted from data on 174,016 patients are as follows: Gender Females - 101K Males - 72.8K Remainder unspecified Race/Ethnicity Hispanic - 75.7K White - 39.5K African American - 31.9K Other - 26.9K Age of patients with the highest rates COVID-19 exposure: 25 – 35 year old (16,626 cases) 35 – 40 year old (13,891 cases)  The lowest number of patients with COVID-19 exposure are for the >75 age population at 2,122.

COMMUNITY HEALTH CENTERS IN ACTION

COVID-19 CONVERSATIONS   This month, NACHC talks with Brian Toomey, MSW, CEO of Piedmont Health, a community health center with eight clinics serving the Piedmont region of North Carolina. Brian shares with NACHC how they are building COVID-19 vaccine confidence among staff, are ensuring equitable distribution of the vaccine, and how he continues to create positive morale among staff nearly one year into the pandemic.

What is the recommended maximum interval period between the first and second dose?  On February 10th, the CDC posted on its website updated interim recommendations from The Advisory Committee on Immunization Practices (ACIP) for the use of Pfizer-BioNTech and Moderna COVID-19 vaccines. Each of the vaccines require two doses. The Pfizer-BioNTech vaccine doses should be given 3 weeks (21 days) apart, and the Moderna vaccine doses should be given 1 month (28 days) apart. However, second doses administered within a grace period of 4 days earlier than the recommended date for the second dose are still considered valid. Doses inadvertently administered earlier than the grace period should not be repeated.  The second dose should be administered as close as possible to the recommended interval. If it is not feasible to and a delay in vaccination is unavoidable, the second dose of Pfizer-BioNTech and Moderna COVID-19 vaccines may be administered up to 6 weeks (42 days) after the first dose. There are currently limited data on efficacy of mRNA COVID-19 vaccines administered beyond this window. If the second dose is administered beyond these intervals, there is no need to restart the series. Are the two currently available COVID-19 vaccines interchangeable?  According to the ACIP, these mRNA COVID-19 vaccines are not interchangeable with each other or with other COVID-19 vaccine products. Studies have not been conducted to evaluate the safety and efficacy of a mixed-product. Both doses of the series should be completed with the same product. In exceptional situations in which the first-dose vaccine product cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimal interval of 28 days between doses to complete the mRNA COVID-19 vaccination series. If two doses of different mRNA COVID-19 vaccine products are administered in these situations (or inadvertently), no additional doses of either product are recommended at this time.  SOURCE: www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#SARS-CoV-2-infection

MONTHLY RESOURCES

NEW: NACHC’s COVID-19 Vaccine Communications Toolkit NACHC has just released its new  COVID-19 Vaccine Communications Toolkit for health centers to use to build COVID-19 vaccine confidence among staff, patients, and their community. The toolkit includes customizable key messages, frequently asked questions, sample social media posts, posters (English and Spanish), and press release and public service announcement script templates.  CDC Resources for Planning and Hosting Satellite and Drive Thru COVID-19 Vaccination Events CDC’s Guide for Planning Satellite and Off-site Vaccination Clinics has been updated to include specific considerations for administering the COVID-19 vaccination. The guide covers all aspects of planning and implementing a mass vaccination clinic including planning, pre, during, and post clinic activities, and includes an off-site vaccination best practices checklist and supply checklist.

This publication is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,000,000, with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.

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