October 18, 2020

Albany, NY

Questions about financing, allocation, supply chain, communication and information requirements

Federal and state collaboration is critical to the safe and effective distribution of Covid-19 vaccines

Questions were asked by 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 to clarify how a COVID-19 vaccine can most effectively be distributed and administered. The distribution and implementation of the vaccine is a huge undertaking that cannot be accomplished without significant logistical coordination, planning and financial support between the federal states and the federal government. The list of questions submitted by Republican and Democratic governors from across the country includes funding to administer a vaccine, allocation and supply chain, and communication and information requirements.

“The National Governors Association, of which I am chairman, sent a letter to the President of the United States last week. We requested a meeting with the President to discuss how this should work between the federal government and states,” said Governor Cuomo. “We are now releasing a compilation of questions from Governors around the country, Democrats and Republicans telling the White House, How is this going to work? We need to answer those questions before the vaccine is available, so that we are ready to go and.” no one is caught flat-footed when the time comes to vaccinate people. “

The list of questions NGA asked from the nation’s governors is available below:

Funding the vaccine administration

  • Are funds being made available to states to support vaccine distribution and other vaccine efforts?
  • Without additional government and local funding to implement COVID-19 vaccination plans, we will be prevented from doing what we can achieve. When can we expect more specific information about resources related to this answer?
  • What are the plans for federal contracts and / or additional funding to support Boots on the Ground for vaccination in Stage 2 and beyond?
  • How are vaccine administration costs covered for uninsured people?
  • Will the federal government set guidelines for allowable vaccine administration costs for those with health insurance (whether this is state insurance, Medicaid, Medicare, CHIP, or any other state funded health insurance)?
  • How is the financing / reimbursement of vaccines handled?
  • We understand that the vaccine will initially be provided free of charge, as will remdesivir. Now, however, states have to pay for remdesivir in the commercial market. How long will the federal government commit to making the vaccine available to states free of charge?

Allocation and supply chain

  • How is the vaccine assigned to the states? Which formula is used?
  • How is the vaccine distributed? Which mechanism will the federal government use?
  • Can the administration provide further guidance as to what prioritization requirements will be a condition for the release of vaccines and how much leeway states have to guide these decisions?
  • Are further changes expected to the PREP Act beyond approving pharmacists and interns to administer vaccines?
  • How does the CDC plan to manage the distribution of vaccines to federal agencies such as federal prisons, the VA, and other federal organizations? Will these companies receive vaccine supplies directly from the CDC or will states manage them?
  • Similarly, when can states expect guidance from the federal government on state responsibility for vaccinating federal employees (e.g., who vaccinates the National Guard, USPS staff, the FBI, etc.)?
  • How is tribal sovereignty respected? The CDC sent a template asking how many doses of vaccine to send to each IHS / tribal health facility, rather than asking states where each tribe would like to send their vaccine doses (this could be one of those facilities, a DOH public health department, a private provider you want to enter into a contract with, etc.)
  • What will be the national strategy for prioritizing vaccines when supply is tight?
  • How does the management of supplies (e.g. needles, syringes, alcohol swabs, plasters, etc.) work?
  • Will there be additional guidance on handling ultra-cold vaccine (e.g. thawing, storage after thawing, reconstitution, etc.)?
  • We are aware of concern that there is already a shortage of dry ice used to store the ultra-cold storage vaccines during clinical trials.
    • If so, does this deficiency affect plans to ship ultra-cold storage vaccine with dry ice and containers that can hold the vaccine for up to a week?
      • If there is a shortage of dry ice, does this change policy for states not to purchase additional ultra-cold freezers?
      • We also need guidelines on the redistribution of ultra-cold storage vaccines. If they come in 1000 can shipments as indicated by the federal government, we will likely need to redistribute them in our rural areas. What will the guidelines be for doing this without compromising the vaccine?
      • How long can the product keep outside of the original packaging in which the 1,000 cans are shipped? Can / will packaging with a smaller volume also be included in the shipment?
      • What will the federal guidelines for under-prioritizing among the initial priority groups be, as there will not initially be enough vaccines for self-employed healthcare workers as a group?

Communication and information requirements

  • There was evidence that large pharmacy chains and possibly intergovernmental health systems are registering directly with the federal government. We need the specific details as many of them reach states as well. This affects our targeted registration of these stakeholders as Covid-19 vaccine providers. When can we expect clarification as to which stakeholders will work directly with the federal government?
  • Will there be a coordinated procedure in several countries to monitor vaccine effects (side effects, lack of immune responses, etc.) to ensure that early warning signs are detected as soon as possible?
  • Will the federal government provide up-to-date / real-time information about tribal nations registering with the CDC for direct delivery instead of registering through the state?
  • Can the administration provide more information on long-term care facilities? Specifically, are you planning to prescribe vaccines in nursing homes through CMS? For example, will vaccine use be linked to further funding from Medicaid? If so, when would such requirements come into force?
  • Will the federal government require states to report personally identifiable COVID vaccine data? We have concerns that this could lead to a lack of confidence and discourage people from getting vaccinated.
  • What is the role of the state in monitoring post-vaccination safety?
  • How many states are using VAMS as their immunization information system (IIS)?
  • Will states share their micro-prioritization in phase 1b?
  • What communication / messaging materials have been developed?
  • How is complex scientific data transmitted and shared publicly? What kind of teaching material is being developed and in what languages?
  • What information is made public about each approved vaccine? How is transparency guaranteed?
  • CDC plans to request a report to the IIS within 24 hours of the vaccine being administered. We know that there is a dramatic delay in data in for flu vaccines. How will coverage of COVID-19 vaccine data differ?

Contact the governor’s press office