Monterey County Health Department Strategy for ...

of 36

Monterey County Health Department Strategy for Implementing California’s COVID-19 Vaccination Plan

2019 Novel Coronavirus Disease (COVID-19) is a highly infectious respiratory disease

caused by the SARS-CoV-2 virus. The Monterey County Health Department (MCHD)

initiated preparedness activities in mid-January 2020 to increase pandemic readiness.

The MCHD Department Operations Center (DOC) activated on March 25, 2020, in

response to Monterey County’s first confirmed COVID-19 case. Vaccination represents

one important component of the DOC’s response.

Purpose

The purpose of this document is to outline MCHD’s strategy for implementing

California’s COVID-19 Vaccination Plan. California has adopted the Centers for Disease

Control and Prevention’s (CDC’s) three-phased approach to vaccination. Details of

California’s COVID-19 Vaccine Plan can be found at:

https://covid19.ca.gov/vaccines/#California's-vaccination-plan. California has committed

to a data-driven approach with an emphasis on equity and on protecting California’s

critical infrastructure and vulnerable populations.

Authority

Legal authority for actions related to response is provided to the Monterey County

Health Officer by California Health and Safety Code Sections 120125-120155 and

Sections 120175-120250.

Vaccination is a routine component of the practice of public health. During the COVID-

19 pandemic, MCHD vaccination planning is the responsibility of the Immunization Unit

located within Public Health Branch, Operations Section, of the Department Operations

Center (DOC). The Public Health Branch Director will assess the resources needs of

https://covid19.ca.gov/vaccines/#California's-vaccination-plan

of 36

the Immunization Unit and make additional resource requests through the Incident

Command structure. Progress reports on significant events objectives and strategies

will follow the Incident Command System.

Projected Need

Monterey County has approximately 434,061 residents. Guidance from the Advisory

Committee on Immunization Practices and the California Department of Public Health

(CDPH) as well as Emergency Use Authorizations (EUA) issued by the Food and Drug

Administration may limit the number of county residents that can be offered the vaccine.

For example, vaccines approved under current EUA have minimum age limitations as

well as contraindications to vaccination. Among those for whom vaccine is

recommended, CDPH has provided the following estimates of groups at higher risk for

occupational exposure who may be offered vaccine before other groups:

• 24,000 health care workers

• 4,237 correctional and public safety workers

• 90,842 other essential workers (e.g., workers in education, agriculture, food)

As more information is known about COVID-19, the Centers for Disease Control and

Prevention will issue and update guidance on groups that are at higher risk of serious

illness. For example, epidemiologic data show that older individuals are at higher risk of

serious illness. The Health Department estimates the following number of individuals

that meet age-based risk of serious illness:

• 47,811 individuals 65 to 74 years of age

• 38,660 individuals 75 years of age and older

Planning Work Group

MCHD convened a COVID-19 vaccine planning workgroup November 2020. The

workgroup will remain informed of California’s COVID-19 Vaccine Plan including

updates to the Plan. The group discusses vaccine allocation, distribution and

administration, in accordance with the California COVID-19 Vaccine Plan. The work

group meets as needed. The group will invite participants as appropriate, which may

include, but are not limited, to the following sectors:

• Health care providers

of 36

• Emergency services

• Public health

• Local government

• Behavioral health

• Social services

In addition, MCHD DOC members regularly participate in industry sector-focused

meetings that include community-based originations, industry leaders, faith-based

organizations, and others. Meeting topics in vaccination planning, population needs,

resource sharing, and complementary strategies.

Human Resources

Personnel will be organized following Incident Command System (ICS). In a pandemic

situation, it may be necessary to secure resources outside of the Monterey County

Health Department to address gaps in the Health Department workforce. Staffing from

partnering agencies, temporary employees, and trained volunteers can play a critical

role in initiating timely disease intervention services. Nursing schools, colleges and

universities, military facilities, and the medical community are sources of potential

workforce to assist in response to pandemic surge.

When the need for additional surge staff arises, the DOC Operations Section Chief will

request resources through the ICS structure. The DOC Public Health Branch Director

will inform the DOC Operations Section Chief of the number of individuals potentially

needed for response, required skills, and anticipated duties. The following activities will

be coordinated by the County Emergency Operations Center (EOC) or DOC to meet

DOC objectives when additional staffing is necessary:

Recruitment

• Obtain job description(s) and skill needs from Public Health Branch Director

o Positions and skill needs include:

▪ Team Leader:

• Experience overseeing and directing work of others

• Good organizational skills

• Excellent communication skills

▪ Vaccinator:

• Licensed medical professionals (or in training to be

licensed), preferably with some public health experience,

that are included on the California Department of Public

of 36

Health’s list of approved professionals to administer

vaccination

(https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immu

nization/Authorized-Licensees.aspx)

• Second language skills including Spanish, Trique, Mixteca,

Zapoteca, or Tagalog, with Spanish being the primary focus

• Attention to detail

• Assessment and documentation skills

▪ Clinical Observer

• Licensed medical professional

• Assessment and documentation skills

▪ Screener

• Licensed medical professional preferred

• Able to measure temperatures and administer COVID-19

screening questions

• De-escalation skills

▪ Support Personnel

• Second language skills as above

• Computer skills including data entry into a variety of

databases and record systems

• General office skills including answering and transferring

phone calls, scanning, copying, and filing.

• Solicit individuals with the required skills

Screening

• Interview potential volunteers and/or review applications to ensure basic skill

requirements are met

• Verify credentials, if required for the available positions

Tracking

• Enter qualified volunteers into a database. Database elements should include, in

addition to any elements required by Human Resources:

o Name

o Date of Birth

o Telephone Number (cell preferred)

o Licensure Information (if any)

o Languages Spoken

o Available work hours (days of week and hours)

Engagement

• Contact qualified volunteers of assignment, to whom to report, and when and

where to report

of 36

• Remove volunteers from tracking list if they are no longer interested in

assignment

Onboarding

• Provide any required Health Department and County orientation, training,

vaccination and testing

• Obtain signatures on any required Health Department forms

• Link to Team Leader

Liability

Liability protection for all incident paid workers and volunteers is covered by the federal PREP Act for instances that require the use of countermeasures to prevent

disease and if the federal Secretary of Health and Human Services has issued a PREP Act declaration. More information about COVID-19 and PREP Act declarations is available at: https://www.hhs.gov/about/news/2020/12/03/hhs-amends-prep-act-declaration-including-expand-access-covid-19-countermeasures-telehealth.html.

Response Teams

Team Focus

Teams will focus all aspects of COVID-19 vaccine procurement or allocation,

distribution, storage, clinic planning, patient scheduling, administration, and reporting.

Monterey County will follow the California COVID-19 Vaccine Plan, which moves

through a phased and tiered system for distribution of vaccine. The California COVID-19

Vaccine Plan be found on CDPH website at: https://covid19.ca.gov/vaccines/. Vaccine

availability will likely be the primary factor when planning vaccine distribution and

vaccination events. Teams focus on one or more areas of the vaccine rollout process.

Team members may serve on one or more teams as needed. Appendix A shows DOC

and Point of Dispending (POD) organizational charts.

Department Operations Center Planning Section

The Planning Section’s role is to work with vaccine subject matter experts to develop a

strategy for vaccination that includes:

• Systems for ordering vaccines, tracking inventory, and recording administered

doses

o MCHD is required to utilize CDPH’s CalVax system for ordering and

inventory management.

• Clinic registration process

https://www.hhs.gov/about/news/2020/12/03/hhs-amends-prep-act-declaration-including-expand-access-covid-19-countermeasures-telehealth.html

https://www.hhs.gov/about/news/2020/12/03/hhs-amends-prep-act-declaration-including-expand-access-covid-19-countermeasures-telehealth.html

https://covid19.ca.gov/vaccines/

of 36

o In order to minimize wasted doses and improve the efficiency of onsite

administration processes, MCHD will use CalVax to pre-register

individuals.

• Vaccine transportation and monitoring

• Staffing ratios and supply needs

• Vaccination site requirements

• Training protocols

• Focus populations

• Medical oversight

A summary of some of the clinic assumptions and key planning details are included in

Appendix B.

Department Operations Center Logistics Section

The Logistics Section is responsible for procuring resources identified as needed for

execution of DOC activities. Logistics staff will utilize Department resources first. When

needs exceed Department resources, Logistics will submit requests to County EOC.

When medical/health resources are required, Logistics will submit requests to the

County Medical and Health Operational Area Coordinator (MHOAC) for regional and

state resources.

Department Operations Center Immunization Unit

The Immunization Unit provides technical guidance for storing, transporting, and

administering vaccine. The Immunization Unit is led by MCHD Vaccine Coordinator, a

position required by CDPH to have completed a specific training in vaccine

management. DOC staff will follow the MCHD Vaccine Management Plan as well as

manufacturer’s, ACIP’s and Vaccine for Children (VFC) program guidance. Successful

management of vaccine depends on:

• A well-thought-out vaccine management plan,

• Properly trained key staff,

• Reliable vaccine storage and transportation units,

• VFC compliant data loggers that are properly calibrated, and

• Careful adherence to routine monitoring and storage tasks that protect vaccine

viability.

MCHD staff will vaccinate under MCHD standing orders and protocols for COVID-19

vaccination and treatment of anaphylaxis (see Appendix C). Job aides for handling and

mixing vaccine can be found in Appendix D.

Department Operations Center Information Technology Unit

Team Leaders will work with Health Department Information Technology staff to obtain

access to Health Department systems, if needed. Team Leaders will also work with

of 36

Health Department Information Technology to secure electronic devices such as

laptops, hot spots, and cell phones, if needed, to support response teams.

Department Operations Center Epidemiology Unit

The Epidemiology Unit provides data support and analysis. Epidemiologists support the

tracking of administered vaccine doses and, as vaccine roll-out proceeds, identifies

areas of low vaccine penetration and potential inequities to guide planning efforts. The

Epidemiology Unit utilizes and promotes state and local vaccine reporting systems

including but not limited to:

• California Immunization Registry (CAIR2)

o All doses of COVID-19 vaccine are required by CDPH to be entered into

CAIR2 within 24 hours of administration.

o Users will successfully complete CDPH training courses to be granted

advanced level access to the system needed to extract data.

Security

Vaccination site security will be coordinated through the Logistics Unit as needed and

coordinated with the clinic’s host site. It is anticipated that crowd control may be an

issue while vaccine supplies are limited. Security and Police participation will be

coordinated as needed to assure the safety of vaccine event staff and participants. If

private security is utilized for the clinic site, the Logistics Unit will notify local law

enforcement agencies in advance of any large-scale clinics.

Additional strategies will be implemented at MCHD locations to ensure vaccine

inventory is received and stored securely, which includes restricting access to vaccine

storage areas and refrigerators and freezers.

Site Procurement

MCHD will build on existing partnerships to procure suitable sites for vaccine

administration. Sites that have been vetted and exercised with partners during prior

influenza seasons will be prioritized. Planning for larger sites is being coordinated

between the DOC Logistics Unit and the Monterey County Emergency Operations

Center (EOC) to support site procurement. Site considerations include:

• Space (square footage)

• Protection from inclement weather

• Traffic flow

• Security

• Lighting

of 36

• Access to water and restrooms

• Parking

• Access to electricity and cellular/Wi-Fi service

A more comprehensive list of site requirements is found in Appendix E. Sites must be

able to start up within a few days’ notice due to the unpredictable stream of vaccine

flowing into Monterey County. Thus, advance planning and procurement is critical.

When COVID-19 transmission rates are high in Monterey County, MCHD will give

preference to outdoor venues and drive-through sites to reduce potential transmission

of COVID-19, with flexibility for indoor sites to accommodate inclement weather.

Vaccine Allocation and Health Equity

CDC and CDPH determine vaccine allocation to Monterey County. MCHD will follow

California’s COVID-19 Vaccine Plan and implement said plan based on the number of

doses allocated by CDPH.

Local epidemiology will also guide vaccine distribution. When vaccine supplies are

limited, certain populations within each phase and tier of California’s COVID-19 Vaccine

Plan may be prioritized using an equity focus. Individuals over a certain age and those

living in the lowest quartile Census tracts of the California Healthy Places Index (HPI)

may be prioritized to address equity, protect those at highest risk of severe disease, and

assist communities disproportionately affected by the pandemic.

Vaccine allocation and distribution will be:

1. Beneficial

Vaccine allocation and distribution will focus on maximizing society benefit. This

includes prioritizing individuals who are at greatest risk of severe illness and

death (65 years of age and older), are most essential in sustaining the ongoing

COVID-19 response (health care workers and emergency medical responders),

and are most essential to maintaining core society functions (food supply workers

and public safety).

2. Equitable

Some sectors of the population have been disproportionately impacted by

COVID-19. The Hispanic/Latino, Asian, Pacific Islander, and Black/African-

American communities in Monterey County have higher rates of COVID-19

infections. Vaccine distribution will focus on ways to ameliorate the burden of

disease in these populations. Those who face greater barriers to access care if

they become ill and those whose living or working conditions give them elevated

risk of infection will receive special consideration as well. Local COVID-19

of 36

morbidity and mortality data will be used to monitor disease burden and COVID-

19 health inequities among subsets of the Monterey County population.

3. Transparent

MCHD will communicate with the public openly, clearly, accurately, and

straightforwardly about the vaccine allocation criteria and framework. Vaccine

allocation and distribution information will be publicly posted on the MCHD

website and social media to maintain public trust during planning and

implementation.

4. Evidence-based

Vaccine allocation and planning decisions will be based on local data and the

best available scientific evidence regarding risk of disease, transmission, and

societal impact.

Metrics used to monitor equitable distribution of vaccine will include but not be limited

to:

• Proportion of vaccine providers who traditionally have served priority populations

and/or priority geographic areas

• Proportion of vaccine allocated to Monterey County that is distributed to

providers serving priority populations and geographic areas

• Vaccination rates and proportions by demographics

Clinic Workflows

Pre-Clinic Sector Engagement

MCHD will engage with organizations in the county and region to identify those

organizations that can contribute resources to clinic planning and clinic implementation.

As the county moves through Phases and Tiers in the California COVID-19 Vaccine

Plan, new priority groups will be targeted for vaccine clinics. Each priority group is

serviced by a variety of agencies and organizations which can change from one priority

group to another priority group. Examples of such organizations include employers and

employer associations, health care providers, advocacy organizations, transportation

agencies, and county and city departments.

MCHD, in coordination with these organizations, will determine which resources each

organization can contribute to vaccine clinics. In some instances, MCHD will provide all

the resources for planning clinics and implementing vaccine clinics. In other instances,

MCHD may provide certain resources while other organizations contribute the

remaining resources. In other instances, MCHD may not provide resources to vaccine

clinics, with other agencies contributing all the necessary resources. Resources

necessary for vaccine clinics include but are not limited to site location, individuals for

of 36

screening and verifying appointments, vaccinators, individuals to observe patients as

required by FDA and the manufacturer and security. Detailed resource and staffing

information is provided in this document.

As an example, an employer may provide job site location and security for the clinic,

while a health care provider familiar with the priority group provides the vaccinators and

observes, while an advocacy group provides screeners and interpreters to welcome and

direct the patients through the vaccine clinic.

The Department may review COVID-19 vaccine clinic plans developed by other

organizations and provide guidance or resources as appropriate. This framework can be

applied to many industry sectors including agriculture and food, education and

childcare, emergency services, defense, etc.

Additional sector-specific considerations are listed in Appendix F.

Pre-Clinic Planning

The planning of vaccine clinics and clinic appointments is dependent upon the number

of available vaccines and vaccinators. Based on staffing ratios, the number of vaccines

and vaccinators determines the number of staff needed for all other vaccine clinic

functions, and ultimately the number of vaccination clinics needed to vaccinate the

entire workforce of a given group within the California COVID-19 Vaccination Plan.

Different types of clinic models may be necessary to serve diverse population groups.

The following models will be considered, depending on the availability of doses and

resources, as well as population needs:

• Medical Provider Based

• Small Points of Dispensing (PODs)

• Medium PODs

• Large PODs

• Mass Vaccination Events

• Pharmacy Based

• Employer Based PODs

Appendix G identifies the dose requirements and types of clinics that will be considered

based on the available doses, as well as current planning status.

The steps below for an employer-coordinated model are based on currently available

mass vaccination management software. Upgrades or changes in software will alter

data points needed to be gathered by employee.

1. Employer organization determines the total number of employees, patients,

clients or residents affiliated with the organization needing to be vaccinated and

begins compiling needed data elements (due to the nature of the data, staff will

of 36

need clearance for working with employee HIPPA data). Required data elements

for CAIR include:

a. Name

b. Date of Birth

c. Address

d. Race

e. Ethnicity

f. Mother’s Maiden Name

g. Answers to Screening/Contraindication Questions.

2. Vaccinating organization assesses the number of vaccines available, the number

of vaccinators available and determines the duration of each clinic and the

number of clinics to be scheduled.

3. Employer and vaccinating organization determine the clinic schedule and

generates “clinic appointments” using agreed upon scheduling system.

4. Employer, employees, patients, clients or residents populate appointments.

5. Vaccinator conducts vaccination clinic and completes data entry.

This strategy can be modified as additional priority populations are targeted for

vaccination, such as age-based populations and other risk-specific groups. In addition

to coordinating with employers, MCHD staff may coordinate with medical providers and

other providers of services to priority populations.

For PODs and clinics coordinated by MCHD, DOC members will develop team rosters

for each clinic. DOC Public Health Branch and Planning Section work collaboratively to

identify and schedule staff. Staff resource needs are conveyed to the Logistics Section,

if additional personnel are needed.

For PODs and clinics coordinated by MCHD, DOC Logics and Planning staff will

conduct a walk-through of each potential site prior to clinic date to plan clinic flow and

identify any potential logistical issues. Following the initial site walk-though, DOC

Planning Section working in conjunction with the Immunization Unit to develop a clinic

flow strategy for the site. The following areas will be identified, as well as movement

patterns between areas:

• Entrance

• Screening and Process Orientation

• Medical Screening

• Education and Consent

• Consultation Area (for individuals needing a more thorough medical history

review)

• Vaccination

• Monitoring and Discharge

• Exit

A sample clinic flows are shown in Appendix H.

of 36

Pre-Clinic Training

In addition to any general County and Health Department required and recommended

training, staff and volunteers assigned to other pandemic response efforts will receive

training following the Just-in-Time Training (JiTT) model. JiTT allows Team Leaders to

train staff and volunteers on specific tasks and duties with a limited scope of

responsibilities. JiTT can be conducted via Zoom or in person just prior to a shift.

Topics include but are not limited to the following topics:

• Basic COVID-19 information including mode of transmission

• Infection control measures

• Vaccine storage and handling issues

• Vaccine mixing and administration

• Clinic flow

• Role-specific administrative tasks

• Worker safety

• Chain of command

• Confidentiality and other legal issues

• Cultural sensitivity and ethical considerations

• Consent for immunization of minor children

The Public Health Branch Director will be responsible for approving training materials

prior to delivery of JiTT. Appendix I contains sample job duty sheets used in JiTT.

Pre-Clinic Supply Preparation

DOC staff assigned to assist with vaccine clinic will inventory medical and office

supplies on a regular basis and request any needed clinic supplies through DOC

Resource Request processes.

At least one day prior to the clinic date, DOC staff will prepare clinic supplies (see below

and Appendix J). This includes:

• Pre-populating vaccine administration forms with vaccine name, lot, and

expiration date.

• Inspecting and packing enough medical supplies to administer the number of

doses planned for the clinic.

o Hand sanitizer

o Band-aids

o Alcohol wipes

o Tissues

o Disinfectant, such as Cavicide or Dispatch, and corresponding Material

Safety Data Sheets

o Anaphylaxis and first aid kit

o Syringes and needles appropriate for the type of vaccine being

administered

of 36

o Nitrile gloves, sizes small, medium and large

o Surgical masks

o Face shields

o Gowns, if recommended by CDC

o N95 respirators for use with symptomatic attendees, variety of brands

o Vaccine diluent

o Sharps containers

o Biohazardous waste bags

o Garbage bags

o Stopwatch or timer

o Thermometers and probe covers

o Copy of medical waste generation and transportation permit

o Copy of Standing Orders to administer vaccine and epinephrine

o Locking briefcase or file box for protected health information

o Vaccines for Children (VFC) vaccine transportation record

o Opt out CAIR notification poster

• Inspecting and packing enough office supplies to administer the number of doses

planned for the clinic.

o Vaccine records

o Clipboards

o Pens

o Highlighters

o Markers

o Tape, blue and gray

• Charging laptops, cell phones, and tables needed for review and entering

vaccine data in the field.

• Conditioning data loggers’ glycol bottles at vaccine temperature.

• Setting data logger alarms to appropriate temperature ranges.

• Packing IT and communication equipment listed above, as well as hot spots and

extension cords.

• Inspecting and packing field clinic supplies including safety vests, chairs, tables,

tents, tent weights, signs, barriers, two-way radios, hazard cones, lights,

stanchions, line dividers, and reflective markers.

• Labeling supply transportation containers.

Vaccine Transportation and Preparation

To maintain efficacy of vaccine and minimize wasted product, vaccine transportation

and preparation will be limited to DOC staff who have completed the VFC immunization

handling and storage courses (https://eziz.org/eziz-training/). The DOC Immunization

Unit leader provides oversight of all vaccine shipped to MCHD for the duration of

MCHD’s custody of it.

Steps to prepare vaccine for transportation include:

https://eziz.org/eziz-training/

of 36

• Condition panels of vaccine coolers at appropriate interval needed prior to

packing cooler.

• Insert and activate data loggers, which have been preset to appropriate

temperate range.

• Enter details of vaccine (brand name, number of doses, lot number, expiration

date) on VFC transportation form, as well as baseline temperature.

• If necessary, when cooler has reached a stable, appropriate temperate, thaw at

appropriate interval per manufacturer’s directions.

o Pfizer: https://www.fda.gov/media/144413/download

o Moderna: https://www.fda.gov/media/144637/download

o Other manufacturers as authorized or approved by FDA

• Pack vaccine according to manufacturer’s directions, counting doses as loading

and enter vaccine brand, lot number, expiration date, condition, and number of

doses being transported on VFC transportation form.

• Seal cooler, noting date, time, and temperature on VFC transportation form.

MCHD may reposition or redistribute COVID-19 vaccine. Vaccine that is repositioned

must always remain in the custody of MCHD staff. MCHD may redistribute doses of

vaccine to an agency that has been approved to receive COVID-19 vaccine directly by

the CDPH. MCHD staff may require onsite inspection of an agency’s cold chain of

storage and monitoring procedures before redistribution of vaccine. VFC chain of

custody forms must be completed when redistributing doses.

Clinic Setup

Clinic staff arrive onsite at least 1 hour prior to the vaccination start time. Team leads

will conduct a walkthrough of the site to determine if there are any changes needed

from the planning site visit. Setup crew unpack equipment and position according to the

pre-determine layout. Team leads meet with their assigned units, provide JIT training,

discuss break schedules, and distribute supplies and equipment. Unvaccinated staff are

utilized to provide a “dry run” of the stations before opening. A clinic setup is included in

Appendix K.

Clinic Management

Vaccine clinics are managed under Incident Command Structure (ICS). DOC Section,

Branch, and Unit leaders are required to complete ICS 100, 200, and 700 training.

Utilization of ICS allows for smoother operations when clinics are staffed with a diverse

collection of county employees from different departments, individuals from outside

agencies, and volunteers. Assignments are provided on an operational period basis.

Incidents are reported to the DOC Operations Section Chief and the DOC

Director/Incident Commander.

The Immunization Unit will take lead for all medical aspects including monitoring

vaccine utilization during the clinic. While clinics are planned to match appointments

with vaccine doses, in the event of surplus vaccine, any doses of unused vaccine that

https://www.fda.gov/media/144413/download

https://www.fda.gov/media/144637/download

of 36

cannot be returned to storage under manufacturer’s guidelines will be offered to

individuals without appointments who may fall in the next phase or tier of the California

COVID-19 Vaccine Plan.

Clinic Closure and Debriefing

At the end of the clinic, team leads meet with their assigned unit for debriefing, which

includes review of challenges and success. DOC staff break down equipment, pack

supplies, and close the site. Equipment is returned to storage. The Immunization Unit

inventories remaining vaccine, documents minimum and maximum vaccine

temperatures, notes any temperature excursions or wasted doses on the VFC form, and

returns viable unused doses to the appropriate storage unit. Coolers are cleaned and

panels returned to cold/frozen storage. DOC staff make note of any resources that may

need to be replenished prior to the next clinic and order/request as appropriate. Staff

are released from duty by their team leader.

Information Dissemination

Information dissemination is the function of the Public Information Officer (PIO) and will

be carried out in accordance with the MCHD Communications Plan, an annex of the

MCHD Emergency Operations Plan. PIO will utilize standard and social media to inform

individuals in phases and tiers when their time for vaccination arises.

Public health messaging prior to vaccination clinics is important. Best practices include

involving local medical providers, community leaders and other trusted community

members in dissemination, providing culturally appropriate information, and providing

clear, focused guidance.

Reporting

Monterey County Health Department will enter vaccination information into the

California Immunization Registry (CAIR2) when Department vaccine is used at a

vaccination clinic. Vaccination information may be entered directly into CAIR2 or may be

entered via interface with other data systems such as appointment scheduling systems.

Department staff will enter vaccine doses in the custody of the Department into state or

federal vaccine inventory systems, such as CalVax.

of 36

Department staff administering vaccine that encounter an adverse reaction in a

vaccinated individual shall report the event into Vaccine Adverse Event Reporting

System (VAERS) as recommended.

The Department will enter additional information into data systems as required by the

California Department of Public Health.

Timeline

The pace at which Monterey County moves through the phases and tiers of California’s

COVID-19 Vaccine Plan is dependent on:

• Approval of vaccine products for use (FDA EUA approvals)

• The number of vaccine doses allocated to Monterey County

• The timeframe in which vaccine doses arrive in Monterey County

• The number of and timing in which local medical providers receive approval from

CDPH to receive vaccine directly

• Changes in the groups prioritized in California’s COVID-19 Vaccine Plan

• Availability of licensed professionals authorized to administer vaccines

Clinic/POD order of operations include:

1. Procure needed supplies

2. Secure vaccinators and support staff

3. Engage and coordinate with partners

4. Secure vaccination sites

5. Confirm adequate supplies including vaccine

6. Schedule first and second dose clinics

7. Inform target population

8. Schedule appointments

9. Conduct clinic/POD

10. Report doses administered

11. Review and revise plan as needed

MCHD will provide up-to-date information about which phases and tiers are being

vaccinated on the MCHD COVID-19 vaccination website. The PIO will also disseminate

said information as above.

of 36

Performance Expectations

Performance expectations for all individuals involved in vaccine clinic planning and

implementation include:

• All staff will wear appropriate PPE during face-to-face interactions as outlined by current CDC, CDPH, and CalOSHA standards.

• Incidents will be reported per MCHD policy.

• Staff administering vaccinations will follow their professional licensure standards, MCHD standing orders, County and Department policies, and ACIP guidelines.

• The client’s privacy will be safeguarded to the extent possible and confidentially maintained in accordance with Federal law, California law, CDPH guidance,

Monterey County Health Officer direction, and Monterey County Communicable Disease Prevention and Control confidentiality and security protocols.

• Department employees and volunteers will adhere to County Human Resource and County Chief Administrative Officer policies

Expansion and De-Escalation

Teams will be scaled as needed to meet needs as determined by local epidemiology,

the Operations Section, and the DOC Director/Incident Commander.

Strategy Review

Due to the constantly changing information about the COVID-19 pandemic including individuals at risk for serious infection, outbreak characteristics, epidemiologic findings, vaccine availability, State and Federal recommended use of vaccines, updates to local and state appointment scheduling and vaccine reporting systems, limited local resources and limited state and federal resource support, new and amended State statutes and local ordinances, changing State Health Officer orders, changing County Health Officer orders, new and updated State response plans including the State Blueprint for a Safer Economy and the California COVID-19 Vaccine plan, availability of local health care providers to participate in vaccination efforts during pandemic surge,

and unique characteristics of populations targeted for vaccine, this strategy represents a framework for local vaccination rollout. The Department will remain agile and modify the strategy as needed.

of 36

MCHD originally drafted and published this document on January 26, 2021. Revisions were made on February 24, 2021, to include expanded health equity information.

of 36

Appendices

Appendix A: DOC and POD Organizational Charts

of 36

Appendix B: Staffing Ratios

Assuming that the clinic is conducted using appointments and pre-registration. The

following assumptions serve as a bases for projected needed staffing and are ultimately

contingent upon the physical layout of the vaccination site, the accuracy of information

provided at pre-registration, the experience of the clinical staff, and ultimately the

vaccine that is being provided. Planning assumptions include:

• One vaccinator can vaccinate approximately 15 people per hour

• Two vaccine drawers/preppers can support 4 vaccinators (Pfizer)

• One observer can monitor up to 30 people

• Two registration staff can support 4 vaccinators

• Two data entry staff can support 4 vaccinators

• Minimum of four crowd control staff needed per clinic

o 1 directing to people to registration

o 1 directing people to vaccination station

o 1 directing people to data entry

o 1 directing people to observation

Public clinics will need additional staff to provide interpretation. Ratios of at least 50%

bilingual staff or interpreter-supported staff will be maintained at all public clinics.

Core Pod Staffing Assumptions (Six Hours of Vaccination Time)

Clinic Site (Number of Doses Administered)

Number of Vaccinators

Number of Vaccine Prep Personnel

Number of Clinical Observers

Number of Support Staff (not Including Logistical

Staff)

150 2 1 1 8

300 4 1 1 8

500 6 2 1 12

1,000 12 3 2 24

1,500 17 5 3 36

2,000 23 6 4 48

of 36

Appendix C: MCHD Standing Orders and Protocols

DOC staff will refer to the most current version of the following MCHD documents

located on the MCHD Public Health Bureau Immunization Program SharePoint Site:

• MCHD Standing Order for COVID-19 Vaccination

• MCHD Standing Orders for Treating Allergic and Anaphylactic Reactions with

Epinephrine

• MCHD Protocol for Responding to Adverse Events and Treating Allergic and

Anaphylactic Reactions

of 36

Appendix D: Vaccine Handling and Mixing Job Aides

Pfizer BioNTech COVID-19 Vaccine:

• CDC Preparation and Administration Summary:

https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/downloads/prep-

and-admin-summary.pdf

• CDC Vaccine Preparation Poster: https://www.cdc.gov/vaccines/covid-19/info-by-

product/pfizer/downloads/diluent-poster.pdf

• CDC Standing Order Template: https://www.cdc.gov/vaccines/covid-19/info-by-

product/pfizer/downloads/standing-orders.pdf

Moderna COVID-19 Vaccine:

• CDC Preparation and Administration Summary:

https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/downloads/prep-

and-admin-summary.pdf

• CDC Standing Order Template: https://www.cdc.gov/vaccines/covid-19/info-by-

product/moderna/downloads/prep-and-admin-summary.pdf

https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/downloads/prep-and-admin-summary.pdf

https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/downloads/prep-and-admin-summary.pdf

https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/downloads/diluent-poster.pdf

https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/downloads/diluent-poster.pdf

https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/downloads/standing-orders.pdf

https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/downloads/standing-orders.pdf

https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/downloads/prep-and-admin-summary.pdf




of 36

Appendix E: Site Requirements

Flexibility and scalability are two key components of potential sites. Below is a list of

important site requirements that should be considered when evaluating a site for a

vaccination clinic.

• Space to accommodate the targeted number of individuals and clinic flow.

• Space to maintain 6 feet of physical distance between individuals in line.

• Space for separate stations as described in the vaccination strategy to scale up

or down as needed, whether utilizing drive-through or walk-up model or hybrid.

• Access to electronic power, WIFI, and/or cellular service.

• Onsite alternatives for poor weather conditions.

• Adequate lighting to conduct medical screenings, administer vaccinations,

complete paperwork, and visually monitor individuals.

• Level ground or floors.

• Access to restrooms and potable water for staff.

• Separate entrance and exit for one-way clinic flow, whether drive-through or

walk-up.

• Loading and unloading zone for equipment.

• Parking for staff.

• Monitoring area following vaccination (side parking area for drive-through or

socially distanced chairs for walk-up).

• Existing traffic plan, particularly if a large mass vaccination clinic is being

planned.

• On site security.

• If the site is to be used repeatedly for several days, on site secure storage.

• If indoors, adequate ventilation to reduce transmission of disease.

• Separate location to isolate ill individuals, particularly if utilizing an indoor venue.

• Able to accommodate individuals with access and functional needs.

• Well-known by the public or easy to find.

• Situated near or on a public transportation route.

of 36

Appendix F: Sector Specific Considerations and Planning

When planning clinics, care will be taken to consider options that address some of the

specific challenges for the following when accessing vaccination services:

• Some individuals may have received their first COVID-19 vaccination in another

area and may not have proof of initial vaccination.

• Some individuals may not have internet access.

• Some individuals may feel uncomfortable using a smart phone or computer to

register for an appointment.

o Call center support in multiple languages will be an important planning

consideration.

• Some individuals may not drive or have private transportation.

o Coordination with local transportation agencies will be another important

planning consideration.

• Some individuals may speak languages other than English and Spanish.

• Vaccination opportunities outside of normal business hours may be needed to

reach workers who do not have a traditional work schedule.

• Some vaccination clinic appointments may need to be longer to address more

complicated medical histories.

• Some individuals may arrive in a van or bus with several others.

• Some individuals may be unable to leave their clients alone while seeking

vaccination services.

• Informal in-home caregivers (those not employed through agencies) may be hard

to identify and subsequently notify of vaccination opportunities.

• Residents of some congregate living facilities may lack transportation to

vaccination clinics.

Agricultural Workers:

• Meet with industry leaders to discuss planning considerations and information

dissemination

• Coordinate with medical services providers who serve agriculture workers and

their families

• Utilize employer-based vaccination clinic models

• Engage community health workers to provide outreach and support vaccination

clinics

Restaurant and Hospitality Workers:

• Meet with industry leaders to discuss planning considerations and information

dissemination

• Utilize employer-based vaccination clinic models for larger employers

• Promote clinic information via social and traditional media to reach workers

employed by small businesses

of 36

• Engage community health workers to provide outreach and support vaccination

clinics

Education and Child Care Workers:

• Meet with sector leaders to discuss planning considerations

• Coordinate with Monterey County Office of Education and higher education

institutions to identify staff and disseminate information

• Utilize employer-based vaccination clinic models

• Obtain lists containing contact information for licensed day care providers from

California Department of Social Services

• Obtain lists from Childcare Planning Council, Bright Beginnings, and First 5

Monterey County for other non-licensed home-based childcare providers (i.e.

Family, Friends, and Neighbors)

Emergency Services:

• Coordinate with Emergency Services employers (law, county emergency

services, etc.) to identify staff and disseminate information on vaccination clinics

In-Home Support Service Workers:

• Utilize Monterey County Department of Social Services to identify and

communicate with in-home support service workers

Residents of Congregate Living Facilities

• Encourage facilities to enroll in the federal pharmacy partnership

• Contract with home health agency to provide vaccinations on site for non-mobile

populations

of 36

Appendix G: Dose Thresholds for Clinic Models and Current Planning Schedule

Number of Doses Received in Monterey County per Week

Distribution Models Clinic/Point of Distribution (POD) Sites

Vaccinating Agencies and Partners

0 to 3,000 Doses per Week


• Small PODs (less than 500 appointments per event)

• Hospitals

• Hospitals

• Large Outpatient Clinic Systems

• Emergency Medical Service Providers

3,001 to 6,000 Doses per Week


• Medium PODs

• Congregate Living Settings

• Hospitals

• Outpatient Clinics

• Schools & Universities

• Libraries

• Community Centers

• Hospitals

• Large Outpatient Clinic Systems


• Public Health Nurses

6,100 to 10,000 Doses per Week


• Large PODs

• Congregate Living Settings

• Pharmacy Based


• Hospitals



• Libraries


• Pharmacies

• Large Employers

• Hospitals




• Volunteer Licensed Professionals

• Contracted Vaccinators

• Pharmacists

>10,001 Doses

per Week • Medical Provider

Based

• Mass Vaccination Events

• Pharmacy Based


• Hospitals



• Libraries


• Pharmacies

• Large Employers

• Event Centers

• Large public spaces

• Hospitals




• Volunteer Licensed Professionals

• Contracted Vaccinators

• Pharmacists

of 36

Appendix H: Sample Clinic Flow Diagrams

Figure 1: Sample Clinic Flow, Drive Through Model

of 36

Figure 2: Sample Clinic Flow, Walk-up Model

of 36

Appendix I: Sample Just in Time Training (JiTT) Job Aides

Position: Registration Assistant, Support Team

RESPONSIBILITIES: greet clients, provide clients with appropriate paperwork, instruct clients how to complete forms, answer client questions, direct clients to area where they can complete paperwork, instruct clients what to do after forms are completed

REPORTS TO: • Support Team Lead - ______, cell: ________

REQUIRED SKILLS: • Ability to communicate effectively

• Ability to sit or stand for long periods of time

PRIORITY

ACTIONS:

• Provide required forms

• Instruct clients how to complete forms

• Direct clients to form completion area

• Instruct clients what to do after completion of forms

ACTION CHECKLIST

□ Receive information from the Support Team Leader regarding the purpose of the screening clinics and clinic goals.

□ Assist with set up and break down of clinic. □ Receive basic information from the Support Team Leader about COVID-19 and vaccinations. □ Receive information from the Support Team Leader about the client forms and how they must be

completed. □ Don Monterey County Health Department vest and wear County identification so that it is clearly

visible. □ Greet clients arriving at registration. □ Ask clients if they received an email confirmation of their appointment.

o If yes, ask if them if they have it with them. If they do, verify they have arrived at the correct date and time. If not, ask for proof of identification, then check name with list of clinic appointments.

o Clients without appointments or without proof of being in focus phase and tier currently being vaccinated:

▪ Politely let them know the clinic today is by appointment only for individuals in the focus phase and tier of the California Vaccination Plan.

▪ Let them know they can submit their interest to be vaccinated when it is their group’s time by filling out a form on the MCHD website.

▪ Call security if client escalates. □ Provide the required forms to clients. □ Advise each client that it is very important they provide a valid email address or phone number so

that we can notify them of their second dose appointment, if appropriate. □ Direct client to next station. □ Report any security or safety issues immediately to the Support Team Leader. □ Check in with the Support Team Leader at the end of the shift. □ Return Monterey County Health Department vest to Support Team Leader.

of 36

Position: Interpreter, Support Team

RESPONSIBILITIES: provide Spanish interpretation assistance in all areas of the clinic

REPORTS TO: • Support Team Lead - _______, cell: _____

REQUIRED SKILLS: • Ability to communicate effectively in Spanish and English

PRIORITY ACTIONS:

• Provide Spanish interpretation for staff and clients

ACTION CHECKLIST

□ Receive information from the Support Team Leader regarding the purpose of the vaccine clinics and clinic goals.

□ Assist with set up and break down of clinic. □ Receive basic information from the Support Team Leader about vaccinations and COVID-19. □ Receive information from the Support Team Leader about the client forms and how they must be

completed. □ Don Monterey County Health Department vest and wear County identification so that it is clearly

visible. □ Float through the clinic providing interpretation services to clients, support team, and nursing team

as needed or directed by the Support Team Leader. □ Provide backup support to the Paperwork Assistant. □ Contact the Support Team Leader immediately if anyone arriving for the vaccination clinic is visibly

sick. □ Answer basic questions about the vaccination clinic and COVID-19. □ Report any security or safety issues immediately to the Support Team Leader. □ Check in with the Support Team Leader at the end of the shift. □ Return Monterey County Health Department vest to Support Team Leader.

of 36

Position: Medical Screener, Nursing Team

RESPONSIBILITIES: review the vaccination form to identify individuals with possible contraindications for vaccination, mask and redirect individuals with COVID-19, direct clients to nursing stations.

REPORTS TO: • Nursing Team Lead – _____, cell: _____

REQUIRED SKILLS: • Licensed by the California Board of Registered Nursing OR Licensed

by the California Board of Vocational Nursing

PRIORITY ACTIONS:

• Screen for medical contraindications for vaccination

• Education patient and obtain informed consent

• Confirm forms are completed legibly and thoroughly

• Direct clients to nursing stations for additional screening or

vaccination

ACTION CHECKLIST

□ Receive training on role and responsibilities from the Nursing Team Leader. □ Assist with set up and break down of clinic. □ Wear County identification so that it is clearly visible. □ Ensure an adequate supply of surgical masks is readily available. □ Greet and receive clients with completed and checked forms from the Support Team. □ Review the COVID-19 vaccination screening form.

o Immediately mask any client who has marked “yes” to any of the questions related to COVID-19 symptoms. Notify the Nursing Team Lead, who will remove the client from the screening area and provide direction for an alternate screening process.

o Refer all individuals who have a possible contraindication to COVID-19 vaccination to the Nursing Team Lead.

□ Confirm forms are completed legibly and thoroughly. □ Maintain an orderly line of waiting clients. □ Answer questions about COVID-19 and vaccination. □ Direct clients with approved paperwork to an available nursing station for additional screening. □ Report any security or safety issues immediately to the Nursing Team Leader. □ Check in with the Nursing Team Leader at the end of the shift.

of 36

Position: Vaccinator, Nursing Team

RESPONSIBILITIES: review screening forms and consents, administer COVID-19 vaccination, provide patient education, follow all Health Department policies on employee safety

REPORTS TO: • Nursing Team Lead – _________, cell: ______

REQUIRED SKILLS: • Licensed by the California Board of Registered Nursing OR Licensed

by the California Board of Vocational Nursing and Psychiatric Technicians OR authorized administer vaccinations

PRIORITY ACTIONS:

• Administer COVID-19 vaccination

• Provide patient education

• Ensure employee safety procedures are followed

ACTION CHECKLIST

□ Receive training on role and responsibilities from the Nursing Team Leader. □ Assist with set up and break down of clinic. □ Wear County identification so that it is clearly visible. □ Wear appropriate personal protective at all times when administering vaccines. □ Follow all County and Health Department safety procedures. □ Greet and receive clients from Primary Screener. Confirm name and date of birth. □ Review forms and ensure signed consent. □ Provide education to client about procedure; answer any client questions. □ Legibly complete the vaccination form.

o Assess for potential reaction; notify Nursing Team Lead if possible contraindications. □ Administer vaccine according to ACIP and manufacturer’s guidelines. □ Place all sharps in an appropriate container. □ Placed completed paperwork in appropriate area. □ Clean and disinfect the nursing station as appropriate. □ Immediately report any security or safety issues including needle sticks, other potential exposures,

and spills to the Nursing Team Leader. □ Check in with the Nursing Team Leader at the end of the shift.

of 36

Appendix J: Clinic Supply Checklist

□ Hand sanitizer

□ Band-aids

□ Alcohol wipes

□ Tissues

□ Disinfectant, such as Cavicide or Dispatch, and corresponding Material Safety

Data Sheets

□ Anaphylaxis and first aid kit

□ Syringes and needles appropriate for the type of vaccine being administered

□ Nitrile gloves, sizes small, medium and large

□ Surgical masks

□ Face shields

□ Gowns, if recommended by CDC

□ N95 respirators for use with symptomatic attendees, variety of brands

□ Vaccine diluent

□ Sharps containers

□ Biohazardous waste bags

□ Garbage bags

□ Stopwatch or timer

□ Thermometers and probe covers

□ Copy of medical waste generation and transportation permit

□ Copy of Standing Orders to administer vaccine and epinephrine

□ Locking briefcase or file box for protected health information

□ Vaccines for Children (VFC) vaccine transportation record

□ Opt out CAIR notification poster

□ Vaccine records

□ Clipboards

□ Pens

□ Highlighters

□ Markers

□ Tape, blue and gray

□ Laptops

□ Cell phones

□ Tables and chairs

□ Data loggers’ glycol bottles conditioned at vaccine temperature

□ Temperature data logger with alarms to appropriate temperature ranges

□ Hot spots

□ Extension cords.

□ Safety vest

□ Chair

□ Table

□ Tents and tent weights

□ Signs

of 36

□ Barriers

□ Two-way radios

□ Hazard cones

□ Light

□ Stanchions

□ Line dividers

□ Reflective markers.

□ Supply transportation containers

of 36

Appendix K: Clinic Setup Checklist

□ Arrive at site at least 1 hour prior to start of clinic

□ Conduct site walk-through, noting any change from pre-clinic layout

□ Hold staging meeting with setup-crew to review site layout

□ Unpack and secure vaccine supply; verify appropriate temperature range is being

maintained

□ Unpack and secure medical supplies

□ Unpack other supplies

□ Set up tents and utilize weights for tents

□ Set up tables and chairs at vaccination stations

□ Place traffic control barriers and cones to direct traffic flow

□ Post signs at entrance and at each station

□ Set vaccination and medical stations

□ Set up documentation stations and test cellular/WiFi service

□ Set up standard and medical waste collection areas

□ Set up medical monitoring area

□ Set up screening stations

□ Post CAIR opt-out disclosure poster

□ Test two-way radios

□ Conduct Just in Time Training (JiTT) with teams

□ Don PPE as appropriate

□ Don safety vests as appropriate

□ Conduct team leader meting to verify ready to active clinic/POD

□ Activate clinic/POD

Monterey County Health Department Strategy for ...

Documents

Transcript of Monterey County Health Department Strategy for ...