COVID-19 Vaccination Plan OREGON Oregon Health Authority | Oregon Immunization Program 11/6/2020 | INTERIM DRAFT 1.1 OREGON COVID-19 VACCINATION PLAN Table of Contents Record of Changes ..................................................................................................... 3 Introduction: Oregon’s COVID-19 Vaccine Plan ..................................................... 4 Health Equity Definition ............................................................................................ 4 Disproportionate Effects of COVID-19 ..................................................................... 5 Roots of Inequity: Social Determinants of Health and Determinants of Equity .... 5 Communities of Color are Disproportionately Affected by COVID-19 ................ 5 Historical Disparities .............................................................................................. 7 A Path Forward .......................................................................................................... 8 Governor’s Health Equity Framework ................................................................... 8 Co-Creation Process ............................................................................................... 9 Section 1: COVID-9 Vaccination Preparedness Planning .......................................11 Section 2: COVID-19 Organizational Structure and Partner Involvement .............15 Coronavirus Response and Recovery Unit (CRRU) ............................................16 Health Security, Preparedness and Response Program (HSPR) ..........................16 Program Communications and Coordination with the Joint Information Center (JIC)/Health Information Center (HIC) ................................................................16 Community Engagement and Equity Team ..........................................................17 Home Rule ............................................................................................................32 State and Local Public Health Coordination ........................................................32 COVID-19 Response Coordination ......................................................................33 Oregon CARES Influenza Project ........................................................................34 Opportunities.........................................................................................................34 Known Gaps and Opportunities ............................................................................35 Tribal preparedness infrastructure ........................................................................36 CARES Flu and COVID-19 Preparation funding ................................................36 Tribal Immunization Preparedness MOUs ...........................................................37 Updates to Tribes and tribal communities ............................................................37 Key Partnerships ...................................................................................................38 1 | P a g e OREGON COVID-19 VACCINATION PLAN Partnerships and Engagement Strategies ..............................................................38 Known Gaps and Opportunities ............................................................................40 Section 3: Phased Approach to COVID-19 Vaccination .........................................42 Pharmacy Partnership for Long-term Care (LTC) Program: ...............................45 Section 4: Critical Populations .................................................................................53 Section 5: COVID-19 Provider Recruitment and Enrollment .................................64 Section 6: COVID-19 Vaccine Administration Capacity ........................................70 Section 7: COVID-19 Vaccine Allocation, Ordering, Distribution and Inventory Management .............................................................................................................72 Section 8: COVID-19 Vaccine Storage and Handling ............................................76 Section 9: COVID-19 Vaccine Administration Documentation and Reporting .....78 Section 10: COVID-19 Vaccination Second-Dose Reminders ...............................81 Section 11: COVID-19 Requirements for IISs or Other External Systems ............83 Section 12: COVID-19 Vaccination Program Communication ..............................87 Section 13: Regulatory Considerations for COVID-19 Vaccination ....................103 Section 14: COVID-19 Vaccine Safety Monitoring ..............................................105 Section 15: COVID-19 Vaccination Program Monitoring ....................................107 Appendix .............................................................................................................105 2 | P a g e OREGON COVID-19 VACCINATION PLAN Record of Changes Date of original version: 10/26/2020 Date Updated Version Summary of changes Number 11/6/20 1.1 Updates to better integrate the needs of people in Oregon living with intellectual and developmental disabilities. 3 | P a g e OREGON COVID-19 VACCINATION PLAN Introduction: Oregon’s COVID-19 Vaccine Plan Oregon’s plan to allocate and distribute COVID-19 vaccine is grounded in a commitment to health equity, which requires an examination of how power and resources are distributed. With this foundation, the vaccine plan presented here represents a starting point for the iterative, responsive work of co-creating this strategy in partnership with communities most impacted by longstanding health inequities and disproportionately impacted by COVID-19. This introduction presents the framework for Oregon’s approach to co-creation and community collaboration. The COVID-19 pandemic has drawn focus to the inequities many communities face. We have been presented an opportunity to put our values into action. This plan is intended to be a living document that represents just one step of many for Oregon as we work toward the goal of eliminating health inequities in our state by 2030. Health Equity Definition The Oregon Health Authority (OHA) has an established definition of health equity which guides the work of the agency. Oregon’s health equity definition is: Oregon will have established a health system that creates health equity when all people can reach their full health potential and well-being and are not disadvantaged by their race, ethnicity, language, disability, gender, gender identity, sexual orientation, social class, intersections among these communities or identities, or other socially determined circumstances. Achieving health equity requires the ongoing collaboration of all regions and sectors of the state, including tribal governments to address: • The equitable distribution or redistribution of resources and power; and • Recognizing, reconciling and rectifying historical and contemporary injustices. 4 | P a g e OREGON COVID-19 VACCINATION PLAN Disproportionate Effects of COVID-19 Roots of Inequity: Social Determinants of Health and Determinants of Equity People’s health depends on much more than just their biology and behaviors. The conditions in which people are born, grow, live, work and age have a profound effect on how healthy they can be. These conditions are known as the social determinants of health. They are not typically within individual control. Rather, they are a product of policies and practices that create an unfair distribution of resources and opportunities. People and communities with limited access to these resources and opportunities, and who have faced barriers that have persisted for decades, if not centuries, are placed at a disadvantage. They experience worse health outcomes and premature death. Epigenetics and other origins of chronic disease also factor into the health outcomes. One legacy of racism and longstanding oppression is that people of color, tribal communities and people living with intellectual, developmental and other disabilities, due to historical and current injustices, structural racism, the colonization of relationships and processes experience overall worse health outcomes. Everyone is experiencing the effects of COVID-19, but not all are experiencing this pandemic the same way. Physical distancing with adequate space and resources is different than physical distancing in a densely populated neighborhood, in a food desert, or for individuals who are still required to put themselves at risk in order to support their families. Individuals with disabilities often rely on in direct support workers to meet their basic needs and are unable to physically distance, which puts them and their staff at risk. Racism, discrimination and the stigmatization of communities as either the source of the issue or as expendable, factor into how people can access both services and safety. Communities of Color are Disproportionately Affected by COVID-19 The inequitable burden of disease and other negative health conditions on communities of color and indigenous and American Indian/Alaska Native communities are not new. COVID-19 has simply highlighted this inequity at a time 5 | P a g e OREGON COVID-19 VACCINATION PLAN when more people are paying attention to illness, health and racial justice in the U.S. Data on COVID-19 cases in Oregon show how this illness has affected tribal communities and communities of color disproportionately. The following tables from OHA’s COVID-19 Weekly Report1 published on October 14, 2020, demonstrate this inequitable burden of disease: Oregon COVID-19