Section I: Vaccination Planning

PIRA_Section I: Vaccination Planning_TEST - Final
Form Approved
OMB Number: 0920-0879
Expiration Date: 03/31/2018

Introduction
Background
The 2009 H1N1 influenza pandemic underscored the importance of communities
being prepared for potential threats to public health security. Because of its
unique abilities to respond to infectious, occupational, or environmental incidents,
the Centers for Disease Control and Prevention (CDC) plays a pivotal role in
ensuring that state and local public health systems are prepared for these and
other public health incidents.
The identification of the novel influenza A (H7N9) virus illnesses in China in 2013
highlights the importance of influenza pandemic preparedness. To date, the
reported case fatality ratio from human H7N9 infections is more than 30%.
Should the H7N9 virus mutate to allow for sustained human-to-human
transmission, it appears capable of causing severe disease in all ages. To better
prepare for such a scenario, it is important to understand the collective ability of
our nation to prepare for and respond to a pandemic of substantially different
epidemiology than the 2009 H1N1 pandemic.
State and local public health departments are first responders for public health
incidents. To better prepare these agencies to respond, CDC provides funding
and technical assistance for state, local, and territorial public health departments
through the Public Health Emergency Preparedness (PHEP) cooperative
agreement. CDC’s Public Health Preparedness Capabilities: National Standards
for State and Local Planning provide national standards that help state and local
public health departments strengthen their ability to respond to all hazards,
including influenza pandemics, and build more resilient communities. Consistent
with this approach, the following Pandemic Preparedness Readiness
Assessment for State and Local Public Health Planners specifically aligns with 11
public health preparedness capabilities and administrative preparedness
planning goals.
Overview
The Pandemic Preparedness Readiness Assessment for State and Local Public

Health Planners promotes state, local, and territorial public health preparedness
and immunization program collaboration through the administration of a selfassessment designed to measure jurisdictional readiness to respond to an
influenza pandemic. Although the content of this assessment does not
encompass every contingency or element necessary to effectively respond to an
influenza pandemic, CDC technical experts in differing programs have helped to
arrange content within the following seven priority planning areas:
1.

Vaccination Planning

2.

Epidemiology and laboratory

3.

Medical Care and Countermeasures

4.

Healthcare Systems

5.

Community Mitigation

6.

Public Information and Communication

7.

Public Health and Immunization Workforce

Information collected from the assessment will not be used to score or
competitively rank public health emergency preparedness or immunization
programs. Rather, this assessment is designed to identify preparedness gaps,
as well as promising state, local, and territorial preparedness practices.
Assessment results will be used by the CDC to inform technical assistance and
future program improvement initiatives.
Definitions
Allocation: Amount of pandemic influenza vaccine available for ordering.
Allocating: Process of dividing available vaccine among CDC’s PHEP awardees
or among registered pandemic influenza vaccine providers and facilities within an
awardee’s jurisdiction.
Critical infrastructure personnel (CIP): The full list of CIP is defined in Guidance
on Allocating and Targeting Pandemic Influenza Vaccine; U.S. Department of
Health and Human Services (HHS)/U.S. Department of Homeland Security
(DHS); 2008 Guidance on Allocating and Targeting Pandemic Influenza Vaccine
Distribution: The process of transporting pandemic influenza vaccine from one
location to another.
Enrollment: The process of enabling registered healthcare providers and facilities

to legally provide pandemic influenza vaccine.
Ordering: Process of requesting pandemic influenza vaccine from either the
federal, state, city, or local government. Orders can be placed against an
allocation or independent of allocation.
Non-pharmaceutical interventions (NPIs): Those interventions that can mitigate
transmission of influenza and do not involve medical countermeasures. NPIs
include voluntary home isolation, school closures, respiratory etiquette, hand
hygiene, and routine cleaning of frequently touched surfaces and objects.
Peak vaccine administration capacity: The highest rate at which a jurisdiction is
able to provide pandemic influenza vaccine to its population; CDC recommends a
peak vaccine administration capacity of at least 10% of the population per
week.
Point of dispensing (POD) / mass vaccination clinic: Location for dispensing
medical countermeasures, specifically for vaccine, during an influenza pandemic
response. Located in a public or private space, this clinic is designed to
vaccinate a large group of persons over a short time period. The POD or clinic
might target the entire population or people in specific priority or high-risk groups.
Public and/or private entities can manage a POD or clinic.
Closed POD: Point of dispensing/vaccination clinic closed to the general public
and open only to a specific group (e.g., staff of a participating business or
healthcare personnel in a specific hospital).
Open POD: Point of dispensing/vaccination clinic open to the general public,
specifically to provide vaccine, during an influenza pandemic response.
Recruitment: The process of soliciting healthcare providers and facilities
interested in and willing to provide pandemic influenza vaccine.
Registration: The submission of required information, similar to an application, by
healthcare providers or facilities interested in providing pandemic influenza
vaccinations.
Retail-based clinics: Non-pharmacy businesses that sell retail products (e.g.,
Walmart, Target) and serve as PODs/mass vaccination clinics.
School-located vaccination clinics: Vaccination clinics that target students and
are typically held on school grounds.
Public reporting burden of this collection of information is estimated to average 120 minutes per
response, including time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing information. An agency may not
conduct or sponsor, and a person is not required to respond to a collection of information unless it

displays a currently valid Office of Management and Budget control number. Send comments
regarding this burden estimate, or any other aspect of this information collection, including
suggestions for reducing this burden to CDC/Agency for Toxic Substance and Disease Registry
Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333;
Attention: PRA (0920-0879).

(End of Page 1)

Section I: Vaccination Planning
The identification of novel influenza A(H7N9) virus illnesses among persons in
China in 2013 highlighted the importance of planning and preparedness for a
potential vaccination response during a severe pandemic. During the 2009 H1N1
pandemic, state and local public health programs had four to five months to
prepare for their 2009 H1N1 vaccination campaigns. Nationally, the maximum
number of persons vaccinated at the peak week of vaccination was
approximately 5-6 million in that week. In a severe pandemic, nationally, at peak
capacity, approximately 30 million doses of pandemic vaccine could be available
for distribution each week. This increased capacity is due to improvements in
vaccine manufacturing and distribution capacity in the United States since 2009
and other potential dose sparing strategies. CDC’s theoretical modeling of a
possible severe influenza pandemic, where all ages are susceptible, suggests
that rapid administration of much larger numbers of pandemic vaccine doses
than available during the 2009 H1N1 pandemic and much earlier in a response is
vital to reducing the number of hospitalizations and deaths associated with a
severe pandemic. Intense planning is needed for broad vaccination campaigns to
be initiated as soon as vaccine becomes available at the state and local level in
order to substantially reduce the potential morbidity and mortality during a severe
pandemic.
Public health programs should aim to vaccinate 80% of their jurisdiction’s
population with two doses (separated by 21 days) of a pandemic influenza
vaccine in less than 16 weeks.
With this national goal in mind, the purpose of this influenza pandemic plan
assessment is to:
• Assess public health emergency preparedness programs’ ability to achieve the
goal of vaccinating 80% of their jurisdiction’s population with two doses of a
pandemic influenza vaccine separated by 21 days in less than 16 weeks.
• Assess gaps and challenges to meeting the national goal
Severe Pandemic Vaccine Preparedness Goal:
Given an 8 week notification to begin a national pandemic vaccination campaign,
state and local programs will achieve at least an 80% pandemic vaccination
coverage for two doses of the pandemic vaccine (separated by 21 days) for their
jurisdiction’s population, within 16 weeks from when the vaccine becomes
available. (Note: In this scenario, time zero would be a declaration of the start of
a national vaccination program. Vaccine would become available two months (8
weeks) after that notification.)
Severe Pandemic Influenza: Preparedness Assumptions
• Disease will be severe, and all ages will be susceptible.
• Demand for the pandemic influenza vaccine will be high throughout the

response; 80% of the population will want to be vaccinated.
• Seasonal influenza vaccine production and campaign could be halted.
• Two doses of pandemic influenza vaccine, separated by at least 21 days will be
recommended for all people ages 6 months and older.
• Most pandemic influenza vaccine will be inactivated and include an adjuvant
(some pre-mixed) and be supplied in multi-dose vials. Some live attenuated
inactivated vaccine (nasal spray) will be available.
• Adequate federal funding will be available to implement a large-scale
vaccination response.
• Federally-supplied pandemic influenza vaccine and ancillary supplies will be
supplied under an Emergency Use Authorization (EUA) in amounts needed to
vaccinate at least 10% of the U.S. population per week at the onset of
distribution.
• CDC will provide standard communication materials on the EUA for the general
public, similar to the Vaccine Information Statement (VIS), and specific
communication to vaccine providers on the EUA.
• Pandemic influenza vaccine distribution based on awardee population will begin
approximately 60 days after notification of a national vaccination campaign.
• Vaccine prioritization may be recommended for the first two to three weeks for
young children, pregnant women, high-risk adults, healthcare workers, and
certain other critical infrastructure personnel (CIP) (see Guidance on Allocating
and Targeting Pandemic Influenza Vaccine U.S.; Department of Health and
Human Services (HHS)/U.S. Department of Homeland Security (DHS); 2008.
Guidance on Allocating and Targeting Pandemic Influenza Vaccine)
• Awardees will be required to legally enroll pandemic influenza vaccine providers
(similar to the 2009 H1N1 response)
• Awardees will be allocated vaccine, as it becomes available, based on their
jurisdiction’s population size (similar to the 2009 H1N1 response)

Please select your jurisdiction:

mAlabama
mAlaska
mAmerican Samoa
mArizona
mArkansas
mCalifornia
mChicago
mColorado
mCommonwealth of the Northern Mariana Islands
mConnecticut
mDelaware
mFederated States of Micronesia
mFlorida

mGeorgia
mGuam
mHawaii
mIdaho
mIllinois
mIndiana
mIowa
mKansas
mKentucky
mLos Angeles County
mLouisiana
mMaine
mMaryland
mMassachusetts
mMichigan
mMinnesota
mMississippi
mMissouri
mMontana
mNebraska
mNevada
mNew Hampshire
mNew Jersey

mNew Mexico
mNew York
mNew York City
mNorth Carolina
mNorth Dakota
mOhio
mOklahoma
mOregon
mPennsylvania
mPuerto Rico
mRepublic of Palau
mRepublic of the Marshall Islands
mRhode Island
mSouth Carolina
mSouth Dakota
mTennessee
mTexas
mU.S. Virgin Islands
mUtah
mVermont
mVirginia
mWashington
mWashington, DC

mWest Virginia
mWisconsin
mWyoming

Please select your position:
mPHEP Director
mImmunization Coordinator
mEpidemiologist
mOther (please specify) ____________________

(End of Page 2)

Vaccine Planning, Management, and Administration
During the most recent H7N9 pandemic vaccine assessment conducted in June
2013, H7N9 vaccination response leads in PHEP awardee jurisdictions were
asked to estimate their jurisdiction’s maximum weekly capacity to administer
H7N9 vaccine given a set of assumptions. H7N9 response leads were also
asked to estimate how many weeks this maximum weekly capacity could be
sustained. The first few questions refer specifically to your prior answers to the
June 2013 assessment, which we provided in the e-mail with the link to this
survey.
(End of Page 3)

Vaccine Administration / Capacity
The following set of questions asks you to think again about your maximum
weekly vaccination capacity, including any revisions to your previous estimates.
(End of Page 4)

Vaccine Administration / Capacity
1. Given any changes in your plan since the June 2013 H7N9 pandemic
influenza vaccine assessment, do you wish to revise your jurisdiction’s estimate
of maximum weekly vaccination capacity?
mYes

>>>> Skip to Page 6: 2. What is your revised estimate?

mNo >>>> Skip to Page 7: 3. Do you wish to revise your estimate of the
maximum number of weeks that you believe your jurisdiction could sustain
vaccination at maximum capacity? (Note: This question does not include any
time your jurisdiction would be vaccinating at less than maximum capacity).

(End of Page 5)

Vaccine Administration / Capacity
2. What is your revised estimate?
(Please enter a whole number) ____________________

(End of Page 6)

Vaccine Administration / Capacity
3. Do you wish to revise your estimate of the maximum number of weeks that you
believe your jurisdiction could sustain vaccination at maximum capacity? (Note:
This question does not include any time your jurisdiction would be vaccinating at
less than maximum capacity).
mYes

>>>> Skip to Page 8: 4. What is your revised estimate?

mNo >>>> Skip to Page 9: 5. How many weeks do you estimate that it would
take for your jurisdiction to accelerate and reach your maximum weekly
vaccination capacity once vaccination begins?

(End of Page 7)

Vaccine Administration / Capacity
4. What is your revised estimate?
(Please enter a whole number) ____________________

(End of Page 8)

Vaccine Administration / Capacity
5. How many weeks do you estimate that it would take for your jurisdiction to
accelerate and reach your maximum weekly vaccination capacity once
vaccination begins?
(Please enter a whole number) ____________________

6. Please estimate the percent of your population that could receive one dose of
vaccine during the time it would take for your jurisdiction to reach your maximum
weekly vaccination capacity:
(Please enter a percentage) ____________________

7. Please estimate the percent of your population that would receive two doses of
vaccine separated by at least three weeks during the time it would take for your
jurisdiction to reach your maximum weekly vaccination capacity. (Please note
that this question will assume that CDC has matched your jurisdictions’ vaccine
capability and that you have received proper advanced notice on vaccine
readiness before a widespread epidemic)
(Please enter a percentage) ____________________

The following questions refer specifically to the newly stated goal of 80% twodose pandemic vaccination coverage within 16 weeks of vaccination initiation.
(End of Page 9)

Vaccine Administration / Capacity
8. Do you expect that your program will be able to vaccinate 80% of your
jurisdiction’s population within 16 weeks of vaccination initiation?
mYes >>>> Skip to Page 11: 9. How did you calculate the number of weeks
your program would need to reach 80% two-dose pandemic vaccination
coverage?
• For example, one way of outlining your thinking would be to estimate the
number of PODs your jurisdiction can simultaneously conduct based on staffing
and resources, how many hours a day and numbers of days per week and
number of total weeks that these PODs can be sustained. Programs would also
need to estimate the number of doses administered per hour per POD.
• Some programs may also outline the estimated number of vaccine providers
which could be enrolled, trained, and would be willing to administer pandemic
vaccines within 60 days and then use any data on the number of doses per day
each provider could reasonably administer.
• Please keep in mind the health department staffing and vaccine provider
enrollment and training requirements for any of your plans.
mNo (Please specify the number of weeks you estimate that your program will
need to vaccinate 80% of your jurisdiction’s population )
____________________ >>>> Skip to Page 12: 10. Please list up to five
barriers you would need to address to reach this newly stated goal of 80% twodose pandemic vaccination coverage in 16 weeks. (Please note that this should
allow, at a minimum, 3 weeks between doses).

(End of Page 10)

Vaccine Administration / Capacity
9. How did you calculate the number of weeks your program would need to reach
80% two-dose pandemic vaccination coverage?
• For example, one way of outlining your thinking would be to estimate the
number of PODs your jurisdiction can simultaneously conduct based on staffing
and resources, how many hours a day and numbers of days per week and
number of total weeks that these PODs can be sustained. Programs would also
need to estimate the number of doses administered per hour per POD.
• Some programs may also outline the estimated number of vaccine providers
which could be enrolled, trained, and would be willing to administer pandemic
vaccines within 60 days and then use any data on the number of doses per day
each provider could reasonably administer.
• Please keep in mind the health department staffing and vaccine provider
enrollment and training requirements for any of your plans.
______________________________________________________________
______________________________________________________________
______________________________________________________________

(End of Page 11)

Vaccine Administration / Capacity
10. Please list up to five barriers you would need to address to reach this newly
stated goal of 80% two-dose pandemic vaccination coverage in 16 weeks.
(Please note that this should allow, at a minimum, 3 weeks between doses).
Barrier 1 ____________________
Barrier 2 ____________________
Barrier 3 ____________________
Barrier 4 ____________________
Barrier 5 ____________________

(End of Page 12)

Vaccination of Critical Infrastructure
11. In an earlier assessment, you were asked whether your jurisdiction had an
operational plan for identifying and vaccinating critical infrastructure personnel
(CIP) as described in Tier 1 and 2 of the 2008 HHS/ DHS Guidance on Allocating
and Prioritization of Pandemic Vaccine (see: Guidance on Allocating and
Targeting Pandemic Influenza Vaccine)
Does your jurisdiction currently have such an operational plan?
mYes, to identify CIP
mYes, to vaccinate CIP
mYes, to identify and vaccinate CIP
mThis is a local health responsibility
mNot sure
mNo >>>> Skip to Page 15: 16. Do you plan to develop an operational plan
for identifying and vaccinating CIP?

(End of Page 13)

Vaccination of Critical Infrastructure
12. Des your plan include using the regular seasonal influenza vaccinators to
vaccinate CIP during a pandemic?
mYes
mNo
mNot sure
mN/A

13. Des your plan include coordination with occupational health providers, to
include closed PODs, to vaccinate CIP during a pandemic?
mYes
mNo
mNot sure
mN/A

14. Does your plan incorporate the use of closed PODs, separate from existing
seasonal influenza clinics, for vaccinating CIP during a pandemic?
mYes
mNo
mNot sure
mN/A

15. What other specific characteristics of your plans to identify and vaccinate CIP
during a pandemic can you share with CDC?
______________________________________________________________

______________________________________________________________
______________________________________________________________

(End of Page 14)

Vaccination of Critical Infrastructure
16. Do you plan to develop an operational plan for identifying and vaccinating
CIP?
mYes
mNo >>>> Skip to Page 18: 18. Which of the following statements BEST
describes the process you will use to divide your pandemic influenza vaccine
among providers and facilities within your jurisdiction? (Note: this question refers
to both the ‘ramp-up’ and ‘maximum capacity’ phases)

(End of Page 15)

Vaccination of Critical Infrastructure
17. Please describe how you might develop and exercise such a plan and the
timeline for doing so:
______________________________________________________________
______________________________________________________________
______________________________________________________________

(End of Page 16)

Vaccine Allocation
The next set of questions focus on the processes your jurisdiction will use to
distribute pandemic influenza vaccine from your allocation. Distribution
procedures may change over time; please answer the following questions with
reference to the first three months after pandemic influenza vaccine becomes
available for administration.
(End of Page 17)

Vaccine Allocation
18. Which of the following statements BEST describes the process you will use to
divide your pandemic influenza vaccine among providers and facilities within your
jurisdiction? (Note: this question refers to both the ‘ramp-up’ and ‘maximum
capacity’ phases)
mWe (i.e., PHEP awardee) plan to divide all or most of our allocation (PHEP
awardee) equally among all of our local jurisdictions by the total population of
each (e.g., if one local health department serves 10% of our state's population,
we will send them 10% of the vaccine allocated to us by CDC). Our local
jurisdictions will be responsible for allocating their proportion to providers and
facilities within their jurisdictions >>>> Skip to Page 19: 19. Do you provide
general guidance to local jurisdictions for how to allocate vaccine to registered
providers and facilities?
mWe (i.e., PHEP awardee) will decide, at the awardee level, how to allocate
vaccine among providers and facilities located within all our jurisdictions. >>>>
Skip to Page 22: 22. What factors or principles will you use to decide how to
allocate vaccine to registered providers and facilities within your jurisdiction? (For
example, a state’s general principle might be with each batch of vaccine the state
is allocated from CDC, they would spread vaccine “wide and thin” – allocating to
many providers, but each would get many small shipments over the entire
response. Another state might choose to focus initial vaccine supplies on mass
vaccination clinics to target priority groups).
mBoth A and B >>>> Skip to Page 19: 19. Do you provide general guidance
to local jurisdictions for how to allocate vaccine to registered providers and
facilities?
mNeither A nor B >>>> Skip to Page 25: 25. What processes will you use to
divide the jurisdiction’s pandemic influenza vaccine allocation?

(End of Page 18)

Vaccine Allocation
19. Do you provide general guidance to local jurisdictions for how to allocate
vaccine to registered providers and facilities?
mYes
mNo

(End of Page 19)

Vaccine Allocation
20. Do most of your local jurisdictions have plans to identify and adjust vaccine
allocation levels (if necessary) due to changes in the target population, spot
shortages, uneven demand for vaccine, etc.?
mYes
mNo >>>> Skip to Page 26: 26. Using the allocation tool provided by CDC,
and based on your pandemic plan and knowledge about your jurisdiction, please
estimate the proportion of your jurisdiction’s weekly vaccine allocation that you
plan to allocate to each of the following type of provider group or venue when
there is ample vaccine supply.
(You may need to work directly with local jurisdictions to understand their plans to
provide this breakdown for your entire state or jurisdiction.)

(End of Page 20)

Vaccine Allocation
21. Do your local jurisdictions’ plans describe the processes, procedures, and
logistics necessary to reallocate pandemic influenza vaccine promptly?
mYes
mNo >>>> Skip to Page 26: 26. Using the allocation tool provided by CDC,
and based on your pandemic plan and knowledge about your jurisdiction, please
estimate the proportion of your jurisdiction’s weekly vaccine allocation that you
plan to allocate to each of the following type of provider group or venue when
there is ample vaccine supply.
(You may need to work directly with local jurisdictions to understand their plans to
provide this breakdown for your entire state or jurisdiction.)

(End of Page 21)

Vaccine Allocation
22. What factors or principles will you use to decide how to allocate vaccine to
registered providers and facilities within your jurisdiction? (For example, a state’s
general principle might be with each batch of vaccine the state is allocated from
CDC, they would spread vaccine “wide and thin” – allocating to many providers,
but each would get many small shipments over the entire response. Another
state might choose to focus initial vaccine supplies on mass vaccination clinics to
target priority groups).
______________________________________________________________
______________________________________________________________
______________________________________________________________

(End of Page 22)

Vaccine Allocation
23. Do you have processes in place to identify and adjust vaccine allocation
levels (if necessary) due to changes in the target population, spot shortages,
uneven demand for pandemic influenza vaccine, etc.?
mYes
mNo >>>> Skip to Page 26: 26. Using the allocation tool provided by CDC,
and based on your pandemic plan and knowledge about your jurisdiction, please
estimate the proportion of your jurisdiction’s weekly vaccine allocation that you
plan to allocate to each of the following type of provider group or venue when
there is ample vaccine supply.
(You may need to work directly with local jurisdictions to understand their plans to
provide this breakdown for your entire state or jurisdiction.)

(End of Page 23)

Vaccine Allocation
24. Does your plan describe the processes, procedures, and logistics necessary
to reallocate pandemic influenza vaccine promptly?
mYes
mNo

(End of Page 24)

Vaccine Allocation
25. What processes will you use to divide the jurisdiction’s pandemic influenza
vaccine allocation?
______________________________________________________________
______________________________________________________________
______________________________________________________________

(End of Page 25)

Vaccine Allocation
26. Using the allocation tool provided by CDC, and based on your pandemic plan
and knowledge about your jurisdiction, please estimate the proportion of your
jurisdiction’s weekly vaccine allocation that you plan to allocate to each of the
following type of provider group or venue when there is ample vaccine supply.
(You may need to work directly with local jurisdictions to understand their plans to
provide this breakdown for your entire state or jurisdiction.)
Closed PODs (i.e., those PODs designed only to administer vaccines to certain
target groups, such as CIP) ____________________
Open PODs - to vaccinate general public ____________________
School-located vaccination clinics ____________________
Providers already enrolled as Vaccines for Children (VFC) providers
____________________
Non-VFC pediatric providers ____________________
Non-VFC adult providers ____________________
Community vaccinators such as visiting nurse associations
____________________
Large retail-based stores or grocery stores ____________________
Large national or regional chain pharmacies ____________________
Indepedent, local pharmacies ____________________
Local health departments (LHDs) ____________________
Other ____________________

(End of Page 26)

Vaccine Provider Enrollment and Training
27. Please estimate the proportion of your jurisdiction’s population that you
expect will be vaccinated through the public health system.
(Please round to the nearest whole percent) ____________________

(End of Page 27)

Vaccine Provider Enrollment and Training
28. Does your jurisdiction plan to provide more than 20% of your vaccine
allocation through PODs?
mYes
mNo >>>> Skip to Page 30: 33. Has your jurisdiction conducted jurisdictionwide multi-POD exercises (greater than 1 POD conducted simultaneously at
different venues) to test POD capacities?

(End of Page 28)

Vaccine Provider Enrollment and Training
29. Has your jurisdiction pre-identified enough personnel to staff such events?
mYes
mYes, but funding / support not available
mNo
mIn progress

30. Has the pre-identified POD staff received training in POD (open and closed)
operations?
mYes
mNo
mIn progress

31. Has the pre-identified staff received training in mass vaccination clinic
operations?
mYes
mNo
mIn progress

32. Does your jurisdiction plan to conduct multiple, simultaneous PODs (open
and closed) or other mass vaccination clinics during an influenza pandemic
response?
mYes
mNo

(End of Page 29)

Vaccine Provider Enrollment and Training
IF JURISDICTION PLANS TO CONDUCT MULTIPLE, SIMULTANEOUS PODS
AND/OR MASS VACCINATION CLINICS
33. Has your jurisdiction conducted jurisdiction-wide multi-POD exercises (greater
than 1 POD conducted simultaneously at different venues) to test POD
capacities?
mYes
mNo >>>> Skip to Page 32: 35. Does your jurisdiction plan to conduct
jurisdiction-wide multi-POD exercises to test your POD capacities?

(End of Page 30)

Vaccine Provider Enrollment and Training
34. Please describe your POD exercises:
______________________________________________________________
______________________________________________________________
______________________________________________________________

(End of Page 31)

Vaccine Provider Enrollment and Training
35. Does your jurisdiction plan to conduct jurisdiction-wide multi-POD exercises
to test your POD capacities?
mYes
mNo

(End of Page 32)

Vaccine Provider Enrollment and Training
36. Does your jurisdiction have laws or regulations in place permitting expanded
authority for additional types of providers, including but not limited to,
pharmacists, pharmacist assistants, medical/nursing students, dentists, medical
provider retiree, and others, to vaccinate during a public health emergency,
outside of those providers typically permitted to vaccinate during regular
influenza seasons and non-emergencies, and state of emergencies?
mYes
mNo >>>> Skip to Page 35: 38. Does your jurisdiction have laws or
regulations in place permitting expanded authority for existing vaccinators,
including pharmacists and other nontraditional providers, to vaccinate persons of
all ages during a public health emergency, if they are typically not permitted to
do so during non-emergencies?
mIn progress

(End of Page 33)

Vaccine Provider Enrollment and Training
37. Please cite the code of the regulation or law and provide relevant URL or
website here:
______________________________________________________________

(End of Page 34)

Vaccine Provider Enrollment and Training
38. Does your jurisdiction have laws or regulations in place permitting expanded
authority for existing vaccinators, including pharmacists and other nontraditional
providers, to vaccinate persons of all ages during a public health emergency, if
they are typically not permitted to do so during non-emergencies?
mYes
mNo >>>> Skip to Page 37: 40. Does your jurisdiction have laws or
regulations in place permitting out-of-state providers to provide vaccinations in
your jurisdiction during a public health emergency?
mIn progress

(End of Page 35)

Vaccine Provider Enrollment and Training
39. Please cite the code of the regulation or law and provide relevant URL or
website here:
______________________________________________________________

(End of Page 36)

Vaccine Provider Enrollment and Training
40. Does your jurisdiction have laws or regulations in place permitting out-of-state
providers to provide vaccinations in your jurisdiction during a public health
emergency?
mYes
mNo >>>> Skip to Page 39: 42. Please provide any other information,
comments, or concerns about these provisions, especially if these provisions
differ by provider type (e.g. pharmacy versus other community vaccinator),
including any information about requirements or guidance to these providers on
reporting vaccination data to immunization information systems:
mIn progress

(End of Page 37)

Vaccine Provider Enrollment and Training
41. Please cite the code of the regulation or law and provide relevant URL or
website here:
______________________________________________________________

(End of Page 38)

Vaccine Provider Enrollment and Training
42. Please provide any other information, comments, or concerns about these
provisions, especially if these provisions differ by provider type (e.g. pharmacy
versus other community vaccinator), including any information about
requirements or guidance to these providers on reporting vaccination data to
immunization information systems:
______________________________________________________________
______________________________________________________________
______________________________________________________________

(End of Page 39)

Vaccine Provider Enrollment and Training
43. Which entity within your jurisdiction would have primary responsibility for
activities related to registering and enrolling healthcare providers and facilities to
become pandemic influenza vaccine providers?
mAwardee health department
mLocal health department(s)
mRegional health department(s)
mOther

44. Please choose the statement below that most accurately reflects your
jurisdiction’s plans to recruit non-Vaccines for Children (VFC) providers serving
primarily adults.
mDirectly using contact information contained in a current list maintained by
public health
mEither directly or indirectly by using contact information collected by an entity
or entities other than public health (e.g., professional organizations)
mBy making a general call for volunteers (e.g., via media)
mOther ____________________

45. If using contact information provided by entity other than public health, please
specify which entity:
______________________________________________________________
______________________________________________________________
______________________________________________________________

IF JURISDICTION PLANS TO RECRUIT NON-VFC PROVIDERS SERVING
PRIMARILY ADULTS

46. Please choose the statement below that most accurately reflects when your
jurisdiction plans to begin registering and enrolling non-VFC providers serving
primarily adults to become pandemic influenza vaccine providers.
mActive registration (or preregistration) is currently ongoing
mPre-declaration
mWhen a pandemic is declared
mWhen a decision is made to initiate a national vaccination program
mOther ____________________

47. Given the increased number of providers you expect to enroll as pandemic
influenza vaccine providers to reach the 80% two-dose pandemic vaccination
coverage in 16 weeks, for which of these areas does your jurisdiction have the
ability to train all newly enrolled providers (check all that apply)?
qVaccine provider ordering requirements
qAppropriate vaccine storage and handling
qAdverse events reporting
qGaining approval for access to the Immunization Information System (IIS)
qSubmitting data to the IIS or similar administration reporting systems
qOther ____________________

(End of Page 40)

Vaccine Ordering and Management
48. Given the increased number of providers and vaccine orders during a severe
pandemic, does your jurisdiction have a staffing and budget plan in place to
manage vaccine orders?
mYes
mNo

49. Please briefly describe how provider vaccine orders will be placed and
managed in your jurisdiction. For example, some jurisdiction may have providers
place orders directly in VTrckS or another system linked to VTrckS, while other
programs may have individual providers submit vaccine requests in some other
manner for the jurisdictions to manage these orders.
______________________________________________________________
______________________________________________________________
______________________________________________________________

(End of Page 41)

Immunization Information System (IIS)
50. Given that 80% of your jurisdiction’s population may have vaccine information
on each of their two pandemic doses entered into your jurisdiction’s IIS, can your
IIS process this increased amount of data?
mYes >>>> Skip to Page 44: 52. Does your IIS have the capacity to track
use of adjuvant and match adjuvant and vaccine type by person?
mNo
mNot sure

(End of Page 42)

Immunization Information System (IIS)
51. Do you have a plan and projected budget needs to increase its capacity?
mYes
mNo
mNot sure

(End of Page 43)

Immunization Information System (IIS)
52. Does your IIS have the capacity to track use of adjuvant and match adjuvant
and vaccine type by person?
mYes >>>> Skip to Page 46: 54. Given the increased number of vaccine
providers and amount of vaccine data, do you have a staffing plan to provide
technical assistance to this number of providers and manage data in your IIS?
mNo
mNot sure

(End of Page 44)

Immunization Information System (IIS)
53. Will you develop a plan and projected budget needs for your IIS to have this
capacity?
mYes
mNo
mNot sure

(End of Page 45)

Immunization Information System (IIS)
54. Given the increased number of vaccine providers and amount of vaccine
data, do you have a staffing plan to provide technical assistance to this number
of providers and manage data in your IIS?
mYes >>>> Skip to Page 48: 56. In the April 2013 IIS survey, many programs
noted that they have pandemic/mass vaccination/preparedness modules or
functionality in their IIS or other system. Does your jurisdiction have such a
module?
mNo
mNot sure

(End of Page 46)

Immunization Information System (IIS)
55. If no, will you develop a staffing plan to do so?
mYes
mNo
mNot sure

(End of Page 47)

Immunization Information System (IIS)
56. In the April 2013 IIS survey, many programs noted that they have
pandemic/mass vaccination/preparedness modules or functionality in their IIS or
other system. Does your jurisdiction have such a module?
mYes
mNo

>>>> Skip to Page 51: 60. How are these functions currently used?

(End of Page 48)

Immunization Information System (IIS)
57. Has this module or functionality been used in any capacity (e.g., seasonal flu
clinic) in your jurisdiction?
mYes
mNo >>>> Skip to Page 52: 61. If your jurisdiction’s IIS or other system does
not have a separate module or functionality, please describe how you would
support a mass vaccination clinic in terms of collecting vaccine administration
data?

(End of Page 49)

Immunization Information System (IIS)
IF JURISDICTION HAS A SEPARATE PANDEMIC / MASS VACCINATION
MODULE
58. When was this module or functionality last used?
______________________________________________________________
______________________________________________________________
______________________________________________________________

59. Please describe the primary functions of the module or system. For example,
do the primary functions of your module or IIS include rapid data entry modes or
specialized reports?
______________________________________________________________
______________________________________________________________
______________________________________________________________

(End of Page 50)

Immunization Information System (IIS)
60. How are these functions currently used?
______________________________________________________________
______________________________________________________________
______________________________________________________________

(End of Page 51)

Immunization Information System (IIS)
IF JURIDISDICTION DOES NOT HAVE A SEPARATE PANDEMIC/MASS
VACCINATION MODULE
61. If your jurisdiction’s IIS or other system does not have a separate module or
functionality, please describe how you would support a mass vaccination clinic in
terms of collecting vaccine administration data?
______________________________________________________________
______________________________________________________________
______________________________________________________________

(End of Page 52)

62. In the April 2013 IIS survey, many jurisdictions noted that they would require
pandemic vaccine providers to report doses administered to the IIS. To the best
of your knowledge, please estimate the timeframe, on average, in which your
jurisdiction would expect providers administering pandemic vaccine to submit
data on the first dose of pandemic vaccine antigen and adjuvant to the IIS after
the vaccination encounter? (See the CY2012 Immunization Information System
Annual Report for current timeliness intervals and the 2013-2017 IIS Functional
Standards)
mAwardee health department
mLocal health department(s)
mRegional health department(s)
mOther

(End of Page 53)