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[Editor's note: this article was updated on Dec. 22 from its original Dec. 11 version.]

As the first doses of the coronavirus vaccine begin being administered, questions remain how a mass vaccination program works: Who will get the vaccine, in what order, and when. While APTA doesn't have authority or direct influence over vaccine distribution, we're reaching out to federal and state policymakers to educate them on the important and crucial role that PTs and PTAs play in health care, and why they must be included in states’ and communities’ vaccine distribution plans. That applies to PTs and PTAs in both facility-based settings and in the community.

APTA is closely monitoring the development of the emergency releases of the vaccine by the FDA and recommendations of CDC’s Advisory Committee on Immunization Practices. We'll keep our members informed of any developments. Here are four things we know so far.

1. The Pfizer/BioNTECH vaccine is being administered, and the Moderna vaccine will be shortly.

Facilitated by the federal government's Operation Warp Speed initiative, doses of the first FDA-approved COVID vaccines are now being distributed across the country, with the first shots administered on Dec. 14. On Dec. 18, the FDA officially approved for emergency use a second vaccine, this one developed by Moderna. Doses of the Moderna vaccine are expected to be administered starting Dec. 21.

2. Distribution plans are up to individual states and health care facilities.

Distribution is being handled at the state level, based on population numbers, and each state is responsible for determining how it will distribute the vaccine.

There are multiple factors to take into account, including the number of individuals who contract the virus and in what settings, who serves the population with the highest mortality or cost-of-care rates, and who is administering the vaccine, to name a few. This analysis from the Kaiser Family Foundation offers insight into states’ preliminary plans to distribute the vaccine and includes links to state prioritization criteria. Consider reaching out to your APTA state chapter to ask about additional guidance and information for your state. Also check out the HHS Assistant Secretary for Preparedness and Response's Technical Resources, Assistance Center, and Information Exchange —TRACIE, for short — a recently developed resource that provides high-level considerations for vaccination administration and planning in health care facilities.

Most state plans follow recommendations from the CDC Advisory Committee on Immunization Practices, or ACIP, which first voted to recommend that health care personnel, defined as paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials, and residents of long-term care facilities be the two groups that are vaccinated first. On Dec. 20, ACIP voted to recommend that people 75 and older and essential frontline workers (the so-called 1b group) be prioritized for the COVID-19 vaccine in the next tiers behind medical workers and nursing home residents. ACIP agreed that the following vaccination round, 1c, should include remaining seniors under 75, other essential workers, and people between the ages of 16 and 64 with high-risk conditions. Additional guidance for states on prioritization is expected soon.

4. Mandates for employee vaccination could involve both federal and state laws and oversight entities — and EEOC has weighed in.

The Equal Employment Opportunity Commission, or EEOC, enforces laws against workplace discrimination and provides guidance regarding disability-related medical inquiries and medical examinations that might be relevant in a pandemic, including whether an employer can compel its employees to be vaccinated. The Americans with Disabilities Act limits employers’ ability to require medical examinations such as blood tests and breath analyses. The commission offers relevant information for employers and employees and addresses questions from the public about EEO laws and COVID-19.

On Dec. 16, EEOC issued updated COVID-19 vaccine guidance, which asserted that the administration of a COVID-19 vaccine to a worker by an employer is not a medical examination, and ordering employees to get a COVID-19 vaccine would not violate the ADA. The EEOC guidance also takes the position that asking or requiring an employee to show proof of receipt of a COVID-19 vaccination is not a disability-related inquiry — and thus permissible — and provides advice on how employers can respond to employees who say that they are unable to receive the COVID-19 vaccine because of a disability or a sincerely held religious belief.

So, what happens when an employee is exempted from a required vaccine? The ADA allows an employer to have a qualification standard that includes “a requirement that an individual shall not pose a direct threat to the health or safety of individuals in the workplace.” However, if a safety-based qualification standard, such as a vaccination requirement, screens out or tends to screen out an individual with a disability, the employer must show that an unvaccinated employee would pose a direct threat due to a “significant risk of substantial harm to the health or safety of the individual or others that cannot be eliminated or reduced by reasonable accommodation.”

If an employer determines that an individual who cannot be vaccinated due to disability poses a direct threat at the worksite, the employer cannot exclude the employee from the workplace — or take any other action — unless there is no way to provide a reasonable accommodation that would eliminate or reduce risk. If there is a direct threat that cannot be reduced to an acceptable level, the employer can exclude the employee from physically entering the workplace, but this doesn't mean the employer can automatically terminate the worker. Employers will need to determine if any other rights apply under the EEO laws or other federal, state, and local authorities.  

EEOC isn't the sole regulatory voice in the matter. The Occupational Safety and Health Administration may also weigh in, but it has not yet provided guidance on a COVID-19 vaccine. However, a 2009 letter of interpretation on mandatory flu shots for employees and guidance on protecting workers during a pandemic is instructive.

In addition, state law is often more stringent, particularly for small employers. CDC has created a list of current state vaccination laws related to health care workers —check in frequently for updates related to the COVID-19 vaccine. Before implementing a mandatory vaccination program, be sure to consult all relevant federal and state regulatory authorities and check with a local attorney who specializes in this area of law.

4. CDC is your best source of information.

CDC doesn't develop vaccines, but it is a key source for reliable information. CDC provides guidance on the COVID-19 vaccine for health care providers, outlines things you should know about the U.S. COVID-19 vaccination program, and shares updates on its vaccination advisory committee's latest recommendations. The agency also plays an influential role in the development of vaccination plans that emphasize information-sharing, boosting the confidence of health care personnel in the vaccine, and engaging communities and individuals. Visit the CDC website to stay up to date.

Also refer to the NIH COVID-19 Treatment Guidelines for the most current clinical guidance on COVID-19 outbreak management.

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