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As the coronavirus vaccines continue to be administered across the country, questions remain how a mass vaccination program works: Who will get the vaccine, in what order, and when.

APTA is monitoring the development of the emergency releases of the vaccine by the U.S. Food and Drug Administration and recommendations of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. We'll keep you informed of any developments. Here are five things you need to know as of March 5.  

1. FDA authorization of the Johnson & Johnson vaccine means that there are three versions being administered, and supplies are being increased nationwide.

The Biden Administration is increasing vaccine supply from 14.5 million vaccines last week to 18 million this week by including the Johnson & Johnson vaccine, authorized for use by the FDA on Feb. 27. The federal government has purchased 100 million doses of the Johnson & Johnson vaccine, which requires only a single shot. Supplies of the Pfizer and Moderna vaccines also are being increased.

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

According to the CDC, vaccine doses are allocated to jurisdictions based on the number of people 18 years or older in proportion to the entire U.S. population. After jurisdictions and other federal and commercial partners are allocated their supplies, they determine where the vaccine goes, such as to health departments, hospitals, and retail pharmacies. Each state is responsible for determining how it will distribute the vaccine.

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 resource page that provides high-level considerations for vaccination administration and planning in health care facilities.

CDC reports COVID-19 vaccine doses delivered and doses administered in the United States publicly through the COVID Data Tracker: COVID-19 Vaccinations in the United States. CDC also reports data on COVID-19 vaccination in long-term care facilities. 

3. Physical therapists are recognized as eligible to furnish the vaccine (with provisions) in some states.

Several states, including Maryland, California, and Colorado, as well as Washington, D.C., recognize PTs as eligible to furnish the COVID-19 vaccine (with provisions, such as mandatory training). Check with your APTA state chapter for guidance on whether your state has issued temporary authority for PTs and PTAs to administer the vaccine. And stay tuned for a practice advisory from APTA that will address the roles and responsibilities of physical therapists administering the COVID-19 vaccine.

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 enforces laws against workplace discrimination and provides guidance regarding disability-related medical inquiries and medical examinations that might be relevant in a pandemic. This includes 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. Also refer to the NIH COVID-19 Treatment Guidelines for the most current clinical guidance on COVID-19 outbreak management.

5. CDC, OSHA, and other federal and state agencies remain your best source of information.

CDC doesn't develop vaccines, but it is a key source for reliable information. CDC regularly updates its resource page on the COVID-19 vaccine, and it shares things you should know about the U.S. COVID-19 vaccination program, as well as 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.

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