LeadingAge Raises Vaccination Prioritization Concerns on CDC Listening Session

Members | January 11, 2021 | by Dee Pekruhn

On Monday, January 11 2021, CDC hosted a Listening Session for COVID Vaccination for Older Adults in the Community. LeadingAge brought forward many of the vaccination prioritization concerns that members have expressed, especially for those who serve independent living, affordable housing/ HUD, and HCBS populations. Ideas for new resources and support from CDC were solicited, and LeadingAge and other aging services associations provided examples and discussion.

CDC representatives were very receptive and interested in ideas for new resources and support. LeadingAge, ASHA and Argentum were especially vocal in providing comment, ideas and discussion on the topic; CDC promised to follow up with states, pharmacy partnership representatives, and attendees of the call.

An interactive and informative listening session, hosted by CDC’s Dr. Carolyn Bridges, explored current issues in the COVID vaccination roll-out for older adults in the community and in residential settings. Dr. Bridges began the call with what she called ‘ground level’ facts and known issues related to the organization and distribution of vaccines to those in the 1A category across states.

In summary, these facts and known issues included:

· An overview of the two vaccines (Pfizer and Moderna) currently in use in the pharmacy partnerships.

· An emphasis on the safety of the vaccines, the rigor of the trials that preceded EUA approval, and assurances that there is no live virus in the vaccines and the mRNA does not interact with recipient’s DNA.

· A discussion about prior COVID infections: vaccination should be delayed until a person is fully recovered from a current COVID infection, and current evidence states there is a low chance of a COVID reinfection for the first 90 days after recovery. As a result, there is no minimum number of days that one must wait between COVID recovery and vaccination.

· CDC recommends that the states decide how the vaccination roll out happens and who is prioritized. The distribution of vaccines will adjust as supply increases.

· Older adult considerations:

o How can older adults access COVID information, especially if they do not have the technology to get information.

o How to grant vaccine access to older people living in wide range – rural, adult family homes, congregate settings.

o How to get vaccines to older people with cognitive decline and no community or social support.

o How to get vaccines to older people with limited or no transportation options.

· For people with underlying medical considerations/ trials, there are not counterindications for vaccinations. CDC prioritizes these individuals in 1C,

· For people who are immunocompromised, they can receive vaccines if their medical providers see no other counterindications.

· For people who have severe allergies to vaccine components or to the first dose of the vaccine, they should NOT receive the vaccine.

· All providers should be prepared to treat severe allergic reactions if they occur.

· An emphasis that even after vaccination, people should wear a mask, wash hands, maintain social distancing.

Following her informative introduction, Dr. Bridges then led an interactive discussion and Q&A session on current concerns, issues or gaps in the roll out of vaccines to older adults living in residential or community-based settings.

A discussion, led by LeadingAge, was then held on the wide variations in prioritization of independent living adults in retirement communities and HUD/ Section 202 housing between states – despite CDC recommending prioritization of these vulnerable older adults in 1A. LeadingAge emphasized the need for clarity to states about the need for this prioritization, and for greater clarity between states and the pharmacy partners on who is included by the state in Tier 1A. Representatives from the American Seniors Housing Association and Argentum echoed these concerns raised by LeadingAge, and CDC was asked to provide greater guidance and urgency to states to prioritize these ‘overlooked’ populations. The goal and hope is to have consistent and proactive prioritization across the states; LeadingAge congratulated CDC on its recommendations for Tier 1A, and recognized that some states are indeed prioritizing these populations as recommended.

Additionally, LeadingAge raised the importance of accommodating the transportation and accessibility needs of community-based older adults in the planning for community-based vaccination clinics. Inclement weather, long waiting lines, mobility and other accessibility concerns should all be anticipated and provided for, wherever older adults receive vaccination. We emphasized the great importance of vaccinating the employees of home care, home health, and other HCBS service providers, upon whom many community-based older adults depend for critical activities of daily living. CDC was urged to offer education and guidance to states to address the unique needs of community-based older adults and the people who care for them.

Dr. Bridges and her CDC colleagues were very attentive and receptive to these observations and suggestions. The question was then asked, what new resources or supports would be helpful to reach these populations and address the noted concerns? LeadingAge asked for targeted education and motivational tools to address staff vaccine hesitancy, including guidance for supervisors who are working with employees to encourage acceptance. This suggestion was echoed by the other aging services associations; AHCA/NCAL offered examples of motivational practices that work (town halls, monetary incentives, drawings, peer encouragement) and those that do not (mandatory vaccination, stated as leading to higher staff turnover).

The topic then turned to resources for vaccination clinics, and LeadingAge asked for a tactical, step-to-step guide or procedural map for planning, implementing and concluding a series of vaccine clinics. Also, we asked for a handy guide that could be given to on-the-ground pharmacy partner staff addressing how to approach the unique needs and abilities of older adults. Upon inquery from CDC, both Argentum and LeadingAge offered to contribute to a future ‘tip sheet’ for vaccination clinics where CDC would like to feature ‘best practices’ from members.

As the session came to a close, Dr. Bridges asked for additional comments or suggestions for community-based older adults. LeadingAge again emphasized the need for community-based older adults and the people who care for them to have accessible, convenient and comfortable accommodations at vaccination clinics – as soon as is possible. We recommended that CDC offer guidance for transportation solutions, mobility and accessibility accommodations, inclement weather considerations, and educational outreach for these populations. LeadingAge also thanked CDC for the many resources and recommendations that have already been shared, and offered ongoing collaboration in the development of new resources.

Others on the call shared concerns about the delay in access to the pharmacy partnership in certain states, such as Maryland, Pennsylvania, Illinois and Wisconsin; CDC pledged to follow up on this concern. Argentum representatives raised the question of the incoming Biden administration prioritizing first-dose vaccination (mobilizing most of the existing vaccines to vaccinate people with one dose, rather than reserving supply to ensure all those who get the first dost also get the second dose.) CDC pledged to follow up on this issue as well.

As LeadingAge becomes aware of new resources, supports and prioritization guidelines that are issued by CDC, we will share them broadly with all members. We continue to seek and use every opportunity to share member experiences with the vaccination process and to  advocate for older adults and those who care for them in all areas of aging services.