Indiana COVID-19 Vaccine Plan

COVID-19 VACCINE ALLOCATION PLAN
Indiana Department of Health
October 2020
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Indiana COVID-19 Introduction i Indiana Department

Vaccination Plan Of Health
EXECUTIVE SUMMARY
Providing a safe and effective COVID-19 vaccine to all Hoosiers is a critical component of the State of
Indiana’s strategy to reduce the spread of COVID-19 and related illnesses, hospitalizations, and deaths
through appropriate allocation and administration of COVID-19 vaccine to all Hoosiers in a safe, timely and
effective manner. The following document serves as an interim draft plan for the Indiana Department of
Health (IDOH), local public health programs, and public health partners on how to plan and operationalize a
vaccination response to COVID-19 within Indiana.
Indiana has established multi-agency cross-disciplinary advisory groups to enhance the development of
plans, activity reach, and risk/crisis response messaging and delivery:
Vaccine Allocation Plan Development Advisory Group: Provided final recommendations on the ethical and
equitable allocation of a limited COVID-19 vaccine. This group remains available to assemble as adjustments
to the plan are needed based on the final allocation total and the safety and efficacy of the vaccine(s).
Ethical Considerations Advisory Group: Reviewed existing documents and assisted in writing and reviewing
ethical approaches to vaccine allocation. This group founded their recommendations with the goals to
decrease overall mortality, mitigate spread, steward scarce resources responsibly, ensure feasibility of
implementation, reinforce and support health care infrastructure necessary to treatment of disease, protect
vulnerable populations, and promote fairness.
Vaccine Review Advisory Group: This group will investigate available information on each COVID-19 vaccine
and will specifically review the safety profile and efficacy of each population of interest (those at clinical risk
and demographic factors).
Equitable Distribution and Communication Advisory Group: Worked to ensure that all Hoosiers were
considered and represented as a component of the vaccine allocation plan. Advised on key components of
communication.
Data Advisory Group: Explored creative data resources and compiled Indiana-specific data for critical
populations.
Vaccination Program Implementation Committee: External committee facilitated by the Indiana

Department of Health’s (IDOH) State Health Commissioner with representation from state and local
government organizations, private sectors, tribes, healthcare, education, and critical infrastructure.
For Phase 1, Indiana will reinforce and support the healthcare workforce and those who are at the most risk
of morbidity and mortality. In the scenario that Indiana does not receive sufficient vaccine to vaccinate all
included in the population of focus, the IDOH has developed a per-county percentage-based metric to
ensure equitable and equal distribution across Indiana.
Phase 1-A: Guiding objective: Reinforce and support healthcare infrastructure & treatment of disease.
• This group includes all paid and unpaid persons serving in healthcare settings who have the potential
for direct or indirect exposure to patients or infectious material.
• Healthcare settings include, but are not limited to: hospitals, long-term care facilities, outpatient
facilities, home health care settings, pharmacies, dialysis centers, emergency medical services,
frontline public health interventions, and COVID-19 diagnostic and immunization teams.
Indiana COVID-19 Introduction ii Indiana Department

Phase 1-B: Guiding objective: Protect the vulnerable.
• Individuals who are at particular risk of morbidity and mortality associated with COVID-19 disease
based on the latest evidence-based criteria.
Phase 2: Guiding objective: Mitigate spread.
• Individuals who are at elevated risk of transmission of the disease because of working or living
circumstances. This includes persons living in correctional facilities, group homes or shelters, and
individuals who’s in-person work is essential, required, and places them in settings where social
distancing is not possible and transmission risk is high.
Phase 3: Guiding objective: General public vaccination.
Phase 1-A will utilize hospitals that are prepared to administer vaccine to all healthcare personnel. Indiana
hospitals were surveyed regarding their readiness to provide vaccine to healthcare personnel, including
those not associated with their facility. Phases 1-B and 2 will expand to utilize local health departments
(LHDs) and partnerships with commercial pharmacies. IDOH has provided a COVID-19 Vaccine Planning
Template to the 94 LHDs and will review each of the plans prior to vaccine delivery to ensure adequate and
appropriate vaccination efforts are addressed locally. The continuous quality improvement at the local level
ensures state and local readiness of dispensing of mass prophylaxis, including vaccines, to Hoosiers across
the state.
IDOH will further augment the local response by deployment of vaccination strike teams embedded in our 10
district mobile response units throughout the State to administer vaccine to those who are not covered by
traditional vaccine providers and/or local public health efforts. Indiana is also piloting a vaccination
partnership with our EMS and paramedicine providers and plans to incorporate them in COVID-19 vaccination
in communities statewide. The Indiana National Guard, an important part of our testing program, will also be
engaged with our phase 2 and 3 mass immunization plan.
To facilitate early vaccination efforts and to ensure proper provider coverage statewide, the IDOH has
developed a web-based/on-line COVID-19 Provider Enrollment form capturing all required datasets as
included in the “CDC COVID-19 Vaccination Program Provider Agreement”. This web-based system will be
used to collect required data that will be transmitted electronically to federal systems, therefore enrolling
Indiana providers as COVID-19 Vaccine Providers. The IDOH will use Tiberius as a visualization tool for
allocations, vaccine administration data monitoring, and transparency.
Currently, 743 providers enrolled in the Indiana Vaccines for Children (VFC) Program are actively vaccinating
and recording vaccination administration data in the Children and Hoosier Immunization Registry Program
(CHIRP), Indiana’s immunization information system. There are 1,923 other facilities that have established a bi-
directional interface with CHIRP. IDOH is working with a third-party registration vendor to identify a
registration platform that will link to CHIRP. Registered COVID-19 vaccination providers will order COVID-19
vaccine through CHIRP. IDOH will utilize existing procedures routinely used for ordering publicly funded
vaccines.
A robust and nimble communication plan will be the foundation of successful COVID-19 vaccine
administration and uptake. The focus must be on ensuring consumer trust by providing information that is
timely, accurate and appropriate. Messages will be crafted specifically to each audience and distributed
through the most effective channels to achieve the maximum response.
Indiana COVID-19 Introduction iii Indiana Department

TABLE OF CONTENTS
I. COVID-19 VACCINATION PREPAREDNESS PLANNING ..................................................................... 7
A. State Improvement Planning .........................................................................................................................................................1
B. Local Improvement Planning ....................................................................................................................................................... 2
II. COVID-19 ORGANIZATIONAL STRUCTURE AND PARTNER INVOLVEMENT ........................ 3
A. Incident Support Model (ISM) DOC Structure ................................................................................................................. 3
B. Vaccine Internal Planning Group and Working Group (Internal) ..................................................................... 4
C. Vaccination Program Implementation Committee (External) ............................................................................ 4
D. Vaccine Advisory Groups (External) ........................................................................................................................................ 5
E. Partnership................................................................................................................................................................................................... 7
F. Multi-Agency Coordination ............................................................................................................................................................ 7
G. Tribal Engagement ...............................................................................................................................................................................8
H. Critical Population Partners............................................................................................................................................................9
III. PHASED APPROACH TO COVID-19 VACCINATION ............................................................................ 11
A. Phase 1: Potentially Limited Supply of COVID-19 Vaccine Doses Available ........................................ 12
B. Phase 2: Large Number of Vaccine Doses Available .............................................................................................. 12
C. Phase 3: Sufficient Supply of Vaccine Doses for Entire Population (Surplus of Doses).............. 13
IV. CRITICAL POPULATIONS................................................................................................................................... 14
A. Identifying and Estimating Critical Populations ...........................................................................................................14
B. Estimates of Critical Populations and Critical Infrastructure Workforce ................................................. 14
C. Prioritization of Critical Populations ...................................................................................................................................... 16
D. Sub-Prioritization of Critical Populations ...........................................................................................................................19
E. Describing, Locating, and Communicating with Critical Populations ........................................................ 21
V. COVID-19 PROVIDER RECRUITMENT AND ENROLLMENT ............................................................ 23
A. Provider Enrollment Efforts......................................................................................................................................................... 23
B. Provider Administration .................................................................................................................................................................. 24
C. Provider Enrollment Data ............................................................................................................................................................. 25
D. Provider Credentialing .................................................................................................................................................................... 25
E. Provider Training .................................................................................................................................................................................. 25
F. Redistribution Approval.................................................................................................................................................................. 26
G. Equitable Vaccine Acess ............................................................................................................................................................... 26
H. Pharmacy Enrollment ...................................................................................................................................................................... 28
VI. COVID-19 VACCINE ADMINISTRATION CAPACITY ............................................................................29
A. Administration Capacity ................................................................................................................................................................. 29
VII. COVID-19 VACCINE ALLOCATION, ORDERING, DISTRIBUTION, AND INVENTORY
MANAGEMENT ........................................................................................................................................................ 31
Indiana COVID-19 Introduction iv Indiana Department

A. Allocation ....................................................................................................................................................................................................31
B. Ordering ...................................................................................................................................................................................................... 33
C. Distribution ................................................................................................................................................................................................ 34
D. Shipment Modalities ......................................................................................................................................................................... 36
E. Inventory Management .................................................................................................................................................................. 37
F. COVID-19 Vaccine Recovery ..................................................................................................................................................... 38
G. Satellite, Temporary, and Off-Site Clinic Storage and Handling .................................................................. 38
H. Local Dispensing.................................................................................................................................................................................. 39
VIII. COVID-19 VACCINE STORAGE AND HANDLING ............................................................................44
A. Cold Chain Management .............................................................................................................................................................. 44
B. Temperature Monitoring ............................................................................................................................................................... 45
C. Strategy to Engage Dry Ice Vendor ..................................................................................................................................... 45
D. Redistribution Transportation ....................................................................................................................................................46
IX. COVID-19 VACCINE ADMINISTRATION DOCUMENTATION AND REPORTING ..................47
A. Collection of COVID-19 Vaccine Doses Adminstered Data .............................................................................. 47
B. Transition of Data to IZ Gateway............................................................................................................................................. 48
C. Provider Reporting Readiness .................................................................................................................................................. 48
D. Real-Time Reporting ........................................................................................................................................................................ 48
E. Provider Accountability .................................................................................................................................................................. 48
F. COVID-19 Vaccine Reports.......................................................................................................................................................... 49
X. COVID-19 VACCINATION SECOND-DOSE REMINDERS................................................................... 51
A. Notification Timing and Product Type ................................................................................................................................51
B. Notification Modalities......................................................................................................................................................................51
XI. COVID-19 REQUIREMENTS FOR IISS OR OTHER EXTERNAL SYSTEMS ................................ 53
A. High-Volume Data Management and Contingency ............................................................................................... 53
B. Indiana IIS (CHIRP) Data Variables ......................................................................................................................................... 53
C. Data Capacity ......................................................................................................................................................................................... 54
D. IIS Enrollment and Onboarding................................................................................................................................................ 54
E. IZ Gateway Connection .................................................................................................................................................................. 54
F. Data Use Agreements ..................................................................................................................................................................... 54
G. Contingency Planning ..................................................................................................................................................................... 55
H. Data Quality.............................................................................................................................................................................................. 55
XII. COVID-19 VACCINATION PROGRAM COMMUNICATION .............................................................. 56
A. COVID-19 Communication Objectives ............................................................................................................................... 56
B. Key Audiences .......................................................................................................................................................................................56
C. Broad Communication Planning Phases .......................................................................................................................... 56
Indiana COVID-19 Introduction v Indiana Department

D. Communication Activties .............................................................................................................................................................. 57
E. Messaging Considerations........................................................................................................................................................... 59
F. Communication Channels ............................................................................................................................................................60
G. Partners and Trusted Sources .................................................................................................................................................. 61
H. Crisis and Risk Communication................................................................................................................................................ 61
XIII. REGULATORY CONSIDERATIONS FOR COVID-19 VACCINATIONS ................................... 63
A. Emergency Use Authorization Fact Sheets ................................................................................................................... 63
XIV. COVID-19 VACCINE SAFETY MONITORING ..................................................................................... 64
A. Vaccine Adverse Event Reporting System .................................................................................................................... 64
B. Vaccine Safety Datalink .................................................................................................................................................................64
C. Clinical Immunization Safety Assessment Project ................................................................................................... 64
XV. COVID-19 VACCINATION PROGRAM MONITORING ......................................................................... 66
A. COVID-19 Vaccination Program Monitoring ..................................................................................................................66
B. Resource Monitoring ........................................................................................................................................................................66
C. Communication Monitoring ........................................................................................................................................................ 67
D. Local Monitoring .................................................................................................................................................................................. 67
E. Program Metrics ...................................................................................................................................................................................68
PLAN ATTACHMENTS
PHASE 1: INDIANA HEALTHCARE PERSONNEL ESTIMATES…………………………………………… ATTACHMENT A
INDIANA SOCIAL VULNERABILITY INDEX…………………………………………………………….……………….…… ATTACHMENT B
HEALTHCARE PERSONNEL ULTRA-COLD DISTRIBUTION TEMPLATE……………….…… ATTACHMENT C
Indiana COVID-19 Introduction vi Indiana Department

RECORD OF CHANGES
Change # Date Description Date Posted Responsible Party
1 10/14 Plan Completed 10/14/2020 IDOH DEP Planning
2 10/16 Executive Staff Approval 10/16/2020 IDOH Executive Staff
Indiana COVID-19 Introduction vii Indiana Department

I. COVID-19 VACCINATION PREPAREDNESS PLANNING
Pandemic vaccination response planning requires collaboration among a wide range of public-
and private-sector partners, including immunization and public health emergency
preparedness programs, emergency management agencies, healthcare organizations, industry
groups that include critical infrastructure sectors, policy makers, and community vaccination
providers (e.g., pharmacies, occupational health settings, doctors’ offices). Many of these
partners are engaged regularly in seasonal influenza and other outbreak vaccination
campaigns, and many have served in past vaccination response campaigns.
A. State Improvement Planning

Improvement planning is the identification of strengths, areas of improvements, and
corrective actions that result from workshops, exercises, or real-world events. The Indiana
Department of Health (IDOH) has identified strengths and gaps in program planning during
exercises and real-world events. Below are lessons learned from two real-world events that
have affected the state of Indiana, the 2009 H1N1 Pandemic and 2018 hepatitis A outbreak.
1. 2009 H1N1 Pandemic

Following the statewide response to the 2009 H1N1 Pandemic within Indiana, specific
strengths and areas of improvement were documented in Indiana’s After-Action Review
(AAR). A comprehensive overview of Indiana’s actions, strengths, and areas of
improvements can be found in the full H1N1 AAR document. Below are highlights from
the AAR regarding vaccine administration, documentation, and messaging. These quality
improvement actions have been incorporated into routine vaccinations and current
COVID-19 vaccine implementation efforts.
Strengths Identified:
• Collaboration with corporations and universities to offer vaccines
• Weekly conference call communications between local health departments (LHDs)
and IDOH
• Development of targeted priority groups
• Provider agreement and CHIRP forms
• IDOH training sessions on vaccines, injections, and administration for volunteers
• Higher uptake among special populations when vaccine was directly provided within
the community
Areas of Improvement Identified:

• Timeliness and initial amount of vaccine was much lower than expected and
subsequent issues getting vaccine early. If there is a delay or change, inform early,
often, and why
• Provide a standardized interpretation and messaging of priority populations within all
counties
• Development of centralized communications and identification of vaccine subject
matter expert (SME)/spokesperson within Indiana
Indiana COVID-19 1 Indiana Department

• Ensure all providers receive the vaccine information statement (VIS) on time
• Communicate accurate and timely information to counteract vaccine hesitancy. Low
interest in vaccine from general public, providers, and healthcare workers initially
• Vaccine hesitancy due to myths and false statements on the internet.
• Provide training on proper use of ancillary supplies (i.e., syringes, needles)
2. 2018 Hepatitis A Outbreak

The IDOH responded to statewide hepatitis A outbreak starting in 2017 associated with a
national outbreak by activating an Incident Command System (ICS). This response
identified a great number of modifications that needed to be made to effectively deploy
vaccination strike teams, including:
• Always have a state employee as part of the team so that state-rented vehicles can
be utilized
• Establish a standard operating procedure for offsite vaccination clinics
• Establish a standard operating procedure for using the mass vaccination module in
the state immunization information system
• Establish a pool of vaccinators who are willing to go into jails, homeless shelters, and
high-risk areas
These modifications enabled IDOH to deploy strike teams for COVID-19 testing in long
term care facilities within 24 hours.
B. Local Improvement Planning

Local health departments (LHDs) frequently engage local partners in exercising Points of
Dispensing (POD) operations and planning scenarios. This continuous quality improvement
at the local level ensures state and local readiness of dispensing of mass prophylaxis,
including vaccines, to Hoosiers across the state. This periodic review and revision of local
plans is integral to the improvement process. Continuous quality improvement is ongoing as
LHDs move through the various phases of workshops, tabletops, functional exercises, and
real-world activities. Local improvement planning is further bolstered by the annual Public
Health Emergency Preparedness (PHEP) program cooperative agreement. The PHEP
cooperative agreement provides funding assistance while setting annual requirements that
help health departments build and strengthen their abilities to effectively respond to a
range of public health threats, including infectious diseases, natural disasters, and
biological, chemical, nuclear, and radiological events. Preparedness activities funded by the
PHEP cooperative agreement specifically target the development of emergency-ready
public health response plans that are flexible and adaptable.

II. COVID-19 ORGANIZATIONAL STRUCTURE AND PARTNER INVOLVEMENT
A. IDOH Department Operations Center (DOC) Incident Support Model (ISM)
Organizational Structure
The ISM is a variation of a traditional Incident Command System (ICS) structure that
separates the information management/situational awareness function from the ICS
Planning Section and combines the functions of the ICS Operations and Logistics Sections
from the ICS Administration/Finance Section. The DOC ISM structure typically focuses
exclusively on support functions rather than operations. With the hands-on nature of some
COVID-19 response operations, the current IDOH ISM incorporates both situational
awareness/support functions and operational elements.
As with the ICS, the director of a DOC ISM is supported by personnel designated to key
functions, subject matter experts, and technical specialists. Staff supporting the Response
Manager include a Public Information Officer and legal advisor. The General Staff sections
consist of Situational Awareness, Planning Support, Resources Support, and DOC Center
Support. The following model represents the overall DOC ISM structure, specific for COVID-
19 vaccine allocation as an extension to the Indiana ESF-8, State of Indiana Emergency
Operations Center (SEOC; Indiana Department of Homeland Security).

B. Vaccine Internal Planning Group and Working Group (Internal)
The IDOH has established an internal vaccine planning group and working group. The
purpose of the working group is to develop the state’s COVID-19 vaccine plan and
operationalize functions referenced within the plan. This group is comprised of multiple
representatives from various divisions within the agency. These representatives are noted in
the agency’s ICS organization chart above. The internal vaccine planning group is
comprised of working group members in addition to policy level executives. High level
strategies, policies, tasking, and planning assumptions originate within the internal vaccine
planning group. These strategies are then operationalized and developed within the
working group.
Indiana Internal COVID-19 Vaccine Planning Group Representation
Policy (State Health Commissioner, Deputy

State Health Commissioner, Chief of
COVID-19 Response Manager
Staff, Chief Medical Officer, Chief Data
Officer, Legislative & External Affairs)
Public Information Officer &
Emergency Preparedness Planning
Communications
Office of Technology and Compliance
Logistics & Resource Support
(OTC) & Information Technology (IT)
Local Public Health Mass Vaccination Immunizations
Legal Finance
C. Vaccination Program Implementation Committee (External)

Reaching intended vaccine recipients is essential to achieving desired levels of COVID-19
vaccination coverage. To ensure equitable access to vaccinations, information about
populations within a jurisdiction and the logistical requirements for providing them access
to COVID-19 vaccination services requires collaboration with external entities and
community partners who are familiar with how they obtain healthcare and other essential
services.
Indiana has established an external vaccination program implementation committee

facilitated by the State Health Commissioner. The purpose of this external implementation
committee is to enhance the development of plans, reach of activities, and messaging and
delivery related to the COVID-19 vaccine. This goal of this external committee is to provide
coordination and communication between state and local governments, private sectors,
tribes, healthcare, education, and critical infrastructure.

Indiana External COVID-19 Vaccine Implementation Committee
Sector within the Community Organization(s) Represented
Corrections Indiana Department of Corrections (IDOC)
Critical Access Hospitals / Rural
Margaret Mary Health
Health
Emergency Management
Indiana Department of Homeland Security
Agencies
Faith-based Purpose of Life Ministries
Federally Qualified Health Center
HealthLinc
/ Community-based Healthcare
Indiana Health Care Association (IHCA), Indiana
Healthcare
Hospital Association (IHA)
Ball State University, University of Notre Dame,
Higher Education Purdue University, Indiana University, Independent
Colleges of Indiana
Indiana Housing and Community Development
Homeless
Authority (IHCDA)
Immunization Coalition Indiana Immunization Coalition
Jails Indiana Sheriff’s Association
Law Enforcement Indiana State Police
Allen County, Ripley County, Vanderburgh County,
Local Public Health Departments
Porter County, Marion County
Indiana Minority Health Coalition (IMHC), Indiana Latino
Minority Health
Institute, Indiana Latino Expo
Occupational Health Associations OurHealth
Indiana Family & Social Services Administration (FSSA)
Organizations serving people with
– Division of Aging, Division of Disability and
disabilities
Rehabilitative Services, Division of Mental Health
Pharmacies Indiana Pharmacy Alliance, Kroger
Native American Indian Commission – Health
Committee, Native American Indian
Tribal
Commission, Potowatomi Native Americans – St.
Joseph County
D. Vaccine Advisory Groups (External)

The following five external advisory groups are facilitated by the IDOH Chief Medical Officer.
The advisory groups convene multiple cross disciplinary subject matter experts (SMEs) to
develop recommendations for equitable allocation, distribution, and accounting for COVID-
19 vaccine.
1. Vaccine Allocation Plan Development Advisory Group

The Vaccine Allocation Plan Development Advisory Group collaborates with the Ethical
Considerations Advisory Group to review available and prior vaccine allocation
recommendations to develop a plan for Indiana.

The Vaccine Allocation Plan Development Advisory Group has representation from the
Indiana Hospital Association (IHA), IDOH Immunizations Division, Indiana University
Richard M. Fairbanks School of Public Health, Indiana University School of Law, Butler
University, Indiana Primary Healthcare Coalition, HealthLinc (federally qualified health
center), Proactive Clinical Partners (medical group), and multiple health systems
(Ascension St. Vincent, Community Health Network, Methodist Hospitals, and Indiana
University Health).
2. Ethical Considerations Advisory Group

The Ethical Considerations Advisory Group reviews existing literature and guidance
regarding ethical considerations related to the vaccine. This group develops the strategy
to ensure that COVID-19 vaccine is ethically allocated across the state.
The Ethical Considerations Advisory Group has representation from the Indiana Hospital
Association (IHA), Indiana University School of Medicine, Indiana University School of
Law, Indiana University Richard M. Fairbanks School of Public Health, Cardon &
Associates, Inc. (long-term care), and multiple health systems (Decatur County Memorial
Hospital, Indiana University Health, Ascension St. Vincent, Kosciusko Community
Hospital, and Community Health Network).
3. Vaccine Review Advisory Group

The Vaccine Review Advisory Group investigates available information on COVID-19
vaccine candidates. Based on CDC, FDA, and ACIP guidance, this advisory group will
develop safety profiles per population, evaluate the efficacy of the vaccine, and develop
an understanding of exclusion criteria.
The Vaccine Review Advisory Group has representation from the Indiana Hospital
Association (IHA), Indiana Health Care Association (IHCA), IDOH Office of Minority Health,
Indiana University School of Medicine, two local health departments (Marion County and
Allen County), and multiple health systems (Eskenazi Health, Logansport Memorial
Hospital, Parkview Health, Methodist Hospitals, Ascension St. Vincent, and Community
Health Network).
4. Equitable Distribution and Communication Advisory Group

The Equitable Distribution and Communication Advisory Group reviews and advises on
equitable inclusion of populations eligible to receive the vaccine. This advisory group
will develop considerations for inclusion and identify communication gaps.
The Equitable Distribution and Communication Advisory Group has representation from
the Indiana Hospital Association (IHA), IDOH Office of Minority Health, Indiana
Community Health Workers Association, Indiana University Richard M. Fairbanks School
of Public Health, and multiple health systems (Hancock Regional, Indiana University
Health, Community Health Network, and Eskenazi Health).

5. Data Advisory Group
The Data Advisory Group researches, collects data, and develops a process for
estimating the number of individuals in each potential category for receipt of the COVID-
19 vaccine.
The Data Advisory Group has representation from the Indiana State Medical Association
(ISMA), Indiana Hospital Association (IHA), Indiana Professional Licensing Agency (PLA),
Regenstrief Institute, Indiana Management Performance Hub (MPH), and two health
systems (Indiana University Health and Ascension St. Vincent).
E. Partnership
To implement an effective, equitable, and representative COVID-19 vaccine strategy, IDOH
has leveraged existing partnerships within the agency, state and local governments,
healthcare, minority groups, private industry, and higher education. These partners are
represented within the internal and external implementation committees and advisory
groups listed above.
F. Multi-Agency Coordination
The evolution of the size and complexity of hazards and threats has demonstrated the need
for effective planning and coordinated emergency response. These events also show
disasters have no geographical, economic, or social boundaries and involve multiple
jurisdictions, agencies, and organizations. To effectively manage efforts of a multi-agency
coordination system, the State of Indiana has adapted its planning and response capability
based upon the following operational constructs:
1. State Emergency Operations Center (SEOC)

The Indiana State Emergency Operations Center (SEOC) is the Indiana Department of
Homeland Security-managed physical location where multi-agency coordination
occurs. The purpose of the SEOC is to provide a central coordination hub for the support
of local, district, and state needs. The SEOC can be configured to expand or contract as
necessary to respond to different levels of incidents requiring state assistance.
The SEOC is staffed and organized with the Emergency Support Function (ESF) concept
incorporated into an Incident Command System (ICS) structure. Agencies that represent
ESF positions are activated in the SEOC during an incident to execute the response
phase of emergency management. The designated primary and support agencies for
the ESF positions in the SEOC can be arranged and tasked as needed by the IDHS
Response Division Director of Operations. The elevated activation level is determined by
the pandemic and the need for coordination and resource support. The ESF primary
agencies remain responsible for the coordination of all phases of emergency
management as outlined in their respective ESF annexes, regardless of their SEOC
staffing assignments.

2. Executive Policy Group
Emergencies and disasters can produce issues requiring prompt decisions to serve
short and long-term emergency management needs. The Executive Policy Group is a
function of Indiana Department of Homeland Security (IDHS) that is established to
address issues concerning the safety and welfare of Indiana residents, property, and the
environment.
The Executive Policy Group has been activated to advise the Governor, local officials
and the public and recommend protective actions to be taken during an
emergency/event. The Executive Policy Group has assembled in the SEOC to assist in
coordination and decision making.
The Executive Policy Group consists of stakeholders with the authority to make policy-
related decisions or make suggestions to support the state’s response and technical
evaluation during an incident but varies depending upon the type, size and complexity
of the incident. The IDHS Executive Director or designee serves as chairperson of the
Executive Policy Group. The Executive Policy group consists of lead agency
representatives from relevant ESFs as well as subject matter experts as necessary.
3. Indiana Districts
The State of Indiana, in conjunction with multiple agencies, has created Homeland
Security and Public Health Preparedness Districts. The district organization and planning
concept is comprised of multiple jurisdictions, disciplines, and agencies. Together they
focus on common strategic goals and objectives to
satisfy and meet national, state, and local homeland
security and public safety needs. By coming
together, many counties, local governments, and
the State benefit from sharing resources,
eliminating redundancy in critical response
activities and coordinating emergency planning,
training, and exercise activities. While each District
varies in infrastructure, organization, hazards, and
other facets, several commonalities of Districts
include: District Planning Councils, Healthcare
Coalitions, Indiana District Response Task Forces,
and other elements.
G. Tribal Engagement
The Pokagon Band of Potowatomi Native Americans is
located in southwestern Michigan and northeastern
Indiana. To engage the Pokagon Band within the State
of Indiana, the IDOH is coordinating with the State of
Michigan, tribal representatives, and the St. Joseph
Figure 1: Indiana Health Preparedness Districts
County Health Department. The Centers for

Disease Control and Prevention (CDC) is working directly with the Indian Health Service (IHS)
to provide vaccination services to the populations they serve.
IDOH coordination with the State of Michigan is crucial since most community members
within the Pokagon Band seek health services through IHS locations in Michigan. The IDOH
and Michigan Department of Health and Human Services (MDHHS) have a unified and
coordinated approach to providing access to the COVID-19 vaccine to the Pokagon Band.
Through joint coordination with MDHHS, it has been determined that 10% of the overall
vaccine allocated to the Pokagon Band will be allocated to the State of Indiana to support
tribal vaccination efforts. Another key partner engaged in the coordination is the St. Joseph
County Health Department, which has strong existing ties and communication with the
Pokagon Band.
Finally, representatives from the Pokagon Band are represented on the IDOH State Health
Commissioner’s External COVID-19 Vaccine Implementation Committee. Representatives
include the Native American Indian Commission – Health Committee, the Native American
Indian Commission, and Pokagon Band of Potowatomi Native Americans – St. Joseph
County.
H. Critical Population Partners

The IDOH has engaged multiple key partners for critical populations through its five
advisory groups and external vaccine implementation committee. These groups represent
the critical populations within communities across Indiana. These partners understand that
populations they serve and represent and are essential in messaging and communicating
about the COVID-19 vaccine. In the early phases of vaccine planning these partners are
important in data gathering of critical population estimates and developing strategies for
engagement and outreach.
Critical Population Partners

Critical Population within the Organization(s) Represented
Community
Corrections Indiana Department of Corrections (IDOC)
Critical Access Hospitals / Rural Margaret Mary Health
Health
Emergency Management Agencies Indiana Department of Homeland Security
Faith-based Purpose of Life Ministries
Federally Qualified Health Center / HealthLinc
Community-based Healthcare
Indiana Health Care Association (IHCA), Indiana Hospital
Healthcare Association (IHA)
Ball State University, University of Notre Dame, Purdue
Higher Education University, Indiana University, Independent Colleges of
Indiana

Indiana Housing and Community Development Authority
Homeless (IHCDA)
Immunization Coalition Indiana Immunization Coalition
Jails Indiana Sheriff’s Association
Law Enforcement Indiana State Police
Allen County, Ripley County, Vanderburgh County, Porter
Local Public Health Departments County, Marion County
Indiana Minority Health Coalition (IMHC), Indiana Latino
Minority Health Institute, Indiana Latino Expo
Occupational Health Associations OurHealth
Indiana Family & Social Services Administration (FSSA) –
Organizations serving people with Division of Aging, Division of Disability and Rehabilitative
disabilities Services, Division of Mental Health
Pharmacies Indiana Pharmacy Alliance, Kroger
Native American Indian Commission – Health Committee,
Tribal Native American Indian Commission, Potowatomi Native
Americans – St. Joseph County

III. PHASED APPROACH TO COVID-19 VACCINATION
Due to changing vaccine supply levels at various points during the COVID-19 Vaccination
Program, planning needs to be flexible but as specific as possible to accommodate a variety
of scenarios. A key point to consider is that vaccine supply will be limited at the beginning of
the program, so the allocation of doses must focus on vaccination providers and settings for
vaccination of limited critical populations as well as outreach to these populations. The
vaccine supply is projected to increase quickly over the proceeding months, allowing
vaccination efforts to be expanded to additional critical populations and the general public. It
is important to note that recommendations on the various population groups to receive initial
doses of vaccine could change after vaccine is available, depending on each vaccine’s
characteristics, vaccine supply, disease epidemiology, and local community factors.
The goal was to make the plan simple, direct, clear, and actionable so that it is easy to
interpret and implement. Keeping it simple, makes it more feasible that more people can be
vaccinated quickly and in an orderly fashion. Various workgroups reviewed national and
other guidance while considering any special considerations or circumstances specific to the
Hoosier State. A phased approach, based on an ethical and equitable distribution schema, is
necessary since not enough vaccine will be released initially to vaccinate everyone and also
provides guidance as more vaccine becomes available.
A large, multidisciplinary group of statewide experts was assembled to help create, give
input, and feedback, and finalize the plan. In an effort to build trust and lend credibility, IDOH
had the foresight to engage this large, diverse group of local experts to assure Hoosiers that
precious vaccine resources will be utilized in an efficient and equitable manner.
Figure 2: COVID-19 vaccination program phases.

A. Phase 1: Potentially Limited Supply of COVID-19 Vaccine Doses Available
In the initial phase, Phase 1, initial doses of vaccine will likely be distributed in a limited
manner with the goal of maximizing vaccine acceptance and public health protection while
minimizing waste and inefficiency.
Key characteristics of Phase 1::

• COVID-19 vaccine supply may be limited
• COVID-19 vaccine administration efforts must concentrate on the initial populations of
focus to achieve vaccination coverage in those groups
• Inventory, distribution, and any repositioning of vaccine will be closely monitored
through reporting to ensure end-to-end visibility of vaccine doses
Indiana is concentrating early COVID-19 vaccine administration efforts on the initial critical
populations identified in Section IV: Critical Populations. The administration of these
COVID-19 vaccination services will be in point-of-dispensing (POD) settings. This allows for
the maximum number of people to be vaccinated while maintaining social distancing and
other infection control procedures.
Indiana is prioritizing enrollment activities for vaccination providers and settings who will
administer COVID-19 vaccine to the Phase 1 populations of focus. IDOH is developing
operational procedures to establish mobile clinics to provide vaccine to individuals who live
in remote, rural areas, and areas with vaccination services deficiencies. While performing
Phase 1 activities, IDOH will continue preparing for Phase 2. This includes recruiting
additional vaccinators to staff PODs, contract needs for vaccination services, and review of
state practice acts to allow for expanded professional practice, if needed.
B. Phase 2: Large Number of Vaccine Doses Available

As the supply of available vaccine increases, distribution will expand, increasing access to
vaccination services for a larger population. As these larger quantities become available,
IDOH will continue to ensure these two objectives are achieved: providing equitable access
to COVID-19 vaccination for all critical populations to achieve high COVID-19 vaccination
coverage and ensuring high uptake in specific populations, particularly in groups that are at
a higher risk for severe outcomes from COVID-19.
Key characteristics of Phase 2:

• COVID-19 vaccine supply will likely be sufficient to meet demand for critical populations
as well as the general public.
• Additional COVID-19 vaccine doses available will permit an increase in vaccination
providers and locations.
• A surge in COVID-19 vaccine demand is possible, so a broad vaccine administration
network for surge capacity will be necessary.
• Low COVID-19 vaccine is also a possibility, so Indiana will monitor supply and adjust our
strategy to minimize vaccine wastage.

In anticipation of an increase in COVID-19 vaccine supply levels during Phase 2, IDOH will
adapt strategies for administration location, vaccine providers, and access to account for
this increased availability. Vaccination efforts will expand beyond the initial population
group outlined in Phase 1. IDOH will ensure equitable access for all populations. The COVID-
19 vaccine will be administered through additional types of vaccination sites, including,
commercial and private sector partners (pharmacies, doctors’ officers, clinics), and public
health sites (mobile clinics, Federally Qualified Health Centers [FQHCs], rural health clinics,
public health clinics, and temporary off-site clinics).
C. Phase 3: Sufficient Supply of Vaccine Doses for Entire Population (Surplus of

Doses)
Ultimately, COVID-19 vaccine will be widely available and integrated into routine
vaccination programs, operated by both public and private partners.
Key characteristics of Phase 3:

• Likely sufficient COVID-19 vaccine supply where supply might exceed demand
• Broad vaccine administration network for increased access
• Increased emphasis on redistribution of existing vaccine
During Phase 3, IDOH will continue to focus on equitable vaccination access to vaccination
services. COVID-19 vaccine uptake and coverage in critical populations will continually be
monitored. IDOH will intervene and develop enhanced strategies to reach populations with
low vaccination uptake or coverage, if observed. The development of partnerships with
commercial and private entities will be utilized to ensure COVID-19 vaccine and vaccination
services are widely available to Hoosiers. Vaccine wastage will continually be minimized
through the monitoring of vaccine supplies and the repositioning of refrigerated vaccine
products.

IV. CRITICAL POPULATIONS
The IDOH is working with external partners within the five COVID-19 Vaccine Advisory Groups
to determine populations of focus for COVID-19 vaccination and ensure equity in access to
COVID-19 vaccination across the state of Indiana. A key goal is to determine critical
populations for COVID-19 vaccination, including those groups identified to receive the first
available doses of COVID-19 vaccine when supply is expected to be limited.
After a short period of potentially limited vaccine supply, supply will increase quickly,
allowing vaccination efforts to be expanded to include additional critical populations as well
as the general public. Indiana is developing strategies to ensure equitable access to
vaccination for each of the critical populations identified below.
A. Identifying and Estimating Critical Populations

IDOH is working with external partners within the External Vaccination Program
Implementation Committee and the five COVID-19 Vaccine Advisory Groups to identify,
collect, and compile critical population estimates. Indiana Professional Licensing Agency
(PLA), U.S. Census, and industry data was used to determine the population estimates per
critical population. In the future, another available option to collect this information is
creating a uniform electronic template utilizing REDCap to collect critical population census
data from partners and stakeholders engaged in the Vaccination Implementation
Committee (External) and various Advisory Committees (External).
B. Estimates of Critical Populations and Critical Infrastructure Workforce

The IDOH COVID-19 Vaccine Allocation Committee prioritized the healthcare workforce and
those people who are at greater risk of morbidity and mortality for Phase 1 of COVID-19
vaccine distribution. Therefore, the Data Gathering Work Group focused on those
populations.
Estimates of the identified critical populations and critical infrastructure workforce are
based on accurate information from population representative organizations, industry
leaders, and public open-source data. IDOH will also leverage the federal HHS data
management system, Tiberius. These accurate estimates are leveraged to minimize
potential waste of vaccine, constituent products, and ancillary supplies. Critical populations,
data sources, and population estimates are shown below.
Critical Population Data Source Population Estimates

Critical Infrastructure Workforce
Healthcare Personnel PLA, Bowen Center 292,838 (licensed + trainees)
94,595 (RN, MD/DO, NP, PA,
Vaccinators PLA, Bowen Center
pharm, EMS)
21,099 (pharm + pharm
Pharmacy Staff PLA, Bowen Center
techs)
Quarterly Census of Employment 14,579 (IU Health estimate)
Ancillary Staff and Wages

School Nurses IDOH 1,200 (estimate)
Indiana DHS, Professional
EMS Personnel Firefighters Union, Volunteer 47,314 (EMS + fire)
Firefighters Association
Other Essential Workers (CISA)
23,556 (telecom, internet
publishing, broadcasting,
Communications OES, QCEW, SOC
print publishing. Motion
picture)
32,042 (chemical
Chemical OES, QCEW, SOC
manufacturing)
Critical Manufacturing OES, QCEW, SOC 534,258 (all)
Commercial Facilities OES, QCEW, SOC 139,426 (construction)
Dams OES, QCEW, SOC 6,057 (water workforce)
Defense Industrial OES, QCEW, SOC 11,651 (national security)
Base
Emergency Services OES, QCEW, SOC 49,072 (EMS + Fire + Police)
Energy OES, QCEW, SOC 5,527 (oil + gas)
Financial OES, QCEW, SOC 99,112 (finance + insurance)
128,492 (includes all public
Government Facilities OES, QCEW, SOC
admin)
161, 995 (agriculture,
forestry, fishing, hunting +
Food & Agriculture OES, QCEW, SOC
food/beverage
manufacturing)
Nuclear Reactors,
OES, QCEW, SOC 10,201 (waste management)
Materials, & Waste
4,790 (internet providers,
Information
OES, QCEW, SOC web search portals, data
Technology
processing servers)
3,430 (waste and
Water OES, QCEW, SOC wastewater treatment
plant)
Transportation 158,775 (air, rail, water, truck,
OES, QCEW, SOC
Systems support)
Healthcare & Public 446,097 (healthcare and
OES, QCEW, SOC
Health social services)
People at Increased Risk for Severe COVID-19 Illness
LTCF Residents Probari, IDOH, FSSA 34,386
People with underlying IHIE 1,814,769
medical conditions
People 65 years of age Census 1,085,743
and older
People at Increased Risk of Acquiring or Transmitting COVID-19
People from racial and
Census 1,511,980
ethnic minority groups
People from tribal Pending data from Michigan
Indian Health Service
communities (will allot 10% to our

population here per CDC
recommendation)
People who are
incarcerated/detained Indiana Criminal Justice Institute 42,786
in correctional facilities
Indiana Housing and Community
People experiencing
Development Authority, Indiana
homelessness/living in 5,471
Coalition for Homelessness
shelters
Intervention and Prevention
People attending
CHE 321,517
colleges/universities
People who work in Indiana Education Employment
258,309
educational settings Relations Board
Indiana Coalition Against
Domestic Violence, FSSA Division
People living and of Mental Health and Addiction,
working in other Indiana Affiliation of Recovery 5,822
congregate settings Residences, Indiana Division of
Disability and Rehabilitative
Services
People with limited access to routine vaccination services
People living in rural
Indiana Rural Health Association 1,466,328
communities
People with disabilities ARC of Indiana 899,701
People who are under-
CDC SVI 596,543
or uninsured
C. Prioritization of Critical Populations
1. Phase 1: Reinforce and Support Healthcare Infrastructure and Protect the Vulnerable
This group includes all paid and unpaid persons serving in healthcare settings who have
the potential for direct or indirect exposure to patients or infectious materials and
individuals who are at particular risk of mortality and morbidity associated with COVID-
19 disease.
Group 1-A: All paid and unpaid healthcare personnel with the potential for direct or
indirect exposure to patients or infectious materials. Healthcare settings include, but are
not limited to: hospitals, long-term care facilitates such as assisted living or skilled
nursing facilities, outpatient facilities, home health care settings, pharmacies, dialysis
centers, emergency medical services, frontline public health interventions, and COVID-
19 diagnostic and immunization teams. This group includes all persons meeting the
definition without regard to job title. See Attachment A: PHASE 1: INDIANA HEALTHCARE
PERSONNEL for a detailed breakdown of county/profession estimates.
This population includes, but is not limited to:
Licensed and non-licensed healthcare workers:

• Nurses, physicians, RT, PT/OT, speech therapists, pharmacy, imaging, laboratory,
social services, case management, non-traditional providers (doulas, midwives),
chaplain services, dental providers, emergency medical services
• EVS, dietary, maintenance, security, other patient facing ancillary staff
Group 1-B: Protect the vulnerable. Includes individuals who are at particular risk of
mortality and morbidity associated with COVID-19 disease based on the latest,
evidence-based criteria. This includes people 65 years and older, people with co-
morbid conditions that place them at higher risk for morbidity or mortality from COVID-
19 (see below), and residents of long-term care facilities. As more information becomes
known regarding the disease and its response to vaccination, some of these individuals
may not be appropriate for vaccination because it is anticipated they will have
inadequate immune response to the vaccination and/or they are at increased risk of
complication secondary to the vaccination itself.
CDC List of Increased Risk Medical Conditions:

• Cancer • Obesity
• Chronic kidney disease • Serious heart conditions
• COPD • Sickle cell disease
• Immunocompromised state • Type 2 diabetes
from solid organ transplant
CDC List of Likely to Increase Risk Medical Conditions:

• Asthma (moderate-to-severe) immune weakening
• Cerebrovascular disease medications.
• Cystic fibrosis • Neurologic conditions, such as
• Hypertension dementia
• Immunocompromised state • Liver disease
from blood or bone marrow • Pregnancy
transplant, immune • Pulmonary fibrosis
deficiencies, HIV, use of • Smoking
corticosteroids, or use of other • Thalassemia
• Type 1 diabetes mellitus
Furthermore, some groups may be excluded because of the parameters for both
emergency use authorization (EUA) and their exclusion from clinical trials, and therefore
use has not been approved for them. Public health officials in consultation with COVID-
19 clinical and scientific experts should arrive at the final list of eligible inclusion criteria.
Prioritizing those who are most vulnerable promotes utility and stewardship, and it is a
critical tool for serving the goals of equity and fairness, particularly as existing data
continue to show a disproportionate burden of the pandemic on some populations.

The CDC Social Vulnerability Index will be reviewed during the allocation process and
applied if there is a limited vaccine during this phase. A document that identifies the SVI
and estimated counts for comorbid conditions per county will assist in targeted
allocation, distribution, and communication during this phase. Counties with higher SVIs
may receive an increased allocation per population.
See Attachment B: INDIANA SOCIAL VULNERABILITY INDEX for a detailed social

vulnerability index and comorbid conditions for each county.
2. Phase 2: Mitigate Spread

Those at elevated risk of transmission of the disease because of working or living
circumstances:
• Persons living or working in prisons, jails, detention centers, and similar facilities
• Persons living or working in group homes or shelters, including but not limited to
homeless shelters, domestic violence shelters, or group homes for persons with
physical or mental disabilities or in recovery
• Individuals whose in-person work is essential, required, and places them in
settings where social distancing is not possible and transmission risk is high:
• Fire and Police • Public health
• Food service • Manufacturing/
• Retail construction (indoors)
• Public transportation • School teachers
• Utilities • Warehouse
3. Phase 3: General Public Vaccination
D. Sub-Prioritization of Critical Populations

In the scenario that Indiana does not receive sufficient vaccine to vaccinate all included in
the initial populations of focus, Indiana has identified the following subset groups (Phase 1-A
and 1-B). These two phases will determine who will receive the first available doses of
COVID-19 vaccine. Additionally, this is a general framework and guidance. Hospitals, care
delivery sites, and jurisdictions have autonomy to implement these guidelines in the way
that make the most sense to their specific populations and community. If the state vaccine
allocation is limited so that there is insufficient supply to vaccinate healthcare personnel
who are willing to receive the vaccine in phase 1a, additional parameters could be applied.
This includes but is not limited to allocating the vaccine to healthcare personnel at higher
risk to exposure to the vaccine or higher risk of morbidity or mortality.
The process for determining subsets of critical populations for vaccination is based on the
classification of risk (low to very high based on position within an organization) for exposure
to SARS-CoV-2. The U.S. Department of Labor’s Occupational Safety and Health
Administration (OSHA) identifies and classifies risk of worker exposure to SARS-CoV-2.
Below are examples of occupational risk classification. Additional information can be found
here https://www.osha.gov/SLTC/covid-19/hazardrecognition.html

Occupational SARS-CoV-2 Hazard Recognition Categorization
Lower Exposure Risk (Caution)

Jobs that do not require contact with people
known to be, or suspected of being, infected
with SARS-CoV-2. Workers in this category
have minimal occupational contact with the
public and other coworkers. Examples
include:
• Remote workers (i.e., those working from

home during the pandemic).
• Office workers who do not have frequent Figure 3: Occupational hazard
close contact with coworkers, customers, or the recognition categories
public.
• Manufacturing and industrial facility workers who do not have frequent close contact
with coworkers, customers, or the public.
• Healthcare workers providing only telemedicine services.
• Long-distance truck drivers.
Medium Exposure Risk

Jobs that require frequent/close contact with people who may be infected, but who are not
known to have or suspected of having COVID-19. Workers in this category include:
• Those who may have frequent contact with travelers who return from international
locations with widespread COVID-19 transmission.
• Those who may have contact with the general public (e.g., in schools, high population
density work environments, and some high-volume retail settings).
High Exposure Risk

Jobs with a high potential for exposure to known or suspected sources of SARS-CoV-2.
Workers in this category include:
• Healthcare delivery and support staff (hospital staff who must enter patients’ rooms)
exposed to known or suspected COVID-19 patients.
• Medical transport workers (ambulance vehicle operators) moving known or suspected
COVID-19 patients in enclosed vehicles.
• Mortuary workers involved in preparing bodies for burial or cremation of people known
to have, or suspected of having, COVID-19 at the time of death.
Very High Exposure Risk

Jobs with a very high potential for exposure to known or suspected sources of SARS-CoV-2
during specific medical, postmortem, or laboratory procedures. Workers in this category
include:

• Healthcare workers (e.g., doctors, nurses, dentists, paramedics, emergency medical
technicians) performing aerosol-generating procedures (e.g., intubation, cough induction
procedures, bronchoscopies, some dental procedures and exams, or invasive specimen
collection) on known or suspected COVID-19 patients.
• Healthcare or laboratory personnel collecting or handling specimens from known or
suspected COVID-19 patients (e.g., manipulating cultures from known or suspected
COVID-19 patients).
• Morgue workers performing autopsies, which generally involve aerosol-generating
procedures, on the bodies of people who are known to have, or are suspected of having,
COVID-19 at the time of their death.
E. Triggers to Move Between Phases

In the case there is limited uptake of the vaccine, IDOH is prepared expand within a phase or
to other phases as needed. This may occur at the state or local level as determined by the
feasibility of redistribution. The success is predicated on the willingness of local
communities to do work in advance: communicate their plan, identify individuals from each
phase that will receive the vaccine so that communities and organizations are ready when
the vaccine is released. Potential triggers that have been discussed to broaden the
allocated group include:
1. Identifying what percent of a target population being vaccinated would indicate

saturation of that target group,
2. Prioritizing efficiency and minimizing waste (stewardship) by expanding in situations

where the vaccine administration is limited by expiration times.
3. Utilizing a system of preregistration to identify that the targeted group has received the
vaccine and then opening up the vaccine to further groups or subsets.
4. Pivot to new group based on safety/efficacy data on particular groups as information

becomes available.
F. Describing, Locating, and Communicating with Critical Populations

To improve vaccination among critical population groups, Indiana must ensure these groups
have access to vaccination services. To inform COVID-19 vaccination outreach efforts,
Indiana has created a visual map of these populations, including places of employment for
the critical infrastructure workforce category, to assist in COVID-19 vaccination clinic
planning, especially for satellite, temporary or off-site clinics. Indiana is also utilizing the
HHS data management and mapping tool, Tiberius, to estimate populations and to map
providers and populations.
The next step is developing and sending key messages regarding vaccination logistics for
these critical populations and critical infrastructure groups. This outreach will include both
promotional and educational information so the critical populations know where they can
get vaccinated and why they should get vaccinated.

IDOH is establishing points of contact (POCs) for each organization, employer, or community
(as appropriate) within the critical population groups. Additionally, critical populations
identified in Phase 1A have completed a REDCap survey to ensure readiness of vaccine
allocation. Partnerships with trusted community organizations can facilitate early agreement
on communication channels and methods for rapidly disseminating information and
ultimately ensuring these groups have access to vaccination. These organizations include
the faith-based, community regional health workers and healthcare clinics and coalitions,
racial and ethnic organizations, and others across the state as informed by the data and
map. Many of these groups and partner organizations are outlined in Section 2G of this plan.

V. COVID-19 PROVIDER RECRUITMENT AND ENROLLMENT
An adequate network of trained, technically competent COVID-19 vaccination providers in
accessible settings is critical to Indiana’s COVID-19 vaccination program success. For this
reason, the IDOH is conducting provider recruitment and enrollment in advance of COVID-19
vaccine availability. Early planning efforts are focused on engaging those vaccination providers
and services that can rapidly vaccinate initial populations of focus (see Section 4: Critical
Populations) as soon as a COVID-19 vaccine is available (Phase 1). Subsequent planning
includes recruiting and enrolling providers to vaccinate additional critical populations and
eventually the general population when sufficient vaccine supply is available (Phases 2 and 3).
A. Provider Enrollment Efforts

The IDOH has developed a web-based COVID-19 Provider Enrollment form capturing all
information defined in the “CDC COVID-19 Vaccination Program Provider Agreement” form.
This web-based system will be used to enroll Indiana providers. Figures 3 and Figure 4
depict screenshots of the IDOH COVID-19 Vaccine Provider Enrollment Portal.
• The web-based app will allow for providers to submit, retrieve, and download their
submitted information in PDF format.
• The application will have fields that will collect info from providers pertinent to various
phases of vaccine availability to patients
• The application will verify provider license numbers with the Indiana Professional
Licensing Agency (PLA) database and will allow only valid and active licensed providers
to be entered.
The IDOH will work with professional organizations such as the Indiana Hospital Association
and the Indiana Pharmacy Alliance to recruit members of their organizations as vaccination
partners. Many of these healthcare providers are already enrolled in either the Indiana
Immunization Information System or the Indiana Vaccines for Children (VFC) Program.
The information collected within the provider enrollment portal is electronically transferred
to the IDOH Children and Hoosier Immunization Registry Program (CHIRP), Indiana’s
immunization information system (IIS) vaccine registry

Figure 4: Section A (Provider Requirements and Legal Agreement) of IDOH COVID-19 Vaccine
Provider Enrollment Portal.
Figure 5: Section B (Provider Profile Information) of IDOH COVID-19 Vaccine Provider Enrollment
Portal.
B. Provider Administration
The IDOH has identified healthcare providers working in a hospital, long term care and/or
pharmacy setting will be the target population for the first available COVID-19 vaccines
doses. This population has been identified based on the guidance from the Centers for
Disease Control and Prevention (CDC) and the Vaccine Allocation Plan Development
Advisory Group hosted by the IDOH Chief Medical Officer.

The providers identified for Phase 1A will be vaccinated using a hub and spoke model.
Vaccine will be sent to large hospitals in central locations and identified populations will be
invited to receive vaccinations at that location (open POD model, when appropriate).
Individuals who received the vaccine as part of Phase 1A will return to the same location at
the appropriate time interval to receive a second dose. An appointment for the second
dose will be made prior to the healthcare professional leaving the site after receiving the
first dose. Since this is a small segment of the population, individual return appointments
will be easily managed. Texts and a reminder postcard will both be utilized as a method to
recall individuals for their second dose for optimal protection.
C. Provider Enrollment Data

COVID-19 provider enrollment data will be captured and stored in a relational database
(Oracle). This will allow the IIS team to easily query the data (using SQL), transform it into
CSV file format and report it electronically to CDC. The IIS Manager will be responsible for
submitting the COVID-19 Vaccination Provider Agreement data to CDC twice a week:
Monday and Thursday by 9:00 p.m. EST via the IZDL Partner Portal. The IIS Manager will run
all necessary checks and audits to ensure that the data is complete and accurate before
submitting to CDC.
D. Provider Credentialing
The COVID-19 Provider Enrollment web app will verify provider license numbers with the
IPLA database and will allow only valid and active licensed providers to be entered. The
provider enrollment app intuitively informs the user if the license number is found inactive
or does not exist in the database. The application also allows for bulk upload of provider info
via Excel file to reduce the burden of data entry. The bulk upload process will verify and
automatically add all providers with active license numbers. Those that could not be
matched or inactive are indicated so they can be corrected.
E. Provider Training
Training of COVID-19 vaccination providers is vital to ensure the success of Indiana’s COVID-
19 vaccine implementation. Indiana will utilize CDC-branded educational resources in
addition to newly developed and pre-existing IDOH materials. These educational training
materials will complement each other. IDOH specific materials will focus on IDOH specific
processes, such as CHIRP reporting. Training completion is tracked within the CHIRP training
module. CDC will provide provider training for federal entities and commercial partners
receiving direct vaccine allocations from CDC.
Indiana will use the CHIRP learning management system, INvest. INvest is a centralized
training resource already developed for enrolled VFC providers that the IDOH utilize to train
enrolled COVID-19 providers. This will include slightly modified training videos and tutorials
on how to use the Vaccine Order Management System (VOMS) within CHIRP for ordering,
receiving, inventory management in addition to vaccine storage and handling modules,
vaccine administration, vaccine wastage and temperature excursions. The IDOH also

intends to develop modules for ACIP recommendations, Vaccine Adverse Event Reporting
System (VAERS), EUA fact sheets for providers and vaccine recipients, and Vaccine
Information Statements (VIS). The system will also allow for a standardized training message
and a tracking system for all enrolled COVID-19 providers.
The following learning objectives will be address in the training module:

• ACIP COVID-19 vaccine recommendations, when available
• COVID-19 vaccine ordering and receiving
• COVID-19 vaccine storage and handling (including transport requirements)
• Vaccine administration, such as reconstitution, use of adjuvants, appropriate needle size,
anatomic sites for vaccine administration, avoiding shoulder injury with vaccine
administration
• Documenting and reporting vaccine administration via Indiana’s IIS or other external
system
• Managing vaccine inventory, including accessing and managing product expiration
dates
• Reporting vaccine inventory
• Managing storage temperature
• Documenting and reporting vaccine wastage/spoilage
• Reporting moderate and severe adverse events as well as vaccine administration errors
to VAERS
• Providing EUA fact sheets or VISs to vaccine recipients
• Submitting facility information for COVID-19 vaccination clinics to CDC’s VaccineFinder
(particularly for pharmacies or other high-volume vaccination providers/settings)
F. Redistribution Approval
The IDOH will utilize the CDC’s COVID-19 Vaccine Redistribution Agreement form for
approval of redistribution by vaccine providers. The IDOH will develop an electronic,
automated portal application for this form, similar to the COVID-19 provider enrollment
form. Not all providers will qualify and receive this form.
In instances where approval is justified, vaccination provider organizations/facilities, third-

party vendors, and other vaccination providers will be allowed to redistribute vaccine.
Approval is coordinated by IDOH’s immunization program and cold-chain procedures are
validated in accordance with the manufacturer's instructions and CDC’s guidance on
COVID-19 vaccine storage and handling.
G. Equitable Vaccine Access

The IDOH Chief Medical Officer chairs a Vaccine Allocation Plan Development Advisory
Group to determine the need by phases in each county of the state. This data will be used
to ensure an equitable distribution by phase across the state based on the percentage of
healthcare workers in each county.

The IDOH is using Tiberius as a visualization tool for allocations, data monitoring and
transparency. Indiana has registered individuals from the IDOH Immunizations Division,
Emergency Preparedness Division, and the Office of Data & Analytics to ensure bench
strength for this resource. Daily dashboards will be generated to illustrate vaccine
administration, vaccine availability and utilization.
Indiana has a robust pool of vaccinators including primary care physicians, pharmacists, and
local health departments. Currently, 743 providers are enrolled in the Indiana Vaccines for
Children (VFC) Program who are actively vaccinating and recording vaccination
administration data in CHIRP. There are 1,923 other facilities that are administering vaccine in
the State of Indiana and have established a bi-directional interface with CHIRP. With this
coverage, the IDOH is confident in its
ability to offer vaccine to vulnerable
populations no matter where they
reside. Figure 6 provides a visual
representation of all vaccine
provider locations in 2019. This
includes private providers, local
health, pharmacies, and
healthcare/hospital locations.
Pharmacies are also great vaccinator

in Indiana. In 2019, 5,336,699
vaccines were administered to
Hoosiers in the pharmacy setting,
illustrating the importance of
including pharmacies in our plan for
reaching vulnerable populations.
Recent data from Walgreens states
that 90% of Hoosiers live within 10
miles of a Walgreens store. The
IDOH has had extensive
conversations with Walgreens,
Walmart, Meijer, and Kroger about Figure 6: 2019 Vaccine Provider Map
their role in delivering COVID-19
vaccinations. The IDOH is also
working with small independent
pharmacies in rural areas to ensure Figure 6: 2019 Vaccine Provider Location Map
additional vaccination touchpoints.
The IDOH will work with providers who have a history of vaccinating a large percentage of
vulnerable populations to ensure that these providers to continue to provide services and
build upon existing relationships. Data can be extrapolated from CHIRP on individuals who
have been vaccinated over the age of 60 or at a specific provider type. This data will be

used for education on the COVID-19 vaccination efforts and outreach for enrollment in the
COVID-19 vaccination effort.
H. Pharmacy Enrollment
The IDOH is working with the Indiana Pharmacists Association (IPA) to engage independent
pharmacists across the state. IPA membership includes both national and regional
pharmacy chains, hospital-based pharmacists, as well as smaller independent pharmacists.
An IPA representative serves on the Vaccine Allocation Advisory Group and the External
COVID-19 Vaccine Implementation Committee. The IPA has also connected the IDOH
Immunization Division Director to Indiana’s Community Pharmacy Enhanced Network, which
represents 23 independent pharmacies, to understand reporting challenges and barriers.

VI. COVID-19 VACCINE ADMINISTRATION CAPACITY
A. Administration Capacity
“Vaccine administration capacity” is defined as the maximum achievable vaccination
throughput regardless of public demand for vaccination. Public health programs should
understand their jurisdiction’s overall potential COVID-19 vaccine administration capacity
using a variety of COVID-19 vaccination provider types and settings. The sections below
describe how vaccine administration capacity has and will be determine in relation to the
three phases of vaccine distribution.
1. Phase 1A
Information from hospitals, healthcare systems, and long-term care (LTC) facilities that is
expected to be used to determine vaccine administration capacity for Phase 1 will be
obtained through the use of the Data Advisory Group and Vaccine Allocation Plan
Development Advisory Group. For the Phase 1: healthcare personnel group, a REDCap
survey was completed to determine several metrics, including:
• Paid and unpaid staff totals

• Ability to be a COVID-19 vaccine distribution center (internal and external HCP)
• Ability to distribute 1000 vaccine doses over 10 days
• Vaccine cold storage availability
• General concerns or issues
The responses aided in completing the required Ultra-Cold Distribution Template (See
Attachment C). These partnerships allow for the continual gathering of accurate and
current data on capacity for vaccine administration within the state of Indiana.
As IDOH continues to engage with the Data Advisory Group and Vaccine Allocation Plan
Development Advisory Group, information on vaccine administration will continue to
evolve and be added to IDOH plans to determine capacity for all hospitals statewide as
well as determine their throughput rates, provider participation rates, and cold storage
options..
2. Phase 1B
Information from local health departments (LHDs) to be used for Phase 2 and beyond
has been obtained through a REDCap survey sent out to all LHDs. This information is
used to determine feasible LHD vaccine administration capacity.
LHD Vaccine Administration Capacity Information

Average throughput per day per POD (8 Hour Shift) 1,581
Percentage of LHDs with Refrigerated Cold Storage 85%
Percentage of LHDs with Frozen (-20) Cold Chain Storage 61%

Data from this survey will also be used in Phase 3 as vaccine availability and
administration capacity increase.
3. Phase 2
Following the move into Phase 2, the IDOH will take a more direct role in vaccine
administration through the use of strike teams and mobile units. These resources will
allow IDOH to provide vaccines directly to the community, focusing specifically on
populations with critical needs that have been identified in the LHD survey described
above. IDOH will work with LHDs to determine places where ability to distribute vaccine
would have the greatest impact and plan accordingly.
Strike Teams
The IDOH will utilize strike teams in the same manner that strike teams were utilized
during COVID-19 sample collection and testing: teams will go to specific identified
areas, either focusing on critical population groups or areas with abnormally high
numbers of cases. These strike teams focused on long term care facilities during
testing operations and will likely do the same during vaccine operations.
Mobile Units
The IDOH is obtaining ten mobile vans with cold storage to use for testing operations
and vaccine distribution and administration. One mobile unit, consisting of two 4-
person teams, will be based in each of the state’s ten preparedness districts and will
be deployed to areas with a demonstrated need of support. It is expected that these
mobile units will have the same throughput capacity as a static testing site
(approximately 80 – 100 tested or vaccinated per day).
4. Provider Recruitment Plans

Provider recruitment plans will be dictated by the phase of vaccine administration the
state of Indiana is currently experiencing. IDOH will utilize the HHS data management
and mapping tool, Tiberius, to visualize areas of low provider engagement. IDOH will
ensure equitable access to all Hoosiers within the state by providing targeted provider
outreach in these areas.

VII. COVID-19 VACCINE ALLOCATION, ORDERING, DISTRIBUTION, AND
INVENTORY MANAGEMENT
A. Allocation
The federal government will determine the
amount of COVID-19 vaccine designated for
each jurisdiction. The IDOH Immunization
Division is responsible for managing and
approving orders from enrolled providers
based on the vaccine allotment from the
federal government. The amount of vaccine
allotted will change over time. Multiple
factors influence allotments, such as critical
population estimates, production and
availability, and overall population within
Indiana.
Allotments of doses to vaccination providers

within Indiana will be based on the following
criteria: Figure 7: COVID-19 Vaccine
distribution flowchart.
• ACIP recommendations (when available)
• Estimated number of doses allocated to Indiana and timing of availability
• Populations served by vaccination providers and geographic location to ensure
equitable distribution throughout Indiana
• Vaccination provider site vaccine storage and handling capacity
• Minimizing the potential wastage of vaccine, constituent products, and ancillary supplies
Indiana will develop the allocation methods for critical populations in the early distribution
of vaccines and in limited supply scenarios. This will be a combination of methods using
Tiberius and then utilizing CHIRP and the pre-booking module for each enrolled COVID-19
provider. This will be a percentage-based process that will allow for the IDOH to base the
total number of doses allocated from the CDC, accounting for the second dose, and
determining the total number of doses of the critical population reported by the provider.
Once the total number of doses allocated is determined, the percentage can be entered
into the pre-booking module. The system will automatically determine the number of doses
per provider for the ordering cycle. For example, if 100,000 doses are allocated to Indiana in
the first order cycle, the IDOH will use a percentage process to send an equitable number
of doses to all Phase 1A providers based on the reported critical population totals reported.
For phase 1A, the percentage of healthcare workers per county has been calculated as a
proportion to the state’s total healthcare worker population. If Indiana’s initial allocation is
insufficient to vaccinate the entire healthcare workforce, allocations will be developed
based on the facility’s ability to vaccinate and county proportion of healthcare workers.

Figure 8 represents the percentage of healthcare personnel who live in each county. Initial
allocations for Phase 1A will utilize the percentages below to ensure equitable statewide
allocation (example: if IDOH is allocated 100,000 doses initially, they will be allocated
statewide based on the percentages displayed). See Attachment A: PHASE 1: INDIANA
HEALTHCARE PERSONNEL for a detailed breakdown of county/profession estimates.
Figure 8: Healthcare Personnel Percentage County Map
Figure 8: Healthcare Personnel Percentage by County Map

B. Ordering
Registered COVID-19 vaccination providers enrolled in CHIRP will order COVID-19 vaccine
through CHIRP. IDOH will utilize existing procedures routinely used for ordering publicly
funded vaccines. This involves uploading orders received in CHIRP into CDC’s VTrckS.
Indiana will initially complete the vaccine pre-booking module process for the early vaccine
orders; once vaccines are more readily available, providers will be able to place orders for
COVID-19 vaccines directly in CHIRP’s Vaccine Order Management System (VOMS). Once
vaccine orders have been reviewed and approved in VOMS, orders will be flagged to be
uploaded to VTrckS. This process involves uploading three separate files in the CDC’s EXiS
system: Provider Order Master, Provider Order Inventory, and Provider Order Orders.
Figure 9: Screenshot of file upload of CHIRP ordering information into VTrckS.
All files are uploaded in a .csv format, and each contain specific information that is used to
establish the new order requirements in VTrckS and must be uploaded in this order. If there
are any errors in any line item of the upload process, the .csv file must be corrected before
it will be accepted. All funding information must also meet the necessary funds codes and
allocation limits set by the CDC. Any order that does not meet the allocation limits will be
rejected and remain unapproved until allocation limits are reached.
CDC will provide the IDOH with regular updates on the available vaccine supply and
vaccine product-specific allocations. During Phase 1, when supply is limited to critical
populations, the IDOH will approve orders based on the likely populations served by the
vaccination provider, the provider’s capacity to store and handle the COVID-19 vaccine
products, and existing inventory. The minimum order size and increment for centrally
distributed vaccines may be 100-1000 doses per order, dependent on updated CDC
guidance. Early in the response during Phase 1, some ultra-cold vaccine (if authorized for
use or approved) may be shipped directly from the manufacturer in large quantities.
Ancillary supplies will be packaged in kits and will be automatically ordered in amounts to
match vaccine orders in VTrckS. Each kit will contain supplies to administer 100 doses of
vaccine, including:
• Needles, 105 per kit (various sizes for the population served by the order vaccination
provider)
• Syringes, 105 per kit
• Alcohol prep pads, 210 per kit
• Surgical masks (4) and face shields (2) for vaccinators, per kit
• COVID-19 vaccination record cards for vaccine recipients, 100 per kit

For COVID-19 vaccines that require reconstitution with diluent or mixing with adjuvant at the
point of administration, mixing kits with syringes, needles, and other needed supplies will be
included. Ancillary supply kits will not include sharps containers, gloves, and bandages.
Additional personal protective equipment (PPE) may be needed depending on vaccination
provider site needs.
The IDOH has existing contracts for distribution assistance. Long-standing relationships with
other state agencies are also in place to expedite services for transportation and storage of
supplies and goods. These same strategies will be utilized for vaccine supplies as needed.
Facilities ordering outside of Indiana’s allocation (i.e., commercial and federal entities with
federal MOUs in place) will order directly from CDC, and CDC will be responsible for
approval of those orders.
C. Distribution
Figure 10: Overview of distribution and administration of COVID-19 vaccine from federal level to
end-user providers.
The federal government will procure and distribute COVID-19 vaccines and ancillary
supplies at no cost to enrolled COVID-19 vaccination providers. CDC will use its centralized
distribution contract to fulfill orders for most vaccine products and associated ancillary
supplies. Some vaccine products, such as those with ultra-cold temperature requirements,
will be shipped directly from the manufacturer to the vaccination provider site.
Indiana will ensure accurate and complete shipping information (e.g., shipment address,
provider contact information, shipping hours) is available in VTrckS for all vaccine shipments
to enrolled vaccination providers. The IDOH sent a survey to determine accurate POD

addresses for all LHDs within Indiana. In addition, the survey also identified populations with
critical needs within the populations each LHD serves.
The CDC’s central vaccine distributor, McKesson, has indicated some holiday “blackout”
days. During these identified blackout days, vaccine will not be shipped from the distributor.
The finalized blackout schedule is not available but will have fewer blackout periods
compared to routine VFC vaccine holiday blackout shipments.
COVID-19 vaccine (and diluent or adjuvant, if required) will be shipped to vaccination

provider sites enrolled by the IDOH Immunization Division within 48 hours of order approval.
Because of cold chain requirements, ancillary supply kits (and diluent, if applicable) will ship
separately from vaccine but should arrive before or on the same day as vaccine.
The federally contracted vaccine distributor uses validated shipping procedures to maintain
COVID-19 vaccine cold chain and minimize the likelihood of vaccine loss or damage during
shipment. Once a vaccine product has been shipped to a COVID-19 vaccination provider
site, the federal government will neither redistribute the product nor take financial
responsibility for its redistribution.
Whenever possible, vaccine should be shipped to the location where it will be administered
to minimize potential breaks in the cold chain. However, there may be circumstances where
COVID-19 vaccine needs to be redistributed beyond the identified primary CDC ship-to sites
(i.e., for orders smaller than the minimum order size or for large organizations whose vaccine
is shipped to a central depot and requires redistribution to additional clinic locations). In
these instances, vaccination provider organizations/facilities, third-party vendors, and other
vaccination providers may be allowed, if approved by the IDOH Immunization Division, to
redistribute COVID-19 vaccine if validated cold-chain procedures are in place in accordance
with the manufacturer's instructions and CDC’s guidance on COVID-19 vaccine storage and
handling. These entities must complete and agree to conditions in the CDC COVID-19
Vaccine Redistribution Agreement for the sending facility/organization and have a fully
completed CDC COVID-19 Vaccination Provider Profile provider enrollment portal entry for
each receiving location. The IDOH will be extremely judicious in allowing redistribution and
limit any redistribution to refrigerated vaccines only. Redistribution of other vaccine
temperatures is subject to change and guidance from CDC and manufactures.
IDOH may allow local transport of vaccines, when approved by IDOH, from one location to
another if adherence to cold chain and tracking requirements are maintained. IDOH has
surveyed local health departments (LHDs) to determine the ability of LHDs to support local
healthcare providers and entities. Redistribution beyond the initial designated primary CDC
ship-to location, must be conducted with the use of vaccine-specific refrigerators and/or
qualified containers and pack-outs. IDOH has engaged a dry ice vendor within Indiana to
provide statewide services, if needed.

D. Shipment Modalities
The U.S. Department of Defense (DOD) will assist with the distribution and administration of
the vaccine. While the U.S. Department of Health and Human Services (HHS) will remain the
lead agency for the federal COVID-19 response, the Defense Logistics Agency (DLA) will
provide contract, logistics, and administrative support to the distribution process.
1. Direct Shipment to Healthcare Providers and Pharmacies

The IDOH, in coordination with LHDs, will recruit vaccine providers and sites to be
COVID-19 vaccine providers. Providers willing to administer the vaccine enroll with IDOH
and agree to the requirements for receiving, storing, administering, and tracking vaccine
administration. Enrolled providers will place orders for the vaccine with the IDOH
Immunization Division.
The CDC provides each state a daily allocation of vaccine based on population, and the
state will prioritize and fill orders by the state immunization program against the
allotment. Orders are then sent to the CDC, and vaccines will be shipped directly to the
provider through a centralized vaccine distributor. For some critical workforce groups,
the state will coordinate separate vaccine clinics with employers, for example, hospitals
or health systems to vaccinate their own workforce.
2. Direct Shipment to Local Health Department for Distribution

The IDOH will allocate a portion of COVID-19 vaccines to LHDs for administration and
outreach within their communities.
3. Direct Shipment to IDOH for Local Distribution

The IDOH will administer some of the vaccine through state-run vaccination sites. To
support these operations, some vaccine allocations will be directly shipped to the IDOH
warehouse. The IDOH warehouse has the capability of distributing vaccine and ancillary
supplies to LHDs, healthcare providers, and IDOH-operated mobile units.
Figure 11: Graphic of vaccine allocation, ordering, and distribution process.

E. Inventory Management
COVID-19 vaccination providers will be required to report inventory of COVID-19 vaccines.
Indiana has a process in CHIRP for ensuring that vaccine inventory is submitted prior to
placing a vaccine order. The IDOH currently requires that providers submit their vaccine
inventory within 14 days of submitting a vaccine order, preferably the same day the order is
being placed. This process, vaccine reconciliation, allows the provider to document if any
doses were wasted or re-distributed (transferred) during the time period since the last
vaccine order was placed. This information will be essential in maintaining accountability of
all COVID-19 doses through the ordering and vaccination process.
It is anticipated that the COVID-19 vaccine will initially be authorized under an FDA EUA.
Vaccines authorized under an EUA will contain slight variation from approved FDA products,
including:
• Expiration Date: The vaccine vials and cartons will not contain a printed expiration date.
Expiration dates may be updated based on vaccine stability studies occurring
simultaneously with COVID-19 vaccine distribution and administration. Current expiration
dates by vaccine lots for all authorized COVID-19 vaccines will be posted on the HHS
website (weblink pending), accessible to all COVID-19 vaccination providers. To ensure
that information systems continue to work as expected, CDC has worked with FDA and
the manufacturers to include a two-dimensional (2D) barcode on the vaccine vial (if
possible) and carton (required) labels that includes a National Drug Code (NDC), lot
number, and a placeholder expiration date of 12/31/9999 to be read by a scanner. The
placeholder 12/31/9999 expiration date is not visible on the vaccine packaging nor
found anywhere else; it is only to facilitate information system compatibility. CDC is
developing “beyond use date” (BUD) tracker labels to assist clinicians with tracking
expiration dates at the point of vaccine administration. The label templates will be
available on the CDC website.
• Manufactured Date: A manufactured date will be on the packaging and should not be
used as the expiration date when documenting vaccine administration. This date is
provided to help with managing stock rotations; however, expiration dates should also
be considered (see above) as using manufactured date alone could have some
limitations.
• 2D Barcode: The 2D barcode available on the vaccine carton (also on the vials for some
vaccines) will include NDC, lot number, and a placeholder expiration date of
12/31/9999.
• QR Code: Each vaccine manufacturer will include a Quick Response (QR) code on the
vaccine carton for accessing FDA-authorized, vaccine product-specific EUA fact sheets
for COVID-19 vaccination providers and COVID-19 vaccine recipients.

A list of authorized COVID-19 vaccine products with corresponding EUA fact sheets for
healthcare providers and vaccine recipients, and up-to-date information by vaccine lot will
be available on the CDC and HHS websites for public access.
F. COVID-19 Vaccine Recovery

COVID-19 vaccine products are temperature-sensitive and must be stored and handled
correctly to ensure efficacy and maximize shelf life. Proper storage and handling practices
are critical to minimize vaccine loss and limit risk of administering COVID-19 vaccine with
reduced effectiveness. Indiana will work with staff at each COVID-19 vaccination provider
site to ensure appropriate vaccine storage and handling procedures are established and
followed.
It is expected that cold chain storage and handling requirements for COVID-19 vaccine
products will vary in temperature from refrigerated (2°C to 8°C) to frozen (-15 to -25°C) to
ultra-cold (-60°C to -80°C in the freezer or within the dry ice shipping container in which
product was received). Ongoing stability testing may impact these requirements. For a
reliable cold chain, three elements must be in place:
• Well-trained staff
• Reliable storage and temperature monitoring equipment
• Accurate vaccine inventory management
The cold chain begins at the COVID-19 vaccine manufacturing plant, includes delivery to
and storage at the COVID-19 vaccination provider site, and ends with administration of
COVID-19 vaccine. The IDOH and vaccination providers are responsible for maintaining
vaccine quality from the time a shipment arrives at a vaccination provider site until the dose
is administered. To minimize opportunities for breaks in the cold chain, most COVID-19
vaccine will be delivered from CDC’s centralized distributor directly to the location where
the vaccine will be stored and administered, although some vaccine may be delivered to
secondary depots for redistribution. Certain COVID-19 vaccine products, such as those with
ultra-cold temperature requirements, will be shipped directly from the manufacturer to the
vaccination provider site
The IDOH will have mechanisms in place to provide pro-active support for vaccine recovery
and will continually monitor vaccine usage, to determine if state-level intervention is
required. The IDOH is prepared to help support dry ice replenishment through a state-
contracted vendor when local resources are exhausted. Any unused products nearing
expected usage deadlines will be evaluated for redistribution to other locations. The IDOH
will utilized the redistribution strategy outlined above in the distribution section.
G. Satellite, Temporary, and Off-Site Clinic Storage and Handling

Satellite, temporary, or off-site clinics in collaboration with community or mobile vaccinators
will assist in providing equitable access for COVID-19 vaccination. However, these situations
require additional oversight and enhanced storage and handling practices, including:

• The quantity of COVID-19 vaccine transported to a satellite, temporary, or off-site
COVID-19 vaccination clinic should be based on the anticipated number of COVID-19
vaccine recipients and the ability of the vaccination provider to store, handle, and
transport the vaccine appropriately. This is essential to minimizing the potential for
vaccine wastage and spoilage.
• COVID-19 vaccines may be transported—not shipped—to a satellite, temporary, or off-

site COVID-19 vaccination clinic setting using vaccine transportation procedures outlined
in CDC’s Vaccine Storage and Handling Toolkit. The procedures will include transporting
vaccines to and from the provider site at appropriate temperatures, using appropriate
equipment, as well as monitoring and documenting temperatures.
• Upon arrival at the COVID-19 vaccination clinic site, vaccines must be stored correctly to
maintain appropriate temperature throughout the clinic day.
• Temperature data must be reviewed and documented according to guidance in the

CDC’s Vaccine Storage and Handling Toolkit.
• At the end of the clinic day, temperature data must be assessed prior to returning
vaccine to fixed storage units to prevent administration of vaccines that may have been
compromised.
• As with all vaccines, if COVID-19 vaccines are exposed to temperature fluctuations at

any time, the temperature excursion should be documented and reported according to
the IDOH Immunization program procedures for temperature reporting through CHIRP.
The vaccines that were exposed to out-of-range temperatures must be labeled “do not
use” and stored at the required temperature until further information.
H. Local Dispensing
Two models will be utilized to distribute the vaccine – push and pull. Indiana will use a
variety of methods to dispense vaccines: distribution directly to residents through state-
administered vaccine sites (strike teams or mobile teams) or LHD PODs, local agencies
and/or private sector partners. When selecting a strategy, the IDOH will consider
operational capacity, the amount of vaccine available, available staff, and facility
requirements.
1. Vaccine Providers
LHD PODs
LHDs utilize a pull model to allow the public to retrieve vaccines from PODs (e.g.,
drive-through clinics, clinics established at schools, and other areas). LHDs will utilize
pre-existing POD plans to register, administer, and document the COVID-19 vaccine.
Private Partners and Major Retail Providers

Private health care providers, hospitals, and retail pharmacies enrolled will be able to
administer the COVID-19 vaccine. The vaccine will be direct shipped to their facility

from the federal government’s distributor. These entities will report vaccine
administration to the IDOH.
IDOH Mobile Units

The IDOH COVID-19 mobile testing units will serve as multi-purpose mobile
vaccination clinics. The mobile units will utilize a push model requiring state officials
to push the vaccine out to entities who are responsible for delivering the vaccine to
specific populations. The mobile units will conduct outreach to vulnerable and at-risk
populations across the state. The units are pre-positioned in the ten preparedness
districts and ready to respond to requests from LHDs and other state-directed
initiatives.
Given the disproportionate burden of COVID-19 on communities of color, the elderly,

and individuals in congregate care settings, “push models” into communities that
face barriers to vaccine access will be important to support equitable distribution for
those most at-risk.
2. Vaccine Surge Support

Indiana National Guard (INNG) medics may be available as a surge support option to
provide increased manpower to administer vaccines in Indiana. To utilize INNG medics
for vaccine administration, current certification by the National Registry of EMTs will
need to be elevated, and an exception approved by IDOH leadership and IDHS-EMS in
order to administer vaccine to civilians. INNG general laborers may also be utilized to
provided registration and administrative assistance at dispensing locations. Support from
the INNG can be requested through the State Emergency Operations Center (SEOC) for
State Active Duty (SAD), if approved by IDHS. Indiana EMS and paramedicine providers
can be utilized to provide vaccine administration and support. Coordination with the
IDHS and local EMS providers will be leveraged to provide surge support locally.
State leaders will review state laws and consider the legal implications of utilizing state
emergency laws to expand existing scopes of practices for vaccine administration.
Below are examples of modified scopes utilized during the H1N1 pandemic and the
state adopting each strategy.
Practitioner Modified Scope

• Pharmacists could administer pneumococcal and influenza
vaccinations (including H1N1) to persons 18 and older with a written
protocol and standing order from physician licensed in DC. (DC)
• Pharmacists could have protocol agreements with physicians

Pharmacists
permitting a pharmacist to order and dispense influenza vaccine
without an individual prescription; limit of 10 orders per physician
within the same or adjacent county to physician’s principal place of
business. (GA)

• Pharmacists’ scope of practice modified to allow them to administer
seasonal and H1N1 vaccine to people 9 years or older. (IL)
• Age range of vaccinees expanded by type of vaccine. (IN)
• Specified pharmacists authorized to administer influenza

vaccinations via written protocol rather than individual prescription.
(LA)
• Pharmacists permitted to administer influenza and other vaccines to

persons aged 9 or older with a prescription. (ME)
• Licensed, certified pharmacists authorized to vaccinate adolescents

ages 13 and older. (MD)
• Commissioner of health authorized to permit pharmacists to

administer seasonal and H1N1 vaccine. (MA)
• Commissioner of health authorized to permit pharmacists to

administer vaccinations if a local board of health requests state
assistance to respond to a public health threat. (MN)
• Pharmacists allowed to administer seasonal and H1N1 vaccinations

at points of dispensing (PODs) under limited circumstances. (NY)
• Pharmacists permitted to administer influenza vaccine to persons

over age 7 without a physician-patient relationship. (TX)
• Licensed or certified professionals authorized to administer seasonal

Pharmacy Students and H1N1 vaccine as per state health agency instructions and
completion of a training program. (IL)
• Paramedics authorized to administer vaccines under local optional
scope of practice. (CA)

and H1N1 vaccine as per state health agency instructions and
• Paramedics allowed to administer H1N1 vaccine to public safety and

Paramedics
healthcare personnel as well as the general public. (MD)
• Commissioner of health authorized to permit paramedics to

• Paramedics permitted to administer H1N1 vaccine and H1N1-related

medications under the direction of a physician and after training.
(OH)
• Advanced EMTs allowed to administer seasonal and H1N1
EMT-Advanced
vaccinations at PODs under limited circumstances. (NY)

EMT-Intermediate
• Intermediate EMTs permitted to administer H1N1 vaccine and H1N1-
related medications under the direction of a physician and after
training. (OH)
Cardiac Respiratory • CRTs allowed to administer H1N1 vaccine to public safety and
Therapists (CRTs) healthcare personnel as well as the general public. (MD)
• Health Commissioner authorized to permit EMTs to administer
vaccinations if a local board of health requests state assistance to
respond to a public health threat. (MN)
EMT/EMS (General) • Conditions of EMS vaccination authority clarified: only if there is a

local/state emergency declaration, an emergency mission number
issued, and EMS providers are registered as emergency workers
under state law and acting under the direction of state/local
emergency management or incident commander. (WA)
• Commissioner of health authorized to permit dentists to administer

seasonal and H1N1 vaccine. (MA)
Dentists
• Commissioner of health authorized to permit dentists to administer
vaccinations if a local board of health requests state assistance to
respond to a public health threat. (MN)
• Dentists allowed to administer seasonal and H1N1 vaccinations at

PODs under limited circumstances. (NY)
• Dental hygienists allowed to administer seasonal and H1N1
Dental Hygienists
• Commissioner of health authorized to permit podiatrists to
administer vaccinations if a local board of health requests state
Podiatrists
• Podiatrists allowed to administer seasonal and H1N1 vaccinations at
• Physician assistants allowed to administer seasonal and H1N1
Physician Assistants
• Midwives allowed to administer seasonal and H1N1 vaccinations at
Midwives
Medical Students and H1N1 vaccine as per state health agency instructions and

• Commissioner of health authorized to permit medical students to
• Registered nurses (RN) could have protocol agreements with
physicians permitting a RN to order and dispense influenza vaccine
Registered Nurses without an individual prescription; limit of 10 orders per physician
within the same or adjacent county to physician’s principal place of
business. (GA)
Nursing Students completion of a training program. (IL)
• Commissioner of health authorized to permit nursing students to

• Specialist assistants allowed to administer seasonal and H1N1
vaccinations at points of dispensing (PODs) under limited
circumstances. (NY)
Assistive Personnel
and Specialist • Licensed nurses authorized to delegate technical vaccine
Assistants administration activities (not professional judgment or decision
making) to unlicensed assistive personnel during a defined
immunization event and consistent with agency policy and
procedures. (NC)
• Commissioner of health authorized to permit veterinarians to
Veterinarians administer vaccinations if a local board of health requests state

VIII. COVID-19 VACCINE STORAGE AND HANDLING
COVID-19 vaccine products are temperature-sensitive and must be stored and handled
correctly to ensure efficacy and maximize shelf life. Proper storage and handling practices are
critical to minimize vaccine loss and limit risk of administering COVID-19 vaccine with reduced
effectiveness. Indiana will work with staff at each COVID-19 vaccination provider site to ensure
appropriate vaccine storage and handling procedures are established and followed.
It is expected that cold chain storage and handling requirements for COVID-19 vaccine
products will vary in temperature from refrigerated (2°C to 8°C) to frozen (-15°C to -25°C) to ultra-
cold (-60°C to -80°C in the freezer or within the dry ice shipping container in which product was
received). Ongoing stability testing may impact these requirements.
For a reliable cold chain, three elements must be in place:
• Well-trained staff
• Reliable storage and temperature monitoring equipment
• Accurate vaccine inventory management
The cold chain begins at the COVID-19 vaccine manufacturing plant, includes delivery to and
storage at the COVID-19 vaccination provider site, and ends with administration of COVID-19
vaccine. IDOH and vaccination providers are responsible for maintaining vaccine quality from
the time a shipment arrives at a vaccination provider site until the dose is administered. To
minimize opportunities for breaks in the cold chain, most COVID-19 vaccine will be delivered
from CDC’s centralized distributor directly to the location where the vaccine will be stored and
administered, although some vaccine may be delivered to secondary depots for redistribution.
Certain COVID-19 vaccine products, such as those with ultra-cold temperature requirements,
will be shipped directly from the manufacturer to the vaccination provider site. If redistributing
vaccine, all cold chain requirements must be adhered to and should limit transport of frozen or
ultra-cold vaccine products.
A. Cold Chain Management

Cold chain storage and handling requirements for each COVID-19 vaccine product will vary
from refrigerated (20°C to 80°C) to frozen (-20°C) to ultra-cold (-60°C to -80°C) temperatures,
and ongoing stability testing may impact these requirements.
Some vaccine will require ultra-low cold (ULC) chain. Ultra-low cold chain can go as low as
-80 ˚C. Vacci-coolers, freezers, coolers, and other cold storage solutions will be utilized to
maintain the vaccine designated temperature. Temperatures are tracked on a continual
basis and are reported and stored in CHIRP.
The IDOH has a network of 750 healthcare providers with the capacity to store and transport
publicly funded vaccine. Each of the 750 healthcare providers enrolled in the program have
stand-alone vaccine storage equipment with continuous temperature monitoring
equipment.

Once vaccine has been ordered and received, strict storage and handling guidelines must
be followed. Vaccines are temperature-sensitive and must be stored and handled correctly
to ensure efficiently and maximize shelf-life.
B. Temperature Monitoring
Indiana will be working on determining the best method for continuous monitoring of all
COVID-19 vaccines, including ultra-cold vaccines. The IDOH currently use data loggers for
all vaccine temperature monitoring in all permanent storage units and all vaccine transport
units and will require that all providers utilize continuous monitoring systems and will
provide these, as needed.
CHIRP has the capability to allow providers to enter their daily temperatures (min/max). The
system also has the ability for providers to upload their daily temperature log in a specified
format. IDOH vaccine ordering management staff can set up alerts when temperature
excursions are recorded within CHIRP. Figure 11 depicts the temperature recording feature
within CHIRP.
Figure 12: temperature monitoring interface in CHIRP.
C. Strategy to Engage Dry Ice Vendor

The (IDOH will follow the Indiana Department of Administration (IDOA) Delegation of
Purchasing Authority Program (DPAP) guidelines for procurement of goods and services.
No less than three vendors will be contacted for their services/products. Vendor selection
will be performed as required by the DPAP guidelines, by an authorized purchasing agent,
and approved by IDOA procurement approvers. The method of selection will be by
competitive bid or special procurement by justification of emergency need, reviewed and
approved by the IDOA procurement approvers. Once selected a requisition and purchase
order will be created, approved and dispatched to the vendor. The vendor will be contacted

with delivery locations 24 hours prior to when products are needed and will invoice
accordingly.
D. Redistribution Transportation
The IDOH will leverage existing private and public partners in the transportation of
redistributed COVID-19 vaccine. Existing partners include, the Indiana Department of
Transportation (INDOT) and private logistics company, Langham Logistics. The identified
modalities have the ability to provide temperature-controlled transportation. Transportation
will include transit to LHD-operated clinics, state-operated mobile sites, and other health
care provider locations. Supplies transported include the vaccine and ancillary supplies.
LHDs have been surveyed to determine their ability to support redistribution locally. Finally,
another redistribution option available to the IDOH is its ten mobile response vehicles,
prepositioned in the ten Indiana preparedness districts and available to provide testing,
vaccine, and outbreak response support across the state. Each vehicle is outfitted with cold
storage capabilities. As vaccine is redistributed, the IDOH will leverage the systems
identified in Section IX: Vaccine Administration Documentation and Reporting to track the
movement of the vaccine.

IX. COVID-19 VACCINE ADMINISTRATION DOCUMENTATION AND
REPORTING
A. Collection of COVID-19 Vaccine Doses Adminstered Data
1. CHIRP
Immunization information systems (IISs), also known as vaccine registries, are
confidential, population-based computerized systems for recording information,
including vaccination history and vaccine doses given by participating health care
providers.
Within the state of Indiana, the Children and Hoosier Immunization Registry Program
(CHIRP) is utilized. CHIRP is a secure web-based application administered by the IDOH.
CHIRP is a lifespan registry designed to permanently store a person’s immunization
records in an electronic format. Healthcare providers can use the registry to both review
vaccination records for their patients and to record all newly administered vaccinations.
The State of Indiana mandates the reporting of vaccine administration by certain age
groups and provider types.
Interfaces with electronic health records and data clearinghouses account for 90% of all
data reported to CHIRP. This data is reported using a Health Level Seven (HL7)
message. A HL7 message is an international standard for the transfer of clinical and
administrative data between software applications. Indiana Code requires the
information to be reported within seven days of vaccine administration.
The IDOH is working with a third-party vendor to help providers collect vaccine dose
level info and report to the registry. PrepMod is currently being evaluated as an option.
• Existing IIS providers reporting electronically -- Providers who are currently reporting
to the IIS will continue to report COVID-19 dose-level information as they do other
vaccines. The only change in their workflow is that COVID-19 administered doses will
need to be reported with 24 hours of administration.
• IIS direct data entry -- Providers have the option to directly log into the IIS and record
patient and vaccine info. The IIS has several functions available for providers to
monitor inventory at the dose level by vaccine, lot number, and other parameters as
well as track wastage and returns.
2. PrepMod
The IDOH is currently evaluating a third-party vendor, PrepMod, as an option to help
providers collect and report vaccine info to the IIS. PrepMod is an end‐to‐end system
that manages key aspects of mass vaccination efforts and pandemic responses. It
connects the public, health care providers, government, and businesses for real‐time
recording, reporting, and monitoring of uptake, coverage, and supply inventory. It

features online consent, self‐scheduling of appointments, recording and reporting
encounters, and interfaces with state IISs and other electronic systems.
B. Transition of Data to IZ Gateway

The IDOH has signed a memorandum of understanding (MOU) and data use agreement
(DUA) to connect and shared vaccination data via the Immunization (IZ) Gateway. We are
working with the IIS vendor and American Immunization Registry Association (AIRA) to set
the connections up between the IIS and the IZ Gateway. Once the connections have been
set within the IIS, the system will able to query for a patient with all states connected to the
IZ Gateway to which the IIS has access. The IZ Gateway will automatically report to the IIS
any Indiana patient who got a vaccine dose in any of the states connected to the IZ
Gateway.
C. Provider Reporting Readiness

The IDOH ensures that each COVID-19 vaccination provider is ready and able to report
COVID-19 vaccine administration and inventory information into CHIRP. The reported
information includes the CDC-defined required data elements. Indiana will use the learning
management system within CHIRP, called INvest. INvest is a centralized training resource
already developed for enrolled VFC providers that the IDOH will utilize to train enrolled
COVID-19 providers. This provider training ensures provider reporting readiness. Providers
must ensure that they have trained staff, internet connection, and adequate reporting
equipment to report vaccine administration data elements every 24 hours.
D. Real-Time Reporting
Satellite, temporary and off-site clinics will be able to directly enter data to the IIS via
manual data. CHIRP is a web-based app and is accessible via any internet enabled device.
and has a standalone inter op engine, PHC-Hub, that handles all electronic data reported to
the system. All data that is sent to PHC-Hub is set for immediate deduplication which will
enable ~90% of the data reported to CHIRP to be instantly available to the providers to be
viewed or queried.
E. Provider Accountability
The Vaccine Ordering Module is a part of the IIS which gives IDOH administrative staff full
access to provider inventory. The IIS also has several inbuilt reports that will help staff
monitor inventory, doses administered, and reported to the system (see Figure 10). IIS staff
also have access to the IIS database run ad hoc reports using database queries to monitor
data for completeness, timeliness, and accuracy. Immunization and IIS staff will follow-up
with providers that do not comply with the documentation and reporting requirement to
ensure compliance. Further future order requests from these providers can be denied for
failing to meet with the program requirements. Appropriate disciplinary actions will be
determined on an as needed basis, if on-time reporting issues occur.

Figure 13: Examples of inbuilt reports that assist staff in monitoring inventory and doses
administered and reported within CHIRP.
F. COVID-19 Vaccine Reports

The IDOH will use CHIRP to generate reports on vaccine utilization by provider, county, and
the state on at least a weekly basis. This functionality is existing and will be set up as a
canned report to be automatically generated on a regular interval. This information will be
submitted to the IDOH Office of Data and Analytics for inclusion in dashboards and to
analyze vaccine utilization in areas of the state.
The IDOH has recently registered and been granted access to the HHS application, Tiberius.
and will use Tiberius as an additional tool for assessing vaccine coverage in high risk areas
and targeting areas of low vaccine utilization.
These two data utilities will enable the State of Indiana to track vaccine utilization across the
state and look for pockets of need. If pockets of need are identified, the IDOH will work with
community vaccination partners to increase vaccination efforts in that area. LHD efforts are

being positioned as back-up vaccinators for identified areas of need or as a vaccination
touchpoint for areas of the state that do not have other vaccination resources.
Areas of low vaccination utilization will be provided to the State Health Commissioner on a
weekly basis so that IDOH leadership is aware of the issue and can allocate resources to
address coverage.
The IDOH will also use CHIRP to track the number of individuals who received a first dose of
COVID-19 vaccine and need a second dose. Daily reports will be run to determine
individuals that need a second dose and what presentation was previously received so that
reminder recalls can be generated for series completion. Daily reports will also be
generated on the number of individuals that are fully protected against the virus due to be
fully vaccinated per ACIP recommendations.

X. COVID-19 VACCINATION SECOND-DOSE REMINDERS
A. Notification Timing and Product Type
For most COVID-19 vaccine products, two doses of vaccine, separated by at least 21 days,
will be needed. Because different COVID-19 vaccine products will not be interchangeable, a
vaccine recipient’s second dose must be from the same manufacturer as the first dose.
Second-dose reminders for vaccine recipients will be critical to ensure compliance with
vaccine dosing intervals and achieve optimal vaccine effectiveness. COVID-19 vaccination
providers should make every attempt to schedule a patient’s second-dose appointment
when they get their first dose.
B. Notification Modalities
Redundant methods and systems will be used to remind vaccine recipients about their
need for second doses. Indiana will utilize current practices for patient reminder/recall in
existing healthcare provider organizations and pharmacies, such as through healthcare
electronic health records (EHRs).
1. Vaccination Record Cards (included in ancillary kits)

COVID-19 vaccination record cards will be provided as part of vaccine ancillary kits.
Vaccination providers should be highly encouraged to complete these cards with
accurate vaccine information (i.e., vaccine manufacturer, lot number, date of first dose
administration, and second dose due date), and give them to each patient who receives
vaccine to ensure a basic vaccination record is provided. Vaccination providers should
encourage vaccine recipients to keep the card in case the IIS or other system is not
available when they return for their second dose. The card provides room for a written
reminder for a second-dose appointment. If vaccine recipients have a smartphone, they
may consider documenting their vaccine administration with a photo of their vaccination
record and entering the date the next vaccine dose is due on their electronic calendar.
2. CHIRP Reminder Recall

CHIRP has a reminder recall option with ability to send emails and text messages to
vaccine recipients. This option is only available if the patient information is available and
accurate within the registry.
3. Postcards
The IDOH has budgeted supplemental funding for second dose reminder postcards,
printing, and postage. The postcard information and distribution schedule would be
determined by information collected in CHIRP.
4. Scheduling of Second Dose During First Dose Administration

During Phase 1, providers may choose to pre-schedule a second dose appointment at
the same vaccination site. This option will be utilized in occupational health settings
where site operations and scheduling are more predictable and anticipated. This option
is currently being evaluated for utilization within Phase 2 and Phase 3.

5. Electronic Medical Records (EMR)
Many health systems, provider offices, and pharmacy locations within Indiana have
robust electronic medical records (EMR) systems. Similar to routine vaccination
reminders, providers will utilize EMR notifications to remind patients of a need for a
second dose.

XI. COVID-19 REQUIREMENTS FOR IIS OR OTHER EXTERNAL SYSTEMS
A. High-Volume Data Management and Contingency
The IDOH has developed solutions for documenting vaccine administration in temporary
and high-volume vaccination settings. Planned contingencies for network outages and
other potential access issues are included.
1. In case of providers using the CDC VAMS application to record and track COVID-19
doses, CHIRP will receive these via the IZ Gateway.
2. CHIRP currently has a mass immunization module (MIM) to handle high volume data.
However, the current MIM does not have the ability to collect all the COVID-19 info that
CDC is requiring jurisdictions to collect. Our IIS vendor is working on updates to this MIM
to able to collect more info than what is being collected now with the targeted date for
completion of these updates in the month of December.
3. CHIRP’s interop engine is able to handle rapid onboarding on new interfaces in case this
becomes necessary
4. CHIRP is hosted on the vendor AWS cloud environment providing reliable backup, and
disaster recovery capabilities to handle network outages and access issues
B. Indiana IIS (CHIRP) Data Variables

CHIRP captures the variables below for persons who will receive COVID-19 vaccine.
Currently, CHIRP can receive race and ethnicity info (both manually and electronically), and
the IDOH is working with the IIS vendor to have all other fields added to the IIS database so
these can be recorded if reported:
• Administration location • Recipient address: state

• Administration location: type • Recipient address: street
• Administration address: city • Recipient address: zip code
• Administration address: county • Recipient date of birth
• Administration address: state • Recipient name: first
• Administration address: street • Recipient name: middle
• Administration address: zip code • Recipient name: last
• Administration date • Recipient race
• CVX (product) • Recipient ethnicity
• Dose number • Recipient sex
• IIS recipient ID • Sending organization
• IIS vaccination event ID • Vaccine administering provider
• Lot number: unit of use suffix
• MVX • Vaccination series complete
• Recipient address: county • Vaccine administering site
• Recipient address: city • Vaccine expiration date
• Vaccine route of administration

The IDOH is working with the vendor to add the optional data elements requested by CDC:
• Comorbidity status
• Recipient missed vaccination appointment
• Serology results and vaccine refusal
C. Data Capacity
CHIRP is currently hosted on the vendor AWS cloud environment. Our Service level contract
with our vendor ensures 99.9% system availability through the year.
CHIRP allows for bidirectional data exchange with electronic medical records (EMR)
systems. Providers can submit demographic and vaccine related info to the IIS and query
demographic, vaccine and forecast info from the IIS. Below is a summary of IDOH’s current
bidirectional interfaces numbers as of date.
Total of all Facilities Bidirectional, Active, Testing, to Test 2715

Total Facilities Live in Production 2330
Total Facilities Currently Testing 336
Total Facilities Pending to Test 49
The IIS vendor releases monthly patch updates that includes bug fixes, new features and
enhancements related to the interop system. We plan to update the system with these
latest releases within 2-3 weeks of the release.
D. IIS Enrollment and Onboarding

The IDOH plans to rapidly enroll and onboard providers to CHIRP. The IDOH will roll out an
online COVID-19 provider enrollment application to electronically collect information and
store in a relational database. The IDOH is currently determining with the IIS vendor if this
information can be directly uploaded to the IIS. In the meantime, the IDOH will hire 1-2 data
entry contract staff to transfer the enrollment info to the IIS. In addition, the IDOH is also in
the process of hiring an onboarding contact staff to help with onboarding providers who will
report data to the IIS electronically.
E. IZ Gateway Connection
The IDOH has executed a memorandum of understand (MOU) and data use agreement
(DUA) to connect and share vaccination data via the IZ Gateway. the IDOH is working with
the IIS vendor and AIRA to set the connections up with the IZ Gateway.
F. Data Use Agreements

The IDOH has established DUAs with the Association of Public Health Laboratories (APHA)
to participate in the IZ Gateway. A DUA has been established with CDC for national
coverage analysis. Finally, an MOU has been executed to share data with other jurisdictions
via the IZ Gateway share component.

G. Contingency Planning
CHIRP is a web-based software system, so internet connectivity is required. The IDOH
currently does not have a solution for offline use. Providers will need manually record
details on paper and have it entered the system once they have internet connectivity. The
IIS is hosted on the AWS cloud environment. IDOH’s service level contract with the vendor
ensures 99.9% system availability through the year.
H. Data Quality
The IDOH is working on the following measures to ensure data completeness, accuracy,
timeliness, and consistency. These include:
• Working with the IIS vendor to ensure infrastructure is in place to handle additional load
on the system
• Working with the IIS vendor to ensure existing modules are updated and new modules
are in place to collect relevant information
• Ensuring reporting modules are in place to check for data completeness, accuracy and
timeliness
• Hiring a Business Analyst contractor to help with onboarding of providers to report to the
IIS electronically and help with ongoing quality assurance activities with respect to data
completeness, accuracy and timeliness
• Ensuring the IIS team has access to the IIS database to run scheduled and ad hoc
queries
• Adding additional staff members to help with onboarding and monitoring ongoing data
reporting from providers

XII. COVID-19 VACCINATION PROGRAM COMMUNICATION
Starting before COVID-19 vaccines are available, clear, effective communication will be
essential to implementing a successful COVID-19 vaccination program. Building vaccine
confidence broadly and among groups anticipated to receive early vaccination, as well as
dispelling vaccine misinformation, are critical to ensure vaccine uptake.
A. COVID-19 Communication Objectives

• Ensure public confidence in the approval or authorization process, safety, and efficacy
of COVID-19 vaccines.
• Help the public to understand key differences in FDA EUA and FDA approval (i.e.,
licensure).
• Engage in dialogue with internal and external partners to understand their key
considerations and needs related to COVID-19 vaccine program implementation.
• Ensure active, timely, accessible, and effective public health and safety messaging
along with outreach to key state/local partners and the public about COVID-19 vaccines.
• Provide guidance to local health departments, clinicians, and other hosts of COVID-19
vaccination provider locations.
• Track and monitor public receptiveness to COVID-19 vaccination messaging.
B. Key Audiences
A robust and nimble communication plan will be the foundation of successful COVID-19
vaccine allocation and uptake. The focus must be on ensuring consumer trust by providing
information that is timely, accurate and appropriate. Messages will be crafted specifically to
each audience and distributed through the most effective channels to achieve the
maximum response.
Key audiences identified include:

• Critical infrastructure workers COVID-19 or develop serious
• Emergency preparedness districts illness)
and health care coalitions • Healthcare providers and
• Employers and businesses pharmacists
• Federally-Qualified Health Centers • Law enforcement and corrections
(FQHCs) and community clinics • Local health departments
• Faith-based communities • Long-term care facilities
• General public (at-risk groups • Media
those mostly likely to spread
C. Broad Communication Planning Phases

Communication of Indiana’s COVID-19 vaccination plan will be coordinated by the IDOH
Office of Public Affairs (OPA). The OPA team has already begun to inform key stakeholders
of the planning process already under way at the state level. The IDOH has also engaged
partners as plans are developed for both the initial Phase 1-A vaccination distribution and
mass vaccination clinics.

OPA is also working with agency leadership and the Vaccination Allocation Advisory
Committee as each phase of the vaccine implementation plan is defined and establishing a
communication plan that corresponds to the overarching operationalization of the
vaccination program.
• Phase 1: Potentially Limited COVID-19 Vaccine Doses Available

o Healthcare workers, EMS, long-term care staff and residents, local health
departments, emergency preparedness districts and healthcare coalitions
• Phase 2: Large Number of Doses Available; Supply Likely to Meet Demand
o Corrections, other critical infrastructure workers, other congregate settings
• Phase 3: Likely Sufficient Supply
o General public with focus on developing strategies to ensure equitable access to
COVID-19 vaccination services
The IDOH established a communication

plan to guide the communication process
throughout the vaccine program operation,
with timelines and tracking mechanisms to
ensure that communications are timely
and proactive as much as possible, yet
flexible to adjust to program changes,
including supply and other available
information.
D. Communication Activties
OPA reviews research and monitors social
media awareness regarding the public’s
perception of the COVID-19 vaccine. This
information will help guide messaging to
ensure that communication addresses the
barriers that most influence vaccine
uptake.
Initial areas of focus:
• About half of U.S. adults (51%) say they

would definitely or probably get a vaccine Figure 14: Pew Research Center survey
to prevent COVID-19 if it were available results on COVID-19 vaccine interest.
today.
• Individual barriers to vaccine acceptance, such as fear of side effects, low perception
of the efficacy, negative past experiences with vaccination services, lack of
knowledge, are discussed as well as the broader sociocultural context.
• African American adults are much less likely to say they would get a vaccine than other
Americans.

• Concerns about side effects and uncertainty around the effectiveness of a vaccine are
widely cited as reasons by those who would not get a COVID-19 vaccine if one were
available today.
• Fewer adults cite not thinking they need the vaccine (31%) or the vaccine’s cost (13%)
as a major reason they would not likely get vaccinated.
Other sources for communication guidance include:

• https://www.astho.org/Programs/Immunization/Communicating-Effectively-About-
Vaccines--New-Communication-Resources-for-Health-Officials/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5137540/
• https://pubmed.ncbi.nlm.nih.gov/28215120/
• https://www.who.int/vaccine_safety/initiative/communication/en/
• https://www.cdc.gov/flu/pdf/partners/nivdp-webinar-communicating-with-
patients.pdf
• https://jamanetwork.com/journals/jamapediatrics/fullarticle/2647983
OPA has also planned the following initiatives:

• Prepare SmartSheet with vaccination distribution phase, communication medium,
responsible party, distribution method and deadline with flexibility to adjust to fluid
situations that will track and coordinate messaging efforts.
• Work in tandem with state’s vaccination work group that focuses on communications in
an advisory capacity to ensure throughout the rollout that the IDOH is addressing any
gaps in reaching those audiences that may require additional or focused outreach.
• Coordinate with the IDOH Immunization Division and Office of Technology and
Compliance to send reminder/recall messages for appropriate second dose and
location, along with scheduling system through external vendor that also provides
registration services.
• Establish dedicated vaccine webpage within the IDOH website that has more detailed
information and possible links to registration maximizing existing audience of more than
187,000 subscribers already receiving web updates.
• Participate in vaccine planning with IDOH Vaccine Working group as plans are created
to ensure advance communication is accurate and consistent based on available
information. Verify that outreach is made with intent and efficiency.
• Ensure that communication meets accessibility guidelines and other requirements for
those with disabilities as well as language requirements.
• Host focus groups throughout the state to identify barriers to vaccine uptake and inform
communications strategy.

• Track and provide education about vaccine safety and efficacy to create materials to
address vaccination barriers.
• Communicate updates to the media through weekly press briefings and as needed
based on the information available.
• Provide support for local health departments, including a toolkit to help promote local
vaccination clinics and regular updates through weekly webcasts.
• Use existing listservs and the Indiana Health Alert Network to provide messaging
directly to healthcare providers to share with patients.
• Create media campaign aimed at increasing uptake of COVID-19 and influenza

vaccinations.
E. Messaging Considerations
All communication will be presented clearly and crafted with the specific audience in mind.
This will include consultation with the IDOH Office of Minority Health and translations as
needed. Placement of the messages will also incorporate a variety of delivery methods.
Key content to be covered in communication efforts:

• Vaccine is available • Addressing psychological barriers
• Cost • The why: for family, for community
• Information on safety/efficacy • What happens after vaccination
All communications will pass the accessibility checker to ensure they can be available to
those with disabilities. The IDOH will also utilize in-house translation services, as well as help
from partners to provide translations in Spanish, Chinese, Creole and Burmese to further
address any communication barriers to ensure access and understanding of COVID-19
vaccination.
Messaging will need to be layered, starting with simple messaging about vaccine
availability and effectiveness and addressing any psychological barriers to vaccine uptake.
Other messaging will be more detailed, such as what is available on the website where the
public can find more detailed information.
Targeted outreach to rural areas and other specific communities, such as Amish or
Potowatomi Indian populations, will also be necessary to provide direct outreach to those
who may not have access to information or fewer healthcare resources in less populated
areas of the state.
Messaging will begin with outreach to the Phase 1A key audiences, including healthcare
providers and associations and the local health departments so they can begin
preparations.

The IDOH has also convened an Equitable Distribution and Communication Advisory Group
to help review the state’s messaging strategy. This group includes a cross-section of
professionals in the healthcare, as well as various communities throughout the state.
The advisory group’s role is to:

• Identify critical populations to receive vaccine and identify approximate estimate of
these populations.
• Identify subsets of populations based on vaccine availability.
• Advise lead Vaccine Allocation Committee to ensure vaccine is distributed equitably
based on supply.
• Review communications plan for roll out of vaccine.
Key components of vaccine communication:

• Ensure it is culturally and generationally sensitive
• Create messaging that is simple and straightforward
• Be transparent
• Distribute in multiple languages and formats
• Partner with other trusted entities to educate critical populations
F. Communication Channels
Traditional media channels:
• Press releases to print, radio and television
• Advertising campaign promoting influenza and COVID-19 vaccine
Digital Media:
• Indiana’s COVID-19 website (187,000 subscribers)
o Add page with vaccination information and helpful links.
o Map of vaccination sites
• Weekly social media messaging to promote press releases, web updates, and other
important education:
o Facebook
o Twitter
o Instagram
• Social media advertising campaign promoting influenza and COVID-19 vaccine
Print resources:
• Multilingual infographics on vaccine education
• Toolkit for LHDs to promote vaccination clinics
Webinars/webcasts:
• Weekly LHD webcasts, with recordings available and presentation with any links sent
immediately following
• Biweekly webcasts for healthcare providers within the state

• Begin regular WebEx meetings with epidemiology field staff to provide vaccine
updates and information that they can share in the field
G. Partners and Trusted Sources

OPA will work in coordination with the following state agencies and organizations to identify,
develop and distribute communication throughout the vaccination implementation:
• Equitable Distribution and • Indiana Department of Health

Communication Advisory Group Divisions
o Refugee Health Program o Rural Health Division
o Office of Minority Health o Emergency Preparedness
o Immunization Division o Long-term Care
• Healthcare Associations:
o Indiana State Medical o Long-term care associations
Association o Indiana Community Health
o Indiana Hospital Association Workers Association
o Pharmacists Association o Rural Health Care Association
o Indiana Immunization Coalition
• Indiana Agencies
o Family and Social Services o Indiana Housing & Community
Administration Development Authority
o Indiana Department of o Indiana Department of
Insurance Corrections
o Indiana Department of o Indiana Professional Licensing
Education Agency
• Indiana Sheriff’s Association • AARP
• Indiana media organizations • American Red Cross
• Indiana Chamber of Commerce • Minority health organizations
• Central Indiana Council on Aging
o Indiana Minority Health o Indiana Native American Indian
Coalition, Inc. Affairs Commission
o Indiana Commission on o Refugee Health Center
Hispanic and Latino Affairs o Rebecca and Vic Stolzfus
(Amish community)
H. Crisis and Risk Communication

In a health emergency, people make decisions differently. They tend to simplify the issues
to for easier understanding with so much new and changing information. They also cling to
current beliefs as a way to provide stability during a difficult period. People may refer to
what they have seen or have previously experienced, which means that first messages
carry more weight. Our driving principles are to be first, be right and be credible while
adhering to the values, goals and initiatives of the IDOH.

In this public health crisis, it is essential that we initially communicate:
• Simply • Repeatedly
• Timely • Credibly
• Accurately • Consistently
We can build trust and credibility by expressing:
• Empathy and caring • Honesty and openness

• Competence and expertise • Commitment and dedication
The goal of our messaging is to acknowledge uncertainty and fears and to reassure as
appropriate with facts and information from credible sources. The IDOH also wants to give
people action items to help reduce their anxiety about the vaccine, which will include
resources for detailed and consistent talking points and resources to find additional
information. The IDOH will be knowledgeable and transparent to build trust and credibility in
all fact sheets, media releases, social media posts and other communication resources with
the public and various stakeholders through the appropriate channels.

XIII. REGULATORY CONSIDERATIONS FOR COVID-19 VACCINATIONS
A. Emergency Use Authorization Fact Sheets
The EUA authority allows the FDA to authorize either (a) the use of an unapproved medical
product (e.g., drug, vaccine, or diagnostic device) or (b) the unapproved use of an approved
medical product during an emergency based on certain criteria. The EUA will outline how
the COVID-19 vaccine should be used and any conditions that must be met to use the
vaccine. FDA will coordinate with CDC to confirm these “conditions of authorization.”
Vaccine conditions of authorization are expected to include distribution requirements,
reporting requirements, and safety and monitoring requirements. The EUA will be
authorized for a specific time period to meet response needs (i.e., for the duration of the
COVID-19 pandemic).
Product-specific EUA fact sheets for COVID-19 vaccination providers will be made available
that will include information on the specific vaccine product and instructions for its use. An
EUA fact sheet for vaccine recipients will also be developed, and both will be made
available on the FDA website and through the CDC website. Indiana will ensure providers
know where to find both the provider and recipient fact sheets, have read and understand
them, and are clear on the requirement to provide the recipient fact sheet to each
client/patient prior to administering vaccine.
Indiana will use INvest, the learning management system within CHIRP. INvest is a
centralized training resource already developed for enrolled VFC providers that the IDOH
will utilize to train enrolled COVID-19 providers. The IDOH will develop training modules for
EUA fact sheets for providers and vaccine recipients, and Vaccine Information Statements
(VIS). The system will instruct enrolled COVID-19 providers to provide EUA fact sheets or
VIS, as applicable, to each vaccine recipient prior to vaccine administration. It will also allow
for a standardized training message and a tracking system for all enrolled COVID-19
providers.

XIV. COVID-19 VACCINE SAFETY MONITORING
An “adverse event following immunization” is a health problem or negative condition that
happens after vaccination (i.e., a temporally associated event). It might be truly caused by the
vaccine or it might be purely coincidental and not related to vaccination. CDC continuously
monitors the safety of vaccines given to children and adults in the United States. VAERS, co-
administered by CDC and FDA, is the national frontline monitoring system for vaccine safety.
A. Vaccine Adverse Event Reporting System

Healthcare providers should report clinically important adverse events following COVID-19
vaccination to VAERS. VAERS is a national early warning system to detect possible safety
problems with vaccines. Anyone—a doctor, nurse, pharmacist, or any member of the
general public—can submit a report to VAERS. VAERS is not designed to detect whether a
vaccine caused an adverse event, but it can identify “signals” that might indicate possible
safety problems requiring additional investigation. The main goals of VAERS are to:
• Detect new, unusual, or rare adverse events that happen after vaccination
• Monitor for increases in known side effects
• Identify potential patient risk factors for particular types of health problems related to
vaccines
• Assess the safety of newly licensed vaccines
• Detect unexpected or unusual patterns in adverse event reports
Per the CDC COVID-19 Vaccination Program Provider Agreement, COVID-19 vaccination
providers are required to report adverse events following COVID-19 vaccination and should
report clinically important adverse events even if they are not sure if the vaccination caused
the event. Vaccine manufacturers are required to report to VAERS all adverse events that
come to their attention. VAERS data-sharing agreements with Department of Defense and
IHS healthcare facilities are being coordinated through the federal government. Indiana will
ensure that enrolled COVID-19 vaccination providers understand the procedures for
reporting adverse events to VAERS. This information will be included in INvest. More
information on submitting a VAERS report electronically can be found at
https://vaers.hhs.gov/reportevent.html.
B. Vaccine Safety Datalink

The Vaccine Safety Datalink (VSD) is a collaboration between CDC’s Immunization Safety
Office and nine healthcare organizations. This active surveillance system monitors
electronic health data on vaccination and medical illnesses diagnosed in various healthcare
settings and conducts vaccine safety studies based on questions or concerns raised from
medical literature and VAERS reports.
C. Clinical Immunization Safety Assessment Project

CDC’s Clinical Immunization Safety Assessment Project is a national network of vaccine
safety experts from CDC’s Immunization Safety Office and seven medical research centers.
This project conducts clinical research and assesses complex adverse events following

vaccination. Healthcare providers can request a consultation for a complex vaccine safety
issue with an individual patient at CISAeval@cdc.gov

XV. COVID-19 VACCINATION PROGRAM MONITORING
Continuous monitoring for situational awareness throughout the COVID-19 vaccination program
is crucial for a successful outcome. Prior to receiving COVID-19 vaccine, Indiana has established
procedures for monitoring various critical program planning and implementation elements,
including performance targets, resources, staffing, and activities.
A. COVID-19 Vaccination Program Monitoring

Vaccine Ordering and Distribution – Reports can be pulled from both VOMS and VTrckS to
track the number of doses that have been ordered and shipped to COVID-19 providers by
PIN # on a daily, weekly and monthly basis to monitor progress on number of doses
shipped versus number of doses administered. This will allow the program to determine if
the IDOH is meeting the needs in each county or part of the state based on the critical
population designated by each provider in each phase.
B. Resource Monitoring
1. Budget and Finance

The IDOH is tracking the budget based on standard accounting principles set forth in the
Accounting and Financial Reporting Regulation Manual by the State Board of Accounts
in PeopleSoft Financial Systems (PeopleSoft). A reconciliation of the funding is done
monthly based on queries pulled from PeopleSoft.
2. Staffing
Having enough adequately trained staff with current situational awareness is key to
successful program implementation. Specialized expertise is required, and it is important
to have backups in each specialty area to guard against interruption of activities
because of illness or other personal situations. For example, if staff are supporting
temporary or off-site COVID-19 vaccination clinics, the hours are likely to be long and
physically taxing. Managers and supervisors need to regularly check in with and support
assigned staff’s wellness and overall resilience to perform the assigned tasks.
3. Supplies
Important activities during the COVID-19 vaccination program might be halted if certain
supplies are depleted without replenishment. Indiana will utilize existing inventory
management processes monitoring for various program components (e.g.,
temporary/off-site clinics, vaccination provider enrollment and training, vaccine
management). Regular monitoring of such records will foster early prompts to order and
replenish supplies and ensure availability as needed. The IDOH will utilizing PPE burn
rates from testing operations and other response activities and extrapolate this burn rate
to vaccine activities. Procedures are in place for ordering and procuring additional
supplies through existing vendors with IDOH.

C. Communication Monitoring
The IDOH has created a SmartSheet to track all communication related to the COVID-19
vaccine program. The tracking sheet is shared and used within OPA, listing each
communication piece, status, distribution method, responsible party, description, deadline,
status notes and translation to ensure that each communication document is well organized
and targeted to the intended audience. The sheet also tracks the approval process,
recipients and completion date to ensure follow through and efficiency. This tool has been
used as our tracking method throughout the response with favorable results.
The IDOH will monitor vaccine uptake and monitor social media to gauge the effectiveness
of the messaging. We will also receive reports on reach for social media posts, media
campaign and any press release and other information Based on that information, we will
adjust the focus of the communication plan. For example, if we see a lower than expected
uptake of vaccine among the older population, we will target messaging to those older than
65 years through a variety of partners, including long-term care associations, primary care
providers, Facebook and the Central Indiana Council on Aging and our rural health partners.
D. Local Monitoring
The District and Local Readiness section, within the Division of Emergency Preparedness,
supports local public health and healthcare preparedness throughout Indiana. This is
accomplished through Northern, Central, and Southern Regional Managers. Each Regional
Manager oversees the District Public Health Coordinator and District Healthcare Coordinator
for each respective District. This section primarily works with local health departments,
hospitals, healthcare coalitions, and other public health and healthcare partners in each
District. This preparedness work includes all five mission areas of the National Preparedness
Goal: Prevention, Protection, Mitigation, Response, and Recovery. Additionally, the District
and Local Readiness section works closely with several other state agencies, public health
and healthcare associations, and many other organizations that have local roles in public
health and healthcare preparedness.
Throughout the response, monitoring and outreach efforts have occurred with LHDs to
maintain a common operating picture. The following highlight action items either ongoing
or that have occurred previously:
• Ongoing weekly LHD webinars with IDOH Executive Staff and SMEs
o Webinars will continue with a heightened emphasis on vaccine planning
• LHD survey completed to ascertain LHD readiness to distribute vaccine
• LHD COVID-19 Vaccine Planning Template
o Distributed to 94 LHDs on 10/16/2020; Anticipated completion date to return
vaccination plans to IDOH for review is 12/01/2020
o The IDOH will ensure that LHDs have sufficiently prepared for vaccine
distribution through via a 2-stage review process

E. Program Metrics
Leveraging the data from the state’s IIS platform, CHIRP, we will be able to provide a variety
of program metrics in both visual, e.g., interactive dashboards, and tabular formats. Some of
the metrics will include: vaccination provider enrollment, doses distributed, doses
administered, vaccination coverage, along with a variety of population metrics. In addition,
we will map out provider enrollment sites such as pharmacies, hospitals, and LHDs similar
to how we mapped out our testing sites, https://www.coronavirus.in.gov/2524.htm,
throughout the state. These metrics and maps will be presented within the state’s existing
COVID-19 website, https://www.coronavirus.in.gov/ . Lastly, we will monitor the
effectiveness (TBD) of the vaccinations and presenting this on our website.


Indiana COVID-19 Vaccine Plan

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Indiana COVID-19 Vaccine Plan

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COVID-19 VACCINE ALLOCATION PLAN

Indiana Department of Health

Indiana COVID-19 Introduction i Indiana Department

Vaccination Program Implementation Committee: External committee facilitated by the Indiana

Indiana COVID-19 Introduction ii Indiana Department

Phase 2: Guiding objective: Mitigate spread.

Phase 3: Guiding objective: General public vaccination.

Indiana COVID-19 Introduction iii Indiana Department

Indiana COVID-19 Introduction iv Indiana Department

Indiana COVID-19 Introduction v Indiana Department

Indiana COVID-19 Introduction vi Indiana Department

Indiana COVID-19 Introduction vii Indiana Department

A. State Improvement Planning

1. 2009 H1N1 Pandemic

Areas of Improvement Identified:

Indiana COVID-19 1 Indiana Department

2. 2018 Hepatitis A Outbreak

B. Local Improvement Planning

Indiana COVID-19 2 Indiana Department

Indiana COVID-19 3 Indiana Department

Indiana Internal COVID-19 Vaccine Planning Group Representation

Policy (State Health Commissioner, Deputy

C. Vaccination Program Implementation Committee (External)

Indiana has established an external vaccination program implementation committee

Indiana COVID-19 4 Indiana Department

D. Vaccine Advisory Groups (External)

1. Vaccine Allocation Plan Development Advisory Group

Indiana COVID-19 5 Indiana Department

2. Ethical Considerations Advisory Group

3. Vaccine Review Advisory Group

4. Equitable Distribution and Communication Advisory Group

Indiana COVID-19 6 Indiana Department

1. State Emergency Operations Center (SEOC)

Indiana COVID-19 7 Indiana Department

Indiana COVID-19 8 Indiana Department

H. Critical Population Partners

Critical Population Partners

Indiana COVID-19 9 Indiana Department

Indiana COVID-19 10 Indiana Department

Figure 2: COVID-19 vaccination program phases.

Indiana COVID-19 11 Indiana Department

Key characteristics of Phase 1::

B. Phase 2: Large Number of Vaccine Doses Available

Key characteristics of Phase 2:

Indiana COVID-19 12 Indiana Department

C. Phase 3: Sufficient Supply of Vaccine Doses for Entire Population (Surplus of

Key characteristics of Phase 3:

Indiana COVID-19 13 Indiana Department

A. Identifying and Estimating Critical Populations

B. Estimates of Critical Populations and Critical Infrastructure Workforce

Critical Population Data Source Population Estimates

Indiana COVID-19 14 Indiana Department

Indiana COVID-19 15 Indiana Department

C. Prioritization of Critical Populations

This population includes, but is not limited to:

Licensed and non-licensed healthcare workers:

Indiana COVID-19 16 Indiana Department

CDC List of Increased Risk Medical Conditions: