The following is an update from Wisconsin Immunization Program.

Vaccine Shipping Delay

The widespread severe weather in many states caused delays in vaccine shipments this week. For example, Wisconsin had a total of nine orders of Moderna vaccine that were delayed this week due to weather.

Due to the continued severe winter weather impacting various parts of the country, we anticipate delays in COVID-19 vaccine shipments and deliveries next week as well. Currently, the Federal Government is prioritizing filling last week’s orders first and expects to clear the Pfizer COVID-19 backlog by close of business on Monday and the Moderna backlog by Tuesday or Wednesday. As such, it is likely that Wisconsin’s vaccinators’ orders will be delivered Wednesday through Friday next week. Please note that the delays have also impacted some deliveries through the Federal Retail Pharmacy Program. If any further scheduling updates are announced, the Wisconsin Department of Health Services (DHS) will notify vaccinators.

Residency Questions

DHS’ agreement with CDC requires us to “distribute or administer vaccine without discriminating on non-public-health grounds within a prioritized group.” DHS has determined that in order to protect the public health of the residents of Wisconsin, vaccine allocated to the State should be administered to those who live, work, or study in the State of Wisconsin. Vaccinators may target their vaccination effort to residents of their particular jurisdiction or constituency, however, may not turn someone away who lives, works, or studies in the State of Wisconsin.

Allocation of First and Second Doses

This is another reminder: At the proper interval, you will receive the same number of second doses to match your first does. Do NOT hold back half of your first dose allocation to complete the series. For example, if you receive 20 doses of Moderna COVID-19 vaccine, administer them to 20 individuals as their first dose. In 4 weeks, you will receive another 20 doses Moderna COVID-19 vaccine for these individuals to complete their series. Due to this automatic allocation of second doses, all vaccinators are expected to provide the second dose to those they have vaccinated. Vaccinators cannot refuse to provide the second dose to prior employees, residents, or participants to which they provided the first dose.

You may give a second dose to individuals who received their first dose elsewhere but were not able to return to that location. These individuals should not be turned away. All efforts to vaccinate them should be made if appropriate vaccine product is available.

The COVID-19 vaccine products are not interchangeable.

Reducing Wasted Vaccines

In keeping with being good stewards of public resources, it is imperative that vaccinators mitigate vaccine wastage to the best of their ability. There are several best practices to do so.

1. Scheduling Practices: Schedule vaccination appointments in accordance with your vaccine inventory and your clinics’ anticipated patient throughput.

2. Estimate your Population Correctly: Accurately estimate how many doses you need. If possible, prior to a vaccination clinic, screen your patients for eligibility and acceptance and plan accordingly for how many doses you will need.

3. Estimate Doses Needed Correctly: If you are consistently drawing up the extra doses out of Moderna vials (e.g., the 11th dose), factor that into your scheduling practices.

4. Only Open Vials as Needed: Make sure you only have one vial open at any given time even if you have multiple vaccinators working concurrently at a clinic.

If after implementing the above steps, vaccinators have extra vials or doses at the end of a vaccination clinic, there are some additional strategies to further reduce vaccine wastage from occurring.

1. Recruit Eligible Individuals: Recruit additional eligible individuals to be vaccinated. Consider outreaching to organizations in your area (e.g., aging and disability resource centers; smaller healthcare agencies) to see if they know of eligible individuals who could come in at the end of the clinic, or the next day.

2. Create a Stand-by List: A list of eligible individuals who could come in sooner than their future scheduled appointment.

3. Unplanned Redistribution: If you are approaching the expiration date (i.e., 120 hours for Pfizer or 30 days for Moderna), you can contact your DHS regional manager (if you have one) or email DHS. DHS can attempt to get those unopened vials to another nearby clinic to use. Do not do this on your own.

4. Last Resort Vaccination: If you identify you have additional doses due to an opened vial at the end of a vaccination clinic day, you are encouraged to use the remaining doses instead of wasting vaccine. DHS strongly encourages all vaccinators to establish protocols to identify individuals who are in the currently eligible group for this extra vaccine before administering vaccine to other individuals who may be readily available but not yet eligible.

In the unfortunate event of vaccine wastage, vaccinators must report it in two ways.

1.Report in WIR: In the event of vaccine wastage, vaccinators must report it in WIR as soon as possible and within 24 hours of identifying the vaccine wastage (see WIR training for detailed instructions). In brief, to report wastage in WIR navigate to your inventory site in WIR. Select the appropriate vaccine/lot with wastage. Update the inventory to reflect the amount of doses wasted and indicate the reason why as, “doses wasted.”

2. Wastage Report (FORM #02768): Use this form to record and report vaccine that is disposed of according to your clinic guidelines for disposal of biologics. You will need to state the number of doses that were wasted and why and email the form to DHSCOVIDVaccinator@wi.gov.

After reporting vaccine wastage, you may be contacted by DHS staff for further details and with technical assistance about how to avoid similar wastage in the future

Updates to Moderna Transport Guidance

On Wednesday, 2/17, Wisconsin DHS sent an email to vaccinators about COVID-19 Vaccine Transport Guidance for Moderna Product to an Off-Site Clinic. Since that time, CDC has provided additional details to their transportation guidance for Moderna COVID-19 vaccine.

Specifically, the Moderna vaccine can be transported more than once. Unpunctured vials can be transported at the frozen temperatures (Between -15°C and-25°C [-13°F and 5°F]) or refrigerated temperatures (2°C and 8°C [36°F and 46°F]). Frozen transport is preferred, if possible.

If the vaccine is being transported at refrigerated temperatures, the total time for transport is 12 hours (cumulative). For example, if the vaccine is transported 1 hour to a clinic and 1 hour back to the primary storage unit, the returned vials have used 2 out of the 12 hour timeframe.  These vials can be transported for 10 more hours.  The beyond-use date labels for this vaccine have been updated to help providers keep track of transport times.  In addition, care should be taken to ensure thawed vaccine does not refreeze.

This information is also included the latest update of the CDC’s Vaccine Storage and Handling Toolkit.

Vaccine Storage and Handling Toolkit | CDC

Moderna COVID-19 Vaccine Information | CDC

Advance Email Notification for COVID-19 Vaccine Shipments from Distributor (McKesson)

Beginning with orders approved on Saturday, February 20, vaccine shipments to providers will be preceded by two emails from McKesson. Both of these emails will be sent from CDCNotifications@mckesson.com and will be sent to the provider (facility) level email address that is transmitted with the order in VTrckS.

1. An order acknowledgment email that is sent once the order has been received into the McKesson system (NEW)

2.  An advance shipment email that is sent once the order has shipped from the McKesson depot and contains the carrier tracking details

If you have questions, please contact McKesson Specialty Customer Care at (833) 343-2703 Monday – Friday, 8 a.m. – 8 p.m. ET  or COVIDVaccineSupport@McKesson.com

Understanding Viral Vector COVID-19 Vaccines

Johnson & Johnson’s COVID-19 vaccine candidate may soon receive emergency use authorization. The Food and Drug Administration (FDA) is reviewing the application and will make recommendations to the Commissioner of Food and Drugs on the authorization of the product after careful review and public deliberation through the Vaccines and Related Biological Products Advisory Committee (VRBPAC). The FDA has scheduled a VRBPAC meeting to discuss this product for February 26, 2021.

Their candidate vaccine is a Viral Vector COVID-19 Vaccine. CDC has released a webpage to help with Understanding Viral Vector COVID-19 Vaccines.

CDC’s Homebound Guidance

Clinical considerations for homebound persons, including information and guidance on management of vaccines and vaccination for persons vaccinated at home or in small group settings (e.g., residential facilities, group homes), is now available on CDC’s website.

Same-Day Transportation to COVID-19 Vaccination Appointments Available for Eligible BadgerCare Plus and Wisconsin Medicaid Members

During the COVID-19 public health emergency, BadgerCare Plus and Wisconsin Medicaid members who are eligible for non-emergency medical transportation (NEMT) services may schedule rides to COVID-19 vaccination appointments with MTM, Inc. (Wisconsin’s NEMT manager) once members have confirmed their appointment. This includes rides scheduled the same day as the appointment.

To schedule a ride, members may call MTM, Inc. at 866-907-1493 (TTY 711). When scheduling their ride, members will be asked to provide their ForwardHealth ID number (from their ForwardHealth ID card) and the address of the vaccination site.

For more information regarding scheduling rides, refer members to the Wisconsin Department of Health Services NEMT website.

Clinical Resources Updates from CDC

Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines | CDC

Management of Anaphylaxis at COVID-19 Vaccination Sites | CDC

Ensuring Access to COVID-19 Vaccine in Long-Term Care Facilities| CDC