NCIRDwt | 10/18/23

National Center for Immunization and Respiratory Diseases

CDC’s Vaccines for Children Program Addendum:

Special Considerations for COVID-19 Updated 10/18/2023

This addendum to the 2023-2024 VFC Operations Guide 

provides supplemental information and guidance related to 

the addition of COVID-19 vaccine to the VFC formulary.

Inventory

 VFC providers will be allowed a flexible, time-limited 

ramp-up period to meet the private inventory 

requirement for COVID-19 vaccine. During this time 

awardees will not require VFC providers to meet 

the private inventory minimum requirements for 

COVID-19 vaccine if they do not intend to vaccinate 

their private pay patients. VFC providers are required to 

meet the private inventory requirement no later than 

March 31, 2024.

 This includes VFC providers who serve only Medicaideligible patients and no privately insured children; 

they are not required to privately purchase COVID-19 

vaccine.

 If VFC providers utilize this flexibility to not maintain 

private stock during this season, providers should 

share information with their privately insured patients 

about other ways to access COVID-19 vaccine in their 

areas, including through local pharmacies and health 

departments. 

 In locations where providers report that demand 

for COVID-19 vaccine is low, awardees should allow 

providers to order the minimum packaging size of VFC 

COVID-19 vaccines, as feasible.

 In these cases, site visit reviewers may observe that 

COVID-19 inventory is a much lower quantity than 

other ACIP-recommended vaccines. 

 Based on information that CDC has received from all 

three COVID-19 vaccine manufacturers, presentations 

for most of the new fall vaccines will be more typical 

(i.e., unit dose presentations rather than multidose 

vials), which will significantly reduce vaccine minimum 

order quantities.

 At the discretion of the awardee, certain specialty VFC 

providers, temporary/off-site vaccination clinics, and 

pharmacies may offer a limited formulary of vaccines, 

such as COVID-19 and influenza vaccines only.

Borrowing

 For VFC providers who maintain private stock of 

COVID-19 vaccine and vaccinate privately insured 

children, bidirectional borrowing of COVID-19 vaccine 

will be allowed for the 2023-2024 respiratory virus 

season as described below.

 CDC's borrowing guidance does not supersede 

jurisdictional policy related to borrowing. VFC providers 

should refer to awardee or jurisdictional policy to 

determine if borrowing is allowed in their jurisdictional. 

 Borrowing is only applicable if the provider is purchasing 

private stock and is approved only for instances when:

 There is a lack of vaccine stock because of delayed or 

spoiled shipments.

 As part of the initial set up of private purchasing 

contracts and ordering systems, there has been a delay 

for the provider in being able to procure private stock 

of COVID-19 vaccine.

 Vaccine will expire soon and will be lost if not used. 

Provider locations with a small privately insured 

patient population can use this option to administer 

short-dated, privately purchased vaccine to a VFCeligible child and replace it with a longer-dated, VFC 

dose.

 New staff calculated ordering intervals incorrectly, 

leading to a lack of sufficient private or public vaccine 

stock.

Vaccines

for Children

U.S. Department of 

Health and Human Services 

Centers for Disease 

Control and Prevention 
NCIRDwt | 10/18/23

CDC | NCIRD | CDC’s Vaccines for Children Program Addendum: Special Considerations for COVID-19

 Borrowed COVID-19 vaccine must be repaid (dose 

for dose) within one month and administered to the 

appropriate population.

If VFC vaccine is borrowed for a privately insured 

patient and then repaid to VFC inventory, the repaid 

dose must be administered to the appropriate 

category of VFC-eligible child. Note: Given the 

variability of COVID-19 vaccine types per age group, 

the same vaccine type borrowed must be repaid.

Vaccine Borrowing Documentation 

 A Vaccine Borrowing Report must be completed when 

either:

 Privately purchased vaccine is administered to a VFCeligible child, or

 VFC vaccine is administered to a privately insured child.

Awardees may report the information using CDC’s 

Restitution

 Given the uncertainty with COVID-19 vaccine demand 

and potential for packaging size concerns, awardees with 

vaccine restitution policies may not penalize providers 

for COVID-19 vaccine wastage due to expiration.

Site Visits

 Awardees are required to conduct all VFC site visits (i.e., 

compliance, enrollment, and unannounced storage and 

handling) in person unless local conditions indicate 

medium or high COVID-19 hospitalization rates.

 If the provider location is in an area experiencing 

medium or high hospitalization rates, awardees may 

choose to conduct hybrid or virtual site visits. Please 

consult the CDC COVID Data Tracker for hospitalization 

rates in your jurisdiction. Awardees must review this 

tracker prior to scheduling the site visit to determine 

the most appropriate visit method (i.e., in-person, 

hybrid, or virtual), and continue to monitor the 

tracker and adjust the visit method as needed up 

until the date of the visit. Awardees will be required to 

acknowledge medium or high hospitalization rates in 

PEAR before a visit can be started.

 Awardees will be allowed to conduct virtual enrollment 

visits for specialty VFC providers, including drive 

thru clinics and birthing facilities due to their limited 

formulary of VFC vaccines.

 Virtual enrollment site visits must be approved in writing 

(email) by VFC staff. Minimally, awardees must review the 

following at the virtual enrollment visit:

 Provider Agreement

 Provider Profile

 Vaccine Management Plan

 Training documentation (if not done by program)

 Electronic storage and handling documentation

 Pictures of storage units

 Pictures of DDL probe placement

 Certificates of calibration

 Pictures of “Do Not Disconnect” Signage Placement

NOTE: All awardees will be required to resume conducting enrollment visits in-person if CDC 

designates.