COVID-19 Vaccination Program Interim 

Playbook for Jurisdictions Operations 

Annex

Guidance 

Centers for Disease Control and 

Prevention

January 2021

Version 1.0

Considerations for Increasing COVID-19 Vaccination: 

Reaching and Increasing Uptake in Priority Populations 

for Jurisdictions 
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Table of Contents

Introduction .................................................................................................................................................. 2

Purpose of document ............................................................................................................................... 2

Considerations for Transitioning Between Phases....................................................................................... 3

Fully vaccinating populations while expanding access............................................................................. 4

Prioritization and Sub-Prioritization of Populations..................................................................................... 5

Considerations for sub-prioritization of populations in Phase 1b and 1c ................................................ 5

Balancing vaccine supply, access, equity, and demand............................................................................ 6

Planning–Developing Strategies to Reach the Population ........................................................................... 8

Estimate priority population size.............................................................................................................. 8

Map vaccine providers for most equitable access.................................................................................... 8

Promote equitable access to vaccination................................................................................................. 8

Plan communication efforts to support vaccine confidence.................................................................... 8

Building vaccine confidence....................................................................................................................10

Implementing Strategies to Increase Population Access to COVID-19 Vaccine .........................................12

Selecting vaccination provider sites........................................................................................................12

Vaccination provider site considerations and throughput.....................................................................14

Role of public health vs. private partnerships........................................................................................15

Private-Public Partnerships – Pharmacy Programs.....................................................................................17

Federal retail pharmacy partnership strategy for COVID-19 vaccination...............................................17

Vaccine allocation strategy .....................................................................................................................17

Program launch.......................................................................................................................................18

Priority populations ................................................................................................................................18

Coordination of private-public partnership — key actions for pharmacies and public health ..............19

Allocation transfer program....................................................................................................................19

Guidance for developing vaccination plans with pharmacy partners....................................................19

Monitoring and Program Oversight............................................................................................................22

Conclusions.................................................................................................................................................23
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Introduction 

Purpose of document

• To serve as a companion document to the COVID-19 Vaccination Program Interim Playbook for 

Jurisdiction Operations (i.e., “Playbook”)

• To provide new guidance and considerations to jurisdictions regarding when and how to 

transition from vaccinating initial populations of focus to reaching and increasing uptake in 

additional priority populations 

• To provide a framework for balancing equitable access, service delivery, and vaccine demand 

• To provide tools for engaging priority populations and increasing vaccine confidence 

• To provide strategies to leverage private-public partnerships
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Considerations for Transitioning Between Phases

On December 1, 2020, the Advisory Committee on Immunization Practices (ACIP) recommended phased 

allocation of COVID-19 vaccines to specific, priority populations while vaccine supply is limited, with 

expansion of populations recommended for vaccination as COVID-19 vaccine supply allows. ACIP 

recommendations are intended to help guide the most equitable distribution of the first available 

vaccine doses. These recommendations are divided into phases1 to support jurisdiction prioritization 

during varying levels of vaccine supply. 

• Phase 1a includes healthcare personnel and long-term care facility residents. 

• Phase 1b includes persons ≥75 years of age and frontline essential workers (non-healthcare). 

• Phase 1c includes persons 65–74 years of age, persons 16–64 years of age with high-risk medical 

conditions, and other essential workers. 

• Phase 2 includes all other persons aged ≥16 years of age not already recommended for 

vaccination in Phases 1a, 1b, or 1c.

Decisions about when to transition from one phase to the next should include considerations of supply, 

demand, and equitable vaccine distribution and access, as well as local, state, or territorial context and 

epidemiology. Jurisdictions should remain flexible to maximize use of all doses by increasing access to 

vaccination and using the principles of supply-chain management as well as tools to help with planning 

(e.g. microplanning applications like Tiberius (Palantir Technologies Inc., Denver, CO)). It is not necessary 

to vaccinate all people in one phase before initiating the next phase; phases can overlap. If vaccination 

provider sites within a jurisdiction are moving independently through the phases and are more than one 

phase apart (e.g., some sites are ready to move to Phase 1c while others are still in Phase 1a), 

jurisdictions should assess vaccine supply, demand, and equitability of vaccine distribution across the 

entire jurisdiction. This assessment can include examining ways to expand vaccination access, demand, 

and capacity as well as addressing vaccine hesitancy within the jurisdiction; this can result in vaccine 

being redistributed between sites within jurisdictions. 

The following situations offer examples of when transitioning to the next phase and expanding vaccine 

availability to additional populations could be warranted:

• When demand in the current phase appears to have been met (e.g., appointments for 

vaccination are <80% filled for several days in a row)

• When supply of authorized vaccine increases substantially (e.g., more vaccine doses are 

available than are necessary to complete vaccination of persons in the current phase)

• When most persons (e.g., 60%–70%) in the current phase are vaccinated, despite efforts to 

increase both access and demand

1 The phases identified in the Playbook were structured prior to the release of ACIP recommendations and are, 

therefore, slightly different than those recommended by ACIP. The phases in this Annex are in alignment with 

current ACIP recommendations.
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• When vaccine supply within a certain location is in danger of going unused unless vaccination is 

expanded to persons in the next phase

Jurisdictions should closely monitor vaccine uptake to assess vaccination coverage and determine when 

their population is ready to move to the next phase of vaccination. In addition to state-specific websites 

and commonly used web pages, there are several data resources available to assist states:

• CDC COVID Tracker: COVID Tracker is CDC’s externally facing website that presents information 

on different COVID-19 specific data points, including vaccination data. Using COVID Tracker, 

states can actively monitor total vaccine doses distributed and administered within their 

jurisdiction and at the national level, people initiating vaccination (receiving a first dose), as well 

as the vaccine uptake in key populations, including those in the Federal Pharmacy Partnership 

for Long-Term Care Program. Data from COVID Tracker are obtained from the CDC Immunization 

Data Lake (see Playbook, Section 9) and contain all doses administered from each jurisdiction 

(including data from the Vaccine Administration Management System [VAMS], Federal 

Pharmacy Partnership for Long-Term Care Program, and certain federal entities (federal entity 

data reported separately from jurisdictions).

• Tiberius: The Health and Human Services’ (HHS) Tiberius platform (see Playbook, Section 15) is a 

tool featuring allocation, distribution, and administration information for each jurisdiction. 

Tiberius is an internally facing tool that allows jurisdictions to view their specific vaccine 

allocation, distribution, and administration data by various demographic characteristics—in 

many cases, down to the county level. Vaccine administration information in Tiberius is 

populated by data from the CDC Immunization Data Lake. Jurisdictions are encouraged to use 

this in-depth information about vaccine allocation, distribution, and uptake to determine when 

they are ready to transition to the next phase of vaccination and ensure distribution in an 

efficient and equitable manner. 

Fully vaccinating populations while expanding access 

Once COVID-19 vaccination has been expanded to additional phases, jurisdictions should strive to 

improve vaccination coverage by continuing to offer and promote vaccination to all persons in earlier 

phases who have not yet been vaccinated. These persons could have been more hesitant or lacked easy 

access to vaccination. See the “Planning–Developing Strategies to Reach the Population” section below

for strategies to improve access and increase demand. 

More information and other considerations for transitioning between phases can be found here: 

https://www.cdc.gov/vaccines/covid-19/phased-implementation.html. 
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Prioritization and Sub-Prioritization of Populations 

ACIP defines frontline essential workers as the subset of essential workers likely at greatest risk for 

work-related exposure to SARS-CoV-2, the virus that causes COVID-19, because their work-related 

duties must be performed on site and involve being in close contact (within 6 feet for a total of 15 

minutes or more) to the public or coworkers. An interim list of essential worker categories mapped to 

standardized industry codes and titles can be found on CDC’s website. This list is intended to help state, 

local, tribal, and territorial officials and organizations prepare for the allocation of initially limited 

COVID-19 vaccine supply by mapping essential industries to corresponding COVID-19 vaccination phases

and workforce categories, as recommended by ACIP. Additional information on the essential workforce 

can also be found in the Cybersecurity Infrastructure and Security Agency’s (CISA) Guidance on the 

Essential Critical Infrastructure Workforce. Frontline essential workers recommended by ACIP to receive 

vaccination in Phase 1b are firefighters, police officers, corrections officers, food and agricultural 

workers, U.S. Postal Service workers, manufacturing workers, grocery store workers, public transit 

workers/transportation, and those who work in the education sector (teachers and support staff 

members) as well as day care workers. Essential workers recommended by ACIP to receive vaccination 

in Phase 1c including people who work in water and wastewater, food service, housing construction, 

finance, information technology, communications, energy, legal services, media, public safety, and 

public health. 

Considerations for sub-prioritization of populations in Phase 1b and 1c

When vaccine supply is limited, jurisdictions may need to sub-prioritize—or assign a higher priority to—

vaccination of certain groups or persons within a given priority group. As jurisdictions make these 

complicated decisions, it will be important to ensure equitable access to vaccination for persons at 

highest risk of severe disease and those who perform essential services and functions. Sub-prioritization 

among groups of non-healthcare essential workers might differ by jurisdiction and encompass a variety 

of workers that are critical to public health, safety, security, and the economy at jurisdictional and 

national levels.

The following are characteristics or factors that might warrant sub-prioritization within groups of 

frontline or other essential workers:

• Groups of workers that are the most critical to maintaining core societal functions

• Groups of workers with unavoidable higher risks of exposure because of their inability to 

perform work duties remotely and necessity of working without adequate protection while in 

close contact with coworkers or members of the public (e.g., persons in meatpacking plants 

who might be working in close quarters or personal care assistants who are providing care for 

people in group homes) 

o Considerations can be informed by the length of time workers are exposed to each 

other and the public as well as the number of contacts they have during a typical 

workday.

• Groups of workers at sites with potential for high transmission rates and outbreaks (e.g., 

correctional and detention facility workers)
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• Ensuring equitable access for populations disproportionately affected by COVID-19 due to social 

and structural factors

o Considerations for sub-prioritization can be informed by CDC’s Social Vulnerability 

Index, CDC’s COVID-19 Hospitalization Surveillance Network (COVIDnet), or other similar 

jurisdictional epidemiological indices.

Sub-prioritization might be needed among groups included in Phases 1b and 1c based on factors other 

than essential worker characteristics, including underlying medical conditions, age, and congregate 

living status as noted below:

• Underlying medical conditions: CDC identifies certain underlying medical conditions, such as 

obesity, diabetes, and hypertension, as high risk for severe COVID-19. However, persons with 

other medical conditions might also be at increased risk of severe disease and should consult 

with a healthcare provider about personal risk factors. As COVID-19 vaccines become more 

widely available in provider locations and pharmacies, healthcare providers may use clinical 

judgment to determine an individual patient’s priority for vaccination.

• Age: ACIP recommends prioritizing adults ≥75 years of age for vaccination in Phase 1b, and 

adults 65–74 years of age in Phase 1c. When vaccine supplies are limited, sub-prioritization of 

adults in both groups may be warranted, such as prioritization of those with underlying medical 

conditions over older adults without any of those conditions. 

o Additionally, communities that have been disproportionately affected by COVID-19 and 

have a younger population distribution, can choose to adopt a different lower age limit 

for vaccination prioritization appropriate to state, local, or territorial epidemiology. 

o When supply is sufficient, state, local, or territorial jurisdictions can consider moving 

quickly from Phase 1b to Phase 1c to allow for expanded access to COVID-19 vaccines 

for all adults 65 years of age and older.

• Congregate living settings: Increased rates of transmission have been observed in congregate 

living settings. Based on local, state, or territorial epidemiology and implementation 

considerations, jurisdictions can choose to vaccinate persons who reside in congregate living 

facilities (e.g., correctional or detention facilities, homeless shelters, group homes, or employerprovided shared housing units) at the same time or just after frontline staff because of their 

shared increased risk of disease.

More information and other considerations for sub-prioritizing groups can be found here: 

https://www.cdc.gov/vaccines/covid-19/phased-implementation.html. 

Balancing vaccine supply, access, equity, and demand 

To achieve high uptake, jurisdictions must strike a balance between vaccine supply, access, and demand. 

If there is low uptake, which can manifest as low coverage, jurisdictions will need to quickly understand 

the reasons and address them before vaccine wastage occurs. In some cases, low uptake could be 

related to health system challenges (supply, access, service delivery) and, in other cases, it could be 

related to low demand (awareness, social/behavioral factors, vaccine confidence). Often, low uptake 

results from a combination of factors that require concerted efforts to ensure adequate supply, 
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decrease barriers to access, and build trust to increase vaccine confidence and demand for vaccination 

across all priority communities and populations. For instance, if limited numbers of appointments are 

filled or lower numbers of vaccinations at a mass clinic are identified, jurisdictions should consider 

changing dates and times to ensure equitable access. In addition, increased communication using 

various methods should be considered to ensure people know the vaccine is available and how to get 

vaccinated. Ensuring vaccination sites are located near public transportation options could also assist 

in increasing access. When demand is found to be low, jurisdictions are encouraged to work with 

community groups and community leaders to understand and address any population concerns. 
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Planning–Developing Strategies to Reach the Population 

Estimate priority population size 

The first step in planning is to identify and estimate the size of priority populations within a jurisdiction.

Estimates of these groups should be as accurate as possible to minimize potential waste of vaccine, 

constituent products, or ancillary supplies. Partner agencies and organizations can be helpful in 

determining accurate estimates of these population groups. Such organizations might include the 

jurisdiction’s emergency management agency, labor department, and chamber of commerce, as well as

healthcare coalitions, local advocacy groups, unions, chronic disease/nutrition groups, the U.S. 

Department of the Interior, federal executive boards, and the Association of Continuity Professionals. 

Jurisdictions can also use Tiberius and other tools available to them, for estimating the size of key 

populations. 

Map vaccine providers for most equitable access 

To improve vaccination among priority population groups, jurisdictions must ensure these groups have 

access to vaccination services. To inform COVID-19 vaccination outreach efforts at the programmatic 

and provider levels, jurisdictions need to know where these groups are located. Jurisdictions should 

create visual maps 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. To ensure equitable access to vaccination services among priority populations and 

identify areas where additional providers might be needed, jurisdictions could also use mapping tools to 

identify areas with health disparities (e.g., CDC’s Social Vulnerability Index Interactive Map). Maps of 

critical populations should then be overlaid with maps of enrolled providers by provider type and 

populations served by these providers. Jurisdictions might also want to consider encouraging and 

supporting healthcare personnel who are existing trusted sources and work in areas serving these 

priority population groups to enroll as vaccination providers. 

Promote equitable access to vaccination 

In addition to factors like geographic proximity, other factors (e.g., methods used to make a vaccine 

appointment, days/times when vaccination is offered, ability to communicate in languages other than 

English, materials tailored to different literacy levels, or transportation challenges) affect a person’s 

ability and willingness to be vaccinated. Communication, outreach, and partnership building within 

communities are key to identifying and addressing these barriers, building trust, and increasing demand 

for vaccination. For example, jurisdictions should consider people’s ability to make an online vaccine 

appointment, or to take time off to get vaccinated (e.g., leaving work or arranging childcare) or deal with 

vaccine side effects if they impact ability to work or care for dependents. Another example would be 

aligning vaccination points of distribution (PODs) near public transportation sites to overcome 

transportation barriers. 

Plan communication efforts to support vaccine confidence

Communication around COVID-19 vaccination is important for all phases of the vaccine rollout. 

Jurisdictional efforts should aim to promote awareness about the risk of COVID-19 infection, benefits of 
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vaccination, transparency about safety monitoring, timeline for vaccine rollout and rationale for 

prioritization. It’s also critical to promote confidence in vaccines, vaccinators, and health systems.

Communication and education/community outreach teams should be adequately staffed and resourced 

to address daily communication needs of the program, effectively engage with diverse communities 

online and offline, and quickly and effectively respond to any crisis. 

The following minimum recommended activities should be considered before broadening populations 

eligible for vaccination. Communication strategies should be regularly revisited to capture additional 

priority audiences and update approaches to reaching them.

1. Update communication strategy and key messages.

• In strategy, include the priority audience, desired behavior, and the interventions, 

trusted messengers, channels, and messages that are needed to promote the desired 

behavior.

• Identify and provide media training for additional spokespersons who reflect and are 

respected by groups eligible for vaccination.

• Develop strategies tailored for reaching priority populations, communities, and people 

who might encounter access or demand challenges to being vaccinated, including 

tailored messages and interventions (see the “Building vaccine confidence” section).

• Update basic talking points and presentation templates (e.g., web links, posters, public 

service announcements, etc.) to promote COVID-19 vaccination for different audiences 

who will be eligible to receive vaccines.

• Update social media and media monitoring rhythm and search terms to track and 

understand common perceptions and concerns in expanded priority populations.

2. Address healthcare personnel questions and concerns about COVID-19 vaccination and vaccine 

confidence.

• Ensure vaccination providers are knowledgeable about evidence-based immunization 

strategies and best vaccination practices, including specific information on COVID-19 

vaccine. This is particularly important when enrolling new providers. A list of 

immunization training and educational materials, including basic and COVID-19-vaccinespecific information, can be found here: https://www.cdc.gov/vaccines/covid19/training.html.

• Use resources from the COVID-19 Vaccination Communication Toolkit For Medical 

Centers, Clinics, and Clinicians to facilitate conversations about vaccine confidence 

among healthcare staff.

• Support healthcare personnel in providing vaccine information and having effective 

vaccine conversations with patients both online and offline (e.g., job aids, webinars, 

articles in patient portals, social media content).

3. Conduct communication, education, and outreach activities to raise awareness, address questions, 

and build vaccine confidence among key public audiences.
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• Establish a rhythm of communication from a credible and steady messenger for all key

audiences, especially expanded populations, such as regular press conferences or web

page updates. Consistency and responsiveness are key.

• Identify trusted messengers from within these audiences that speak powerfully to

different audiences online and offline and cultivate a relationship with them to amplify

messages and provide feedback to the jurisdiction.

• Adapt CDC materials or create additional communication materials in different formats

for specific audiences to promote consistency in reaching these populations across

jurisdictions.

• If time allows, pretest these materials through focus groups or online surveys.

• Establish or strengthen partnerships with the private sector and community- and faithbased organizations to share communication materials and collaborate on joint

communications (e.g., radio public service announcements, employee newsletter, social

media channel takeover) and community engagement activities (e.g., webinars, town

halls, listening sessions).

• Track questions received by your immunization program and misinformation circulating

online in order to identify common concerns that could be addressed with updated

materials.

Building vaccine confidence

To achieve high demand for vaccines across all at-risk populations, people must have confidence and 

trust in the vaccines, the vaccinators, and the health system that provide them. This is particularly 

important in communities of color and other communities disproportionately affected by COVID-19 who 

might have low trust in the health system. Building confidence requires consistent engagement with 

communities where information is regularly shared, questions and concerns are discussed and fully 

addressed, and barriers to equitable access are lowered. Promoting vaccine confidence should be 

followed by improving vaccine access to ensure that vaccine is both acceptable and accessible, 

particularly for disproportionately affected communities or those who have faced historic barriers to 

accessing health services. This might involve ensuring that vaccination clinics are available during 

different times of day to accommodate varying shifts and schedules or conducting mobile clinics in 

multiple locations. Clear communication about who is prioritized and why, is important for reaching 

priority populations. 

Jurisdictions should recognize that current implementation challenges might increase anxiety and 

frustration and perpetuate reduced trust in government or perceptions of bias in existing systems. 

However, jurisdictions can work to minimize anxiety and frustration for people who really want the 

vaccine but can’t get it or need to wait their turn by providing them with action-oriented options. 

Examples include learning more about vaccines in community meetings, having conversations about 

COVID-19 vaccines with their family and friends, or supporting eligible family members in getting 

vaccinated by driving a grandparent to the vaccination provider site or volunteering to babysit for a 

neighbor who needs time for a vaccine appointment. When people get vaccinated, they can post selfies 

on their social media feeds, sign up for v-safe, a smartphone-based tool (released in December 2020)
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that uses text messaging and web surveys to check in with vaccinated people for adverse events after a 

COVID-19 vaccination, or share their reasons for vaccination with their family and friends.

The CDC Vaccinate with Confidence framework for COVID-19 vaccines can serve as a guide on how to 

build vaccine confidence at the jurisdiction level. Fact sheets, presentations, templates, and guidance 

documents are available on CDC’s website, including those designed for different audiences, such as 

healthcare personnel, jurisdictions, community organizations, and long-term care facilities. 
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Implementing Strategies to Increase Population Access to COVID-19 

Vaccine 

As vaccine supply increases, leveraging a wide variety of potential community COVID-19 vaccination 

providers and settings is essential to providing equitable access to COVID-19 vaccination for all people in 

all communities. Public health programs should understand their jurisdiction’s overall potential COVID19 vaccine administration capacity, (see Playbook, Section 6), using a variety of COVID-19 vaccination 

provider types and settings across all geographic areas within the jurisdiction.

Jurisdictions should continuously monitor provider enrollment, doses ordered and administered, and 

vaccination coverage to ensure equitable access to vaccination and uptake among disproportionately 

affected populations and other groups with historically low access to vaccination services. As monitoring 

activities indicate, efforts should be made to enhance access and demand among these groups.

A successful vaccine administration strategy requires a mix of vaccination provider sites: pharmacies, 

primary care physician offices, federally qualified health centers, on-site vaccination clinics, small mobile 

vaccination clinics, closed PODs, large-scale open PODs/mass vaccination clinics, and satellite, 

temporary, or off-site clinics. To scale up vaccination efforts, public health programs must identify 

populations, plan outreach and communication, select vaccination provider sites, direct people to 

vaccination provider sites, and ensure follow-up reporting. Public health programs must also be 

responsible for vaccine logistics and operations (ordering, transport, storage, management, clinic 

planning, second dose reminders, etc.). To successfully manage each of these areas and vaccinate the 

population quickly, it is important to use the most appropriate vaccination provider site(s) for each 

population. It will also be important to leverage private-public partnerships within the community to 

augment vaccination activities (e.g., partnerships with community- and faith-based organizations). 

Selecting vaccination provider sites

Selecting vaccination provider sites requires balancing increasing access to vaccine, throughput (number 

of persons that can be vaccinated), and operational considerations. Figure 1 provides an example of 

considerations to assist in determining the most ideal site(s) for each population group. 

Several factors should be considered when selecting a vaccination provider site for a population. These 

factors include whether the population is mobile (i.e. can easily access health services via private or 

public transport), easily identifiable, and responds well to outreach. Information about these factors 

may help identify the most appropriate strategy for a given population. Some considerations are listed 

below: 

• For populations with limited mobility, including those who might be homebound or have other 

access issues, on-site vaccination is essential. Engaging home health agencies and community 

nurses who serve these populations can be helpful. At present, vaccines cannot be transported 

more than once. To minimize wasted doses when vaccinating home-bound populations, 

jurisdictions may consider vaccinating other people in the home if there are extra doses. 

• Mobile populations (essential workers and others) who can be easily identified through 

credentials (identification, badges) and who may be willing to seek vaccination after basic 
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outreach (e.g., emails, posters, etc.), could be directed to sites that are already accessible in the 

community, such as pharmacies/retail clinics. These sites could offer a faster solution to 

vaccination access, as long as each site can vaccinate the required number of people. 

• For select essential worker populations that require more intense outreach, jurisdictions might 

want to consider providing more direct access to vaccination through on-site vaccination clinics 

in occupational settings or mobile vaccination units that travel within the community for 

healthcare personnel who do not have access to occupational health services. Closed PODs may 

also be designated to serve these types of groups.

• For mobile populations who are not easily identifiable through identification or badges, the best 

vaccination provider strategy will depend on how well the group responds to outreach (i.e., 

whether they will seek a location to get vaccinated). If they respond well to outreach, the best 

option could include sites with low burden in terms of logistics and operations. These would 

need to be coupled with solutions to help identify eligible persons (i.e., through providing 

vouchers that can be used at closed PODs or in pharmacies).

• For mobile populations that are easily identifiable but might need additional outreach, the best 

option will be a trusted community vaccination service, such as mobile vaccination or on-site 

clinics in trusted community venues. 

• For broad-scale efforts to reach the general population once vaccine supply is plentiful, consider 

mass vaccination clinics/open PODs that will allow for maximum throughput without the need 

for priority population eligibility screening.
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Figure 1: Framework for selecting vaccination provider sites for specific populations

Vaccination provider site considerations and throughput

Determining the type and number of locations to mobilize depends on many variables, including 

population (e.g., size, occupation, age), programmatic operational burden, scalability, and throughput. 

Assessments can be scaled up based on assumptions of vaccination stations and workforce. Assume 

each vaccination station will include one vaccinator working a 10-hour shift. Additional workforce is also 

needed to support clinic operations. The model below in Table 1 presents considerations for various 

vaccination provider sites outside the healthcare system, and assumes that every vaccination station will 

require appropriate infection control procedures as well as staff who manages registration, triage, 

vaccine preparation (including storage and handling), vaccine administration, and postvaccination 

patient monitoring and discharge. 

Table 1: Vaccination provider site considerations

Vaccination 

provider site 

Programmatic 

operational 

burden

Easily 

scalable if 

enough 

supply?

Works well 

in low 

supply 

situation 

Estimated No.

of vaccination 

stations 

Monthly 

throughput/site

(doses)

On-site vax clinic High No2 Y 2–4 Variable

Small clinics/mobile 

vax clinics

Medium No2 Y 2 4,020

(201 doses/day)

Medium/pop-up 

clinics

Medium Depends Y 5 24,000

(1,200 

doses/day)

Large-scale, open 

PODs/mass vax 

clinics 

High Depends N 10 79,680

(3,984 

doses/day)

Pharmacy retail Low Yes Y 3–5 1,680–2,800
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(84–140 

doses/day) 2

On-site vaccination clinics and small/mobile clinics could be augmented by expanding hours to include evenings 

and weekends and/or by offering drive-through services.

Types of clinics for consideration include:

• Federally qualified health centers (FQHCs) 

• Mobile vaccination units

• Pop-up community clinics 

• Pharmacy partnerships

• Mass vaccination clinics

Role of public health vs. private partnerships

With private partners taking on high-volume vaccination of the general public and with pharmacies,

urgent care clinics, and other private organizations providing additional support as vaccination provider 

sites, the logistical and operational burden is lowered for public health. This permits public health 

agencies to focus vaccination efforts on increased communication, tailored messaging for populations 

that might require additional outreach, and strategies to increase vaccine access through mobile 

clinics, mini-clinics in trusted community locations, or on-site vaccination support for select communities 

(see Table 2 below). Public health programs can support partners by helping to direct populations to 

vaccination provider sites, while private partners can support public health programs in operationalizing 

the vaccination program within communities (e.g., on-site vaccination support, mobile vaccination). The 

logistics of the vaccination process involve several steps. Ensuring success at each step can be 

augmented through private-public partnerships, as noted in Figure 2. 

Table 2: Role of private partners vs. public health 

Private Partners Public Health 

Focus on vaccination operations/logistics to: 

• Improve uptake in the general population

(high volume).

• Increase access to vaccination provider sites. 

Focuses on reaching populations that might

require tailored outreach, including: 

• Rural populations

• Communities of color

• Highest risk essential workers that might

need more intense outreach

• People experiencing homelessness 
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Figure 2: Vaccination process
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Private-Public Partnerships – Pharmacy Programs

The Federal Retail Pharmacy Partnership Strategy for COVID-19 Vaccination is a public-private 

partnership established by the federal government that involves 21 national pharmacy partners and 

network administrators representing over 40,000 retail pharmacy locations nationwide. With more than 

90% of people in the United States living within five miles of a pharmacy, pharmacies are uniquely 

positioned to support broad COVID-19 vaccination efforts. Pharmacies have built-in expertise in 

vaccination campaigns reaching large portions of the population based on annual flu vaccination efforts. 

In addition, many pharmacies have existing strategies and infrastructure in place for second-dose 

management because of their experience in administering the two-dose Shingrix shingles vaccine. 

Jurisdictions can leverage private-public partnerships with pharmacies to augment community access to 

COVID-19 vaccine, both for priority population groups when supply is still limited and for more broad 

distribution as vaccine supply increases. The U.S. Government and CDC have developed two programs in 

addition to the Federal Pharmacy Partnership for Long-Term Care Program, to facilitate distribution of 

COVID-19 vaccine allocation to pharmacies for administration in communities across the country: 

• The Federal Retail Pharmacy Partnership Strategy will launch on a national scale, with select 

pharmacy partners receiving a direct allocation of COVID-19 vaccine. Timing and scale of 

activation (how many partners, how many stores) will depend on various factors, including 

supply. The program will roll out incrementally in close coordination with jurisdictions and will 

be expanded when there is enough vaccine supply to turn on the program equitably nationwide. 

• The Allocation Transfer Program provides jurisdictions an opportunity to transfer vaccine 

allocation to federal pharmacy partners to help vaccinate priority populations against COVID-19 

before the Federal Retail Pharmacy Program launches nationwide.

Federal retail pharmacy partnership strategy for COVID-19 vaccination 

As vaccine supply increases, the federal government will begin an incremental rollout of the Federal 

Retail Pharmacy Partnership Strategy for COVID-19 Vaccination, which will allow federal pharmacy 

partners to begin ordering vaccine directly from the federal government for distribution to broad 

population groups. The program will be implemented using federally allocated vaccine and will not 

impact weekly jurisdictional allocations. Pharmacy partners will be required to report to CDC the 

number of doses of COVID-19 vaccine (a) ordered by store location in CDC’s Vaccine Tracking System

(VTrckS) and (b) on hand in each store reported through VaccineFinder. Pharmacy providers will also be 

required to report CDC-defined vaccine administration data elements to jurisdiction immunization 

information systems (IISs) or through other agreed upon methods (e.g., formatted data extracts) if IIS 

reporting is not available. Reporting agreements will be defined by CDC. 

Vaccine allocation strategy

Pharmacy partners will receive a federal allocation of vaccine to begin the Federal Retail Pharmacy 

Partnership Strategy for COVID-19 Vaccination. The allocation provided for this program is separate

from jurisdictions’ weekly allocations. 
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Vaccine supply will be distributed from the COVID-19 Vaccination Program to pharmacy partners for 

distribution to retail locations based on various factors, including equity to access, demand, supply, and 

number of stores. This strategy is designed to capitalize on the pharmacy partners' expertise in

managing supply and demand in their network of retail locations across the country, given that uptake 

and throughput might vary by jurisdiction over time. CDC will continuously monitor each pharmacy 

partner’s inventory by jurisdiction to help ensure equitable access across the country and will 

collaborate with pharmacy partners to shift inventory to best meet public health needs. 

Program launch

When the Federal Retail Pharmacy Partnership Strategy for COVID-19 Vaccination begins, there will not 

be enough vaccine for all of the 40,000+ retail pharmacy locations enrolled to start providing COVID-19 

vaccine at the same time. As such, the Federal Retail Pharmacy Strategy for COVID-19 Vaccination will 

roll out incrementally. As COVID-19 vaccine supply increases, additional pharmacy locations will receive 

vaccine until the entire network of 40,000 locations is activated. 

To support the program’s launch, jurisdictions were asked to provide input on which federal pharmacy 

partners would get vaccine first. To assist in this process, CDC provided all jurisdictions with a 

recommendation of one or more pharmacy partners to receive vaccine from the federal government as 

part of the program’s launch. 

CDC selected these pharmacy partners based on a mapping exercise that showed which partners 

provide the best coverage to reach populations at highest risk of becoming severely ill from COVID-19, 

including people 65 years and older (the age-based population recommended for vaccination during 

Phase 1C, and those who are socially vulnerable (using the social vulnerability index). These mapping 

tools allowed CDC to identify the fewest number of pharmacy partners in each jurisdiction that would 

provide the best access to COVID-19 vaccine for many of people who need it most. As supply grows, 

pharmacy partners will be able to expand beyond their initial starting points and into other jurisdictions, 

based on their expertise of how to best meet demand. Other pharmacy partners will be engaged at this 

point as well. 

Jurisdictions were recently asked to confirm which partners they preferred to begin receiving vaccine in 

their jurisdiction. These initial selections are just a starting point, and the number of pharmacy partners 

and sites receiving vaccine will increase as the program expands.

Priority populations

Pharmacy partners will focus on providing vaccine to broad populations, likely age-based to start, to 

maximize the volume of doses administered and improve population uptake. CDC recognizes that 

jurisdictions will be in different phases of vaccine rollout when the program begins and will work with 

jurisdictions to ensure the pharmacy partners selected for launch are prioritizing a population group for 

vaccination that falls within their jurisdiction’s current prioritization schedule.

The Federal Retail Pharmacy Partnership Strategy for COVID-19 Vaccination is meant to augment 

vaccine availability for broad populations in each jurisdiction, while reducing the burden on jurisdictions 

related to provider enrollment and logistical coordination. Jurisdictions will need to continue to develop 
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public health strategies for certain populations such as rural populations, communities of color, and 

essential workers that require more intense outreach, including those who cannot easily access 

pharmacies or other healthcare providers. 

Coordination of private-public partnership — key actions for pharmacies and public 

health

The program relies on collaboration with public health. This is especially important for communication 

efforts encouraging people to seek vaccination at pharmacy locations, particularly for populations and 

communities that might require more intense outreach. As the retail program launches, public health 

outreach to the community will be critical. 

CDC will work with jurisdictions to ensure that pharmacies providing COVID-19 vaccine in their 

communities as part of the Federal Retail Pharmacy Partnership Strategy for COVID-19 Vaccination, are 

prioritizing vaccine recipients by age range according to the jurisdiction’s current prioritization schedule 

(i.e., 75 or 65 years of age and older). 

Allocation transfer program

CDC is providing jurisdictions with an opportunity to transfer vaccine allocation to federal pharmacy 

partners to help vaccinate priority populations against COVID-19 before the Federal Retail Pharmacy 

Partnership Strategy for COVID-19 Vaccination launches. The Allocation Transfer Program launched the 

week of January 11, 2021 and allows jurisdictions to transfer doses from state allocations to federal 

pharmacy partners to assist in vaccinating select populations. This option allows jurisdictions to skip 

having to enroll federal pharmacy partners as COVID-19 vaccination providers in their jurisdictions to 

assist with vaccination activities. Jurisdictions must coordinate with the pharmacy partner(s) in advance 

to develop a thoughtful plan that both parties agree with, before submitting a transfer request to CDC. 

Guidance for developing vaccination plans with pharmacy partners

Jurisdictions should consider the following points when developing a vaccination plan with pharmacy 

partners. 

1. The priority populations the pharmacy partner(s) will vaccinate against COVID-19 

• Jurisdictions can consider the following points when making this decision:

o ACIP recommendations for populations to prioritize for vaccination during different 

phases of vaccine distribution

o The estimated population size of these priority groups within the jurisdiction

2. If the pharmacy partner(s) need to conduct occupational or age-based screening prior to vaccination 

to ensure prioritized populations are receiving priority access to the vaccine

• If yes, jurisdictions should discuss the following points with the pharmacy partner(s):

o Types of screening tools necessary (e.g., occupational credentials, proof of age, 

vouchers, etc.)

o Timing of screening (i.e. either prior to the vaccination appointment using an online 

form or email or on site at the time of appointment). If on site, infection control 

practices should be considered to limit number of people
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o Planning for people who request an appointment or come on site for vaccination 

but do not have proper identification according to the jurisdiction’s screening 

criteria (e.g., considering whether it’s appropriate to redirect these people to the 

local public health department). Discussions should involve scenario planning for 

how to respond to people who insist on vaccination without proper credentials, 

including security considerations and other implications of vaccinating outside the 

jurisdiction’s prioritization schedule. 

3. How the pharmacy partner(s) can best reach the populations being prioritized for vaccination

• Some pharmacy partners might be able to provide satellite or mobile clinics to reach priority 

populations where they live or work, which can help increase vaccine uptake. If a 

jurisdiction coordinates satellite or mobile clinics with a pharmacy partner, it should plan at 

least two clinics at each location so that vaccine recipients can easily access their second 

dose and complete the vaccine series. 

4. How to communicate to priority populations about where and how to access COVID-19 vaccine

• When developing a communication strategy, jurisdictions might want to caution pharmacy 

partner(s) against widespread advertising about COVID-19 vaccine availability. Advertising 

through communication channels that are intended to reach the specific populations you 

are planning to vaccinate (e.g., employer communication vehicles, trade organization or 

third-party listservs, direct mail advertising, etc.) and ensuring appointments can be easily 

made, can help ensure priority populations are able to access to the vaccine first, before the 

general public. 

5. How much vaccine to transfer to the pharmacy partner(s) on a weekly basis

• Jurisdictions can consider the following points when making this decision:

o The population size of the groups being prioritized for vaccination through use of 

pharmacy partner(s)

o The number of retail locations the pharmacy partner(s) have in the jurisdiction and 

the number of vaccine doses they can administer on a weekly basis (throughput) 

o The amount of vaccine needed for satellite or mobile clinics, if applicable, taking 

into account that throughput might be different for off-site clinics compared to 

retail locations 

o Strategies to best optimize access to the vaccine without exhausting the 

jurisdiction’s overall inventory 

6. Which vaccine product to transfer to the pharmacy partner

• Jurisdictions may transfer allocation of any COVID-19 vaccines authorized for emergency use 

by the U.S. Food and Drug Administration but must ensure pharmacy partner(s) have the 

capacity to store and handle the product before the request is submitted to CDC. The 

pharmacy partner(s) must agree to the vaccine allocation being provided. CDC recommends 

allocating only one vaccine product to each partner to simplify planning, reporting, and 

managing second doses.

7. If cross-coordination with neighboring jurisdictions is needed to ensure consistent and clear 

messaging to priority populations
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• Jurisdictions that are a part of a tri-state area or that include cities that span state lines 

might want to coordinate to use the same pharmacy partner(s) to vaccinate a priority

population. For example, if Kansas is using Walmart to vaccinate its teachers, Missouri might 

want to consider the same approach so that teachers in Kansas City will hear one consistent 

message on where to go in their community for vaccination. 

8. How pharmacy partner(s) should manage excess vaccine or vaccine nearing its expiration date, if 

uptake among the agreed upon priority populations is low

• Jurisdictions should anticipate that pharmacies might have excess vaccine inventory if 

uptake among priority populations is lower than expected. To prepare for this, jurisdictions 

should discuss plans with pharmacy partners to vaccinate those outside of the priority

population in advance, so that no vaccine is wasted.

 
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Monitoring and Program Oversight 

Providers perform vital functions within the COVID-19 Vaccination Program, including properly storing, 

handling, and managing vaccine supply as well as administering vaccine to intended recipients. Thus, it is 

essential for providers to have a clear understanding of COVID-19 Vaccination Program requirements. 

Training, site visits, and other oversight measures are important for maintaining or improving providers’ 

adherence to these requirements. Site visits, in particular, are a key opportunity to further develop and 

strengthen relationships with enrolled providers. 

Although the guidelines for COVID-19 Vaccination Program oversight are still being established, awardee 

jurisdictions will eventually be responsible for conducting site visits either in person (preferred) or 

virtually to provide monitoring and quality assurance support (supportive supervision) and to promote 

quality improvement. These visits will involve reviewing and assessing COVID-19 vaccination provider 

operations with the following goals: 

• To assess COVID-19 vaccination provider adherence to program requirements

• To identify and address areas where providers are doing well and areas needing additional 

follow-up

• To identify and address educational needs of COVID-19 vaccination providers to help them meet 

program requirements

• To ensure vaccine recipients are receiving properly managed and viable vaccine

• To ensure that vaccine is distributed according to jurisdictional priorities and ensuring equity in 

the distribution 

Additional, detailed information on monitoring and oversight of the COVID-19 Vaccination Program will 

be released at a later date. 
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Conclusions 

In conclusion, the considerations suggested in this document are meant to help inform assessments of 

current phase and decisions on when to transition to the next phase of the COVID-19 Vaccination 

Program. It’s important to recognize that these considerations will likely need to be adapted to the local, 

state, or territorial context and could change over time. These considerations can also be applied to 

transitions among groups sub-prioritized within a phase, in conjunction with factors specific to 

jurisdictional needs. Jurisdictions requiring assistance implementing the strategies presented in this 

document can seek assistance from CDC.