Workers set up a vaccination site at the Richmond Raceway in Henrico. (Henrico County)
Assembling a large pool of vaccinators is key to widely administering COVID-19 vaccines. But in Virginia, it’s been a challenge — mostly because of stringent requirements for many would-be volunteers.
It’s an issue that a bipartisan group of state legislators is working to address. Sen. Siobhan Dunnavant, R-Henrico (a practicing OB-GYN), is the lead patron on an emergency bill that would allow any qualified health care provider in Virginia to volunteer as a vaccinator.
The legislation is co-sponsored by Sens. Jen Kiggans, R-Virginia Beach, a nurse practitioner, and Todd Pillion, R-Washington County, a dentist. Two Democratic senators — George Barker, Fairfax, and Chap Petersen, Fairfax City, have also signed onto the bill, describing it as vital to speeding up the pace of vaccinations in the state,
“The issue has been the workforce,” said Barker, a senior member of the Senate Education and Health committee, at a Thursday briefing on the bill. “There aren’t that many people who work at local health departments, and we have not the program to bring in enough volunteers.”
The problem is playing out at hospitals and local health departments across the state. Right now, health care providers are encouraged to volunteer as vaccinators through the state’s Medical Reserve Corps, a group established to respond to public health emergencies. But registering for the MRC is a rigorous process that requires a background check and hours of orientation and training.
Ryan McKay, the director of policy and planning for the Blue Ridge Health District, said the process can range from five or six online training courses to nine or 10, depending on the volunteer. And it includes modules not only on the Pfizer and Moderna vaccines — currently the only two authorized for use by the U.S. Food and Drug Administration — but more basic courses on bloodborne pathogens, safe vaccine handling and cold chain management.
It also includes a final skills test with a public health nurse who walks through a vaccination appointment with a volunteer. That process can take anywhere from an hour to an hour and a half, sometimes diverting time from staff who would otherwise be helping with vaccinations.
McKay said his district has dedicated four or five employees solely to training, but has still struggled to build up its workforce quickly enough to keep with demand.
“We learned we couldn’t get big enough, fast enough,” he said. “We couldn’t get enough vaccinators to roll out a thousand shots a day.”
It’s not just local health departments that have been challenged. In a call with Gov. Ralph Northam last week, hospital executives said many systems were struggling with staffing as they handled vaccinations and a massive surge of COVID-19 hospitalizations — which remain higher than they’ve ever been in Virginia.
Hospitals asked Northam to issue an executive order that would allow recently retired staff and other qualified employees to administer vaccines after a brief refresher course.
In a letter to Health Commissioner Dr. Norman Oliver and Dr. Danny Avula — who was named as Virginia’s vaccine coordinator earlier this month — 17 city managers and county administrators in the Hampton Roads region also asked for state help in streamlining the training process.
“We are seeking a temporary waiver for the non-essential requirements to more quickly facilitate the registration of additional vaccinators,” the letter reads. “Another possibility would be for VDH to allow nurses or other qualified healthcare professionals to certify and work under our hospital systems’ emergency credentialing to allow them to vaccinate.”
The bipartisan legislation seeks to ease many of the current barriers by waiving the reserve corps training and orientation requirements with the exception of courses on injection best practices and vaccine information, which the Virginia Department of Health would still be able to require.
And while an adequate number CPR-certified staff would still need to be present at vaccination events, the bill would waive a requirement that all vaccinators have a CPR certificate within the last two years.
“In medicine, we don’t always renew our certificate every two years because it’s continuity that happens over the years,” Dunnavant said at the briefing.
Importantly, the bill would also expand the number of providers who can volunteer as vaccinators. Those include state medical students and EMS providers, as well as all health workers licensed within the state’s Department of Health Professions (including dentists).
Barker said that many of those providers are currently required to be overseen by another health worker in order to administer vaccines. EMS employees, for example, are often certified to work under a specific director, which can further complicate efforts to rapidly build a vaccinator workforce.
“We’re setting up operations to deal with a situation where you already have trained medical professionals, who clearly have given lots of shots in their lives, to truly have the capability to do it,” Barker said. “And don’t necessarily need to understand how every detail of the health department works.”
In a separate interview on Saturday, Avula said the administration had received similar requests and was drafting language for a potential executive order. Northam has not publicly addressed the issue at his COVID-19 briefings.
An amended version of the legislation passed through the Senate Education and Health committee unanimously on Thursday. It contains an emergency clause, which would allow it to go into effect immediately if signed by the governor.
Dunnavant said she hoped to have it passed by the Senate and the House within a week. One potential sticking point is a clause in the bill that would offer civil immunity to health care providers who volunteer to administer the COVID-19 vaccine — except in cases of gross negligence or willful misconduct.
While the clause would strengthen protections for providers, hospitals described liability protections as a “critical component” expanding the volunteer workforce. Barker said it would remove a potential barrier so that volunteers wouldn’t face lawsuits for allergic reactions and other rare adverse events that can occur after vaccination.
“This is a very extraordinary situation,” Petersen added at the briefing. “To waive civil immunity — I would almost never vote for it. But this time I’d vote for it. I think it’s critical in order to make sure we have the professionals available.”
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