A provider with Augusta Health administers a dose of the Pfizer COVID-19 vaccine in December. (Courtesy of Augusta Health)
They didn’t quite get it done in a week.
But Virginia lawmakers still mobilized quickly to pass emergency legislation aimed at expanding the state’s pool of COVID-19 vaccinators — a bipartisan priority as health officials prepare to ramp up large-scale vaccination events over the next few months.
Sen. Siobhan Dunnavant, R-Henrico, said building a qualified workforce has been a limiting factor as local health districts work to expand their immunization efforts to a broader swath of Virginians. A practicing OB-GYN, Dunnavant was the lead patron on the Senate version of a bill that allows any qualified health care provider in Virginia to volunteer as a vaccinator.
That bill passed unanimously in the House on Monday evening. Dunnavant also joined her Senate colleagues earlier that afternoon in voting unanimously for the opposite chamber’s nearly identical version, sending the bill to Gov. Ralph Northam for a signature. As emergency legislation, it will go into effect as soon as it’s signed.
Northam signaled his support for the bill at a news briefing last week, describing it as an important step in ensuring vaccines are distributed equitably across the state. And both legislators and supporters say quickly expanding Virginia’s vaccinator workforce is vital to making sure the state can quickly administer the shots it’s sent.
“Challenge us,” Dunnavant joked at a news conference in January, discussing the timeline for passing the bill. “I’d say give us a week.”
Onboarding volunteers has already proven a challenge for local health districts over the first seven weeks of the state’s vaccine rollout. Currently, officials are routing most would-be vaccinators through the Medical Reserve Corps, a group established to respond to public health emergencies.
But the process of signing up as an MRC volunteer comes with strict training requirements, which many providers say have become a barrier to quickly approving and deploying vaccinators in the field.
“There’s gonna need to be so many more boots on the ground that if we require the same level of preparation before they can start vaccinating, we’re going to have yet another bottleneck,” said Melissa Earley, a board member for the Virginia Nurses Association who’s volunteered with the MRC for the last several years.
Even under an expedited process, Earley said volunteers had to go through a background check and complete several training courses on the structure of the MRC in addition to learning specifically about the two COVID-19 vaccines currently approved under emergency use authorization in the United States. Local health departments have said the training can also include basic information on vaccination safety — even for providers with years of experience.
As a result, many health care workers across Virginia have signed up for the MRC but are still waiting to finish the sign-up process. As of Jan. 29, the group reported that 25,050 volunteers had been approved but only 16,072 were considered deployable. Of those, only 6,893 were medical workers eligible to give out shots (another 9,179 are support personnel).
“That leaves roughly 9,000 that are still going through onboarding,” Earley said. “And we’re going to need enough people to vaccinate the entire state.”
The final version of the legislation, sponsored in the House by Del. Lamont Bagby, D-Henrico, expedites and expands the volunteer process in several main ways. While the bill still requires volunteer training on the safety and administration of COVID-19 vaccines, it explicitly waives the typical background check, training and orientation for the MRC.
It also dramatically expands the number of providers eligible to sign up as vaccinators. Those now include any medical professional licensed by the state’s Department of Health Professions — including dentists and pharmacists — as well as medical students who have been trained in administering vaccines. Both bills also clarify that both professional and volunteer EMS workers can give out the shots.
Under the legislation, those providers are granted civil immunity except in cases of gross negligence or willful misconduct, meaning they can’t be sued for allergic reactions and other rare adverse events that can occur after vaccination. Hospitals and other professional groups have described liability protection as a “critical component” of expanding the volunteer workforce — ensuring that providers can’t be penalized for helping with the state’s rollout.
Clark Barrineau, the assistant vice president of government affairs for the Medical Society of Virginia, said the bill also creates a streamlined process for hospitals, universities, localities and other sites that want to volunteer their spaces for vaccine clinics or share workers to help administer the shots. That’s been a concern on the part of many localities, including in the Hampton Roads region, where city and county leaders told state health officials that required memorandums of understanding with their local department of health were creating another bottleneck in the sign-up process.
“As we’ve gone a few weeks into this rollout, we’ve really seen providers want to step up and volunteer,” Barrineau said. “I think the intent of this bill is really to find a way that people can volunteer much more easily and facilities can offer themselves as venues for these events without running into the problem of — candidly — lawyers.”
House legislators also successfully included a provision that will require vaccinators to collect race and ethnicity data for patients when they administer the vaccines. Demographic information on immunizations has been a challenge in Virginia, where more than 400,000 doses are missing the information.
But for the shots with race and ethnicity data attached, nearly 315,000 out of the state’s total 843,230 vaccines have gone to White patients, according to VDH data. Black patients account for 46,674 and Latino patients account for 26,987, though both groups have disproportionately shouldered the burden of cases in Virginia and across the country.
Dr. Danny Avula, the state’s vaccine coordinator, said VDH is currently working to cross-check vaccinations with data from other state agencies in an effort to retrospectively attach demographic information. But in a news briefing last week, Northam said the requirement would help ensure that racial equity is “baked into” the state’s distribution strategy.
“It’s the right thing to do, and it’s a critical tool to provide you with the transparency you expect,” he said.
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