In a new update on COVID-19 developments affecting the long term care profession, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) has addressed provider concerns about how to manage the so-called third clinics permissible under the government’s vaccine program.

According to the association, the Centers for Disease Control and Prevention’s (CDC’s) Long-Term Care (LTC) Pharmacy Partnership Program provides three COVID-19 vaccination clinics for LTC facilities enrolled in the program.

“As many LTC facilities are closing in on their third clinic, questions have arisen whether residents and staff will be able to receive a first dose of the vaccine at the third and final clinic,” the association said. “AHCA/NCAL has been actively working with CDC, CVS, and Walgreens on this issue.”

CDC policy is to optimize vaccine access for residents and staff, which means delivering the first dose of either vaccine at the third clinic. However, the pharmacies will defer to state/jurisdictional guidance, AHCA/NCAL said.

“So, if your state health department decides not to allow first doses at the third clinic in all cases, for example, the pharmacy will follow that guidance,” they added.  

If residents and staff receive the first dose of the vaccine at the third clinic, it is important that providers determine how these individuals will access the second dose. For assistance in securing the second dose on behalf of staff or residents, providers should:

• Contact their state public health department for more information on vaccine availability. 

• Call on of the retail pharmacies involved in CDC’s Federal Retail Pharmacy Program. Retail pharmacies participating in the program vary by state and territory; visit the CDC website to find out which pharmacies are participating in which state. 

If a provider is in a state that is delivering the Pfizer-BioNTech vaccine through the Pharmacy Partnership, it will be more challenging to access a second dose due to the unique cold chain storage requirements, AHCA/NCAL said. If all potential options for administering the second dose have been exhausted, clinical leadership may consider the following:

• Counseling residents to finish the vaccine series using the Moderna vaccine. The Advisory Committee on Immunization Practices recommends: “In exceptional situations in which the first-dose vaccine product cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimum interval of 28 days between doses to complete the mRNA COVID-19 vaccination series.”

• Delay of the second dose administration up to six weeks (42 days). CDC guidance dictates that in situations where it is not feasible to adhere to the recommended interval (21 days for Pfizer and 28 days for Moderna, the second dose can be administered up to six weeks 42 days) after the first.