25-0007_Final.pdf

Immunization Services Division

Notice of Funding Opportunity

Application due March 13, 2025

Strengthening Vaccine‑Preventable Disease Prevention and Response Opportunity number: 25-0007

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 8

Program description 10

Step 2: Get Ready to Apply 46

Get registered 47

Step 3: Prepare Your Application 50

Application contents and format 51

Step 4: Learn About Review and Award 58

Application review 59

Award notices 63

Step 5: Submit Your Application 64

Application submission and deadlines 65

Application checklist 67

Step 6: Learn What Happens After Award 68

Post-award requirements and administration 69

Contacts and Support 74

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date Applications are due by 11:59 p.m. Eastern Time on March 13, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 8

Program description 10

Basic information Centers for Disease Control and Prevention (CDC)

National Center for Immunization and Respiratory Diseases

Immunization Services Division

This funding opportunity supports public health systems to protect people and communities from vaccine-preventable diseases by equitably increasing access, confidence, and demand for vaccines.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Strengthening Vaccine- Preventable Disease Prevention and Response

Opportunity number:

25-0007

Announcement type:

New

Assistance listing:

93.268

Key dates

Application deadline:

March 13, 2025

Informational call:

January 8, 2025

Expected award date:

June 25, 2025

Expected start date:

July 1, 2025

See other submissions for other time frames that may apply to this

NOFO.

Summary CDC’s Immunization Services Division (ISD) Notice of Funding Opportunity (NOFO) continues and builds upon the ongoing work of the Section 317 and Vaccines for Children (VFC) Programs. These programs remain central to the U.S. immunization program infrastructure to achieve high vaccination coverage, low incidence of vaccine-preventable disease (VPD) and maintain or improve response to vaccine-preventable public health threats.

The VFC Program provides vaccines to children whose parents or guardians may not be able to afford them. Serving as an important contributor to health equity, the program helps support fair and just opportunities for all children to get their recommended vaccinations on schedule and achieve their highest level of health.

Section 317 of the Public Health Service Act helps meet the costs of prevention health services, and 317 priorities include preserving immunization infrastructure, maintaining vaccine supply as a safety net for uninsured adults, and responding to VPD outbreaks.

Activities in this funding opportunity are included within the following seven priority strategies.

• Strengthen Program Infrastructure and Management.

• Increase Vaccine Access.

• Improve Vaccination Equity.

• Promote Vaccine Confidence and Demand.

• Enhance Data and Evaluation.

Step 1: Review the Opportunity 5

• Strengthen Program Support for Partners.

• Enhance Vaccination Response Readiness.

There are three components in this NOFO, and you are required to apply to all three components.

• Component 1: Core.

• Component 2: Rapid small-scale response to VPD outbreaks or other public health emergencies (funded).

• Component 3: Rapid large-scale response to VPD outbreaks or other public health emergencies (approved but unfunded).

Funding details Type: Cooperative agreement

Expected total program funding over the performance period:

$2,000,000,000

Expected total program funding per budget period: $400,000,000

Expected awards: 66

Expected average award amount per budget period: $6,060,606

We plan to award projects for 5 12-month budget periods for 5 year period of performance.

The number of awards is subject to available funds and program priorities.

Funding strategy You must apply to all three components. You will submit one application that includes the work plan and budget for all three components. The work plan and budget will be completed in the Vaccines for Children Cooperative Agreement Management Platform (VFC CAMP). Each component will be awarded to 66 recipients.

Component 1 The funding formula is a weighted jurisdiction-by-jurisdiction calculation made up of the following factors:

• Base amounts.

• Population.

• Land area.

• Uninsured adults.

Step 1: Review the Opportunity 6

• Births.

• Poverty.

• Rural population.

• VFC providers.

• VFC-eligible population.

Component 2

• Funding for rapid small-scale VPD outbreak activities. The estimated yearly funding is $250,000, as available.

Component 3

• Approved but unfunded rapid large-scale VPD outbreak activities. The estimated yearly funding is $3,000,000, as available.

Step 1: Review the Opportunity 7

Eligibility Statutory authority The Vaccines for Children (VFC) Program is authorized under:

• Section 1928 of the Social Security Act. [42 U.S.C. section 1396s].

• Section 317 of the Public Health Service Act [42 U.S.C. section 247b], as amended.

Direct assistance (DA) is available through this NOFO. DA may be requested for:

• Public Health Advisors, including salary and travel.

• Statistical Analysis Software (SAS) licenses.

Eligible applicants Only these types of organizations may apply. State, territorial, local, and tribal government organizations may also opt to select a bona fide agent to apply on their behalf.

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Territorial governments and Freely Associated States.

Applicants must meet certain population thresholds as described here. This strategy allows ISD to reach the greatest number of people while balancing the need for direct support to some of the largest cities in the United States.

Eligible applicants include:

• The 51 state health departments or their bona fide agents, including the District of Columbia.

• Local health agencies or their bona fide agents, if they serve a city population* of 1.4 million or more (i.e., Chicago, Houston, New York City, Philadelphia, San Antonio).

◦ If the city does not have a public health department, then the county covering the jurisdiction may apply (i.e., Los Angeles, CA covered by Los Angeles County and Phoenix, AZ covered by Maricopa County).

• All U.S. territories and the Freely Associated States in the Caribbean and Pacific (American Samoa, Commonwealth of the Northern Mariana

Step 1: Review the Opportunity 8

Islands, Guam, Puerto Rico, the U.S. Virgin Islands, the Freely Associated States of the Federated States of Micronesia, Republic of Palau, and Republic of the Marshall Islands). Note: The Freely Associated States do not participate in the Vaccines for Children Program.

*Population for city jurisdictions. Source: U.S. Census Bureau, 2022 American Community Survey 5-Year Data (2018 - 2022) - Table S0101.

Bona fide agents must submit documentation that demonstrates their arrangement with the eligible applicant. See Attachments.

Responsiveness criteria We will review your application to make sure it meets these requirements.

These are the basic requirements you must meet to move forward in the competition. We won’t consider an application that:

• Is from an organization that doesn’t meet eligibility criteria. See requirements in eligibility.

• Is submitted after March 13, 2025.

• Proposes research activities. See 45 CFR 75.2 for the definition of research.

See the application checklist to understand which elements of your application are part of the responsiveness criteria.

Application limits In addition to the responsiveness criteria, you must follow these limits related to the number of applications your organization can submit.

Under this NOFO, you may submit only one application under your organization’s UEI.

Cost sharing and matching funds There is no cost-sharing requirement for this NOFO.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://www.ecfr.gov/current/title-45/part-75#p-75.2(Research)

Program description Background Overview Sustaining and strengthening vaccine access for everyone in the United States is more important today than ever before. While the nation’s immunization infrastructure has improved since the Vaccines for Children (VFC) Program became operational in 1994, important work remains to increase vaccination coverage, confidence, and demand and advance equitable access and uptake across the lifespan.

The VFC Program has significantly reduced vaccine inequities among children.

However, disruptions, such as the COVID-19 pandemic, can have sustained impacts on childhood immunization. Adolescent immunization continues to lag for selected recommended vaccines.

Adult immunization is also a challenge. National Immunization Survey (NIS) data show current and new vaccines are low, and racial, ethnic, and other disparities persist.

To stop misinformation from eroding public trust in vaccines, public health must work with the community partners and trusted messengers to improve confidence in vaccines through culturally appropriate communication strategies.

The following seven strategies address these challenges and help protect all people from vaccine-preventable diseases:

• Strengthen program infrastructure and management. Invest in the critical people and the equitable distribution of resources needed to maintain and strengthen the nation’s immunization infrastructure.

• Increase vaccine access. Ensure that all communities and populations have equitable access to vaccines. This opportunity invests in programs that identify and prioritize populations of focus, and their defined needs, based on:

◦ Disparate vaccine coverage rates associated with structural and social conditions.

◦ Unique and intersectional geographic, sociodemographic, and other characteristics.

Step 1: Review the Opportunity 10

• Improve vaccination equity. Support efforts to reduce disparities in vaccinations and pursue equitable distribution and administration of vaccines. This opportunity invests in programs that focus on:

◦ Knowledge-building regarding disparities in vaccination coverage.

◦ Collaboration with trusted community partners.

◦ Increasing uptake across communities.

• Promote vaccine confidence and demand. Invest in increasing trust, confidence, and demand for vaccines across communities.

• Enhance data and evaluation. Invest in enhancing existing data systems and creating new tools to improve the quality of data and of program outcomes.

• Strengthen program support for partners. Invest in enabling and building partner capacity in immunization across the country. This opportunity builds and leverages strong networks of partners and increases collaboration opportunities to help advance vaccine confidence, equity, and demand activities.

• Enhance vaccination response readiness. Invest in improved systems, data, and capabilities to respond to emerging threats and improve readiness across the nation.

◦ Component 2: Rapid small-scale response to VPD outbreaks or other public health emergencies.

◦ Component 3: Rapid large-scale response to VPD outbreaks or other public health emergencies.

This funding opportunity builds on the strong historic work of the past and lessons learned during the pandemic. It also pushes forward with a commitment to increase vaccination coverage across the lifespan for all people and population groups. As the nation transitions out of the COVID-19 pandemic, routine vaccination remains a key part of healthy living for children, adolescents, and adults.

Related work

• Immunization and Vaccines for Children [CDC-RFA-IP19-1901]

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 11 https://www.grants.gov/search-results-detail/309317

Purpose The purpose of this funding opportunity is to protect all people from vaccine-preventable diseases using these seven strategies:

• Strengthen program infrastructure and management.

• Increase vaccine access.

• Improve vaccination equity.

• Promote vaccine confidence and demand.

• Enhance data and evaluation.

• Strengthen program support for partners.

• Enhance vaccination response readiness.

These strategies will reduce morbidity and mortality from vaccine-preventable diseases.

Approach Program logic model The following logic model includes the strategies and activities required under this NOFO for Components 1, 2, and 3.

The logic model also includes the program’s expected outcomes. Outcomes are the results that you intend to achieve and usually show the intended direction of change, such as increase or decrease.

Not all outcomes apply to all strategies. The table shows how they apply.

You will use these outcomes as a guide for developing performance measures.

Step 1: Review the Opportunity 12

Table: Strategies and outcomes

Strategies and Activities Short-Term Outcomes Intermediate Outcomes Long-Term

Outcomes

Strengthen program infrastructure and management

• Maintain diverse and qualified staff.

• Manage and distribute vaccine assets using VTrckS.

• Maintain IIS capabilities.

• Train and monitor Vaccines for Children (VFC) and Adult Immunization Program (AIP) providers.

• Conduct effective fiscal management.

Increase vaccine access

• Develop, maintain, and enhance network of public and private vaccination providers to equitably administer VFC, Section 317, and state-funded vaccines to eligible adults and pediatric populations.

Improve vaccine equity

• Use qualitative and quantitative data to identify populations of focus.

• Implement and evaluate interventions.

Promote vaccine confidence and demand

• Increased staff capacity to implement and monitor immunization program.

• Increased network of providers in diverse settings and low-income areas.

• Strengthened provider practices through site visits.

• Increased and strengthened collaboration with community partners and trusted messengers to increase vaccine access, equity, confidence, and demand.

• Increased partner education opportunities and effective outreach messages.

• Increased network of providers in tribal health organizations, federal IHS-run facilities, and Urban Indian organizations.

• Increased vaccination efforts in mobile clinics, community centers, and social gatherings.

• Increased vaccination of children, adolescents, and adults in communities experiencing vaccine hesitancy and inequities.

• Increased dissemination of inclusive and accessible educational materials and outreach messages to mitigate mis/dis-information.

• Increased monitoring and evaluation of the immunization program and surveillance systems.

• Maintain IIS interoperability, data completeness, and efficiency.

• Increased preparedness for emergency response to outbreaks and other

• Increased vaccine access.

• Increased vaccine confidence and demand.

• Enhanced data and evaluation.

• Strengthened program support for partners.

• Improved vaccination equity.

• Enhanced vaccination response readiness.

Step 1: Review the Opportunity 13

Strategies and Activities Short-Term Outcomes Intermediate Outcomes Long-Term

Outcomes

• Establish partnerships with trusted messengers and organizations, dissemination of inclusive and accessible education materials and messages, and mitigation of vaccine mis/disinformation.

Enhance data and evaluation

• Operate and maintain data systems, including IIS capabilities and data quality.

Strengthen partner support

• Develop or engage a coalition.

• Provide education opportunities.

Enhance vaccination response readiness

• Conduct vaccine-preventable disease surveillance.

• Conduct outbreak planning and exercises, including mass vaccination exercises.

• Decreased mis/ disinformation regarding vaccination.

• Maintained Immunization Information System (IIS) according to

CDC IIS

Functional Standards.

• Developed and updated pandemic and emergency vaccination response plan in collaboration with community partners.

• Increased strength and resilience across the immunization workforce.

public health emergencies.

• Increased community understanding of immunization.

• Maintained quality, compliance, and integrity of the VFC program, Section 317 and state-funded vaccination programs.

• Maintained procedures ensuring vaccines purchased from federal contracts are properly ordered, stored, and managed.

Step 1: Review the Opportunity 14

Strategies and activities This section elaborates on the strategies and activities described in the logic model and provides details about how you expect to implement your program.

You must execute the NOFO requirements and meet period of performance outcomes for each strategy outlined.

You can find strategy and activity resources and examples in the Strengthening Vaccine-Preventable Disease Prevention and Response Companion Guide (CG) located in VFC CAMP Knowledge Center.

Component 1: Core

Strategy 1: Strengthen program infrastructure and management

To strengthen the immunization program, you will be expected to:

• Assess program capacity and needs.

• Plan for resource allocation and use.

• Build staff capacity.

• Monitor funding and expenditures.

• Coordinate with local health departments and partners to ensure immunization access across jurisdictions.

To fulfill these expectations, you must complete the following activities:

• Manage vaccine purchase and distribution according to CDC guidelines.

◦ Order, distribute, and administer vaccines with the appropriate funding source and in sufficient quantities to meet the needs of the populations being served. Ensure that VFC vaccines are administered only to eligible participants.

◦ For vaccines purchased with non-CDC funds:

▪ When entering bulk orders or approving state-funded direct ship provider orders, approved funds must be available at the time the order is entered or approved.

▪ Bulk orders must be purchased and received at the CDC depots prior to placing provider orders.

◦ Purchase an alternative vaccine, as directed by CDC, to obtain state, local, or CHIP credit when unable to purchase a vaccine due to vaccine shortages or contract minimums.

Step 1: Review the Opportunity 15

◦ Store and handle vaccines according to CDC recommendations in the Vaccine Storage and Handling Toolkit.

• Attend and contribute to CDC-led, immunization-program-related meetings, technical site visits, calls, surveys, trainings (e.g., recipient immunization meetings, monthly all-recipient calls, new program manager orientation, reverse site visits, VFC, IQIP, IIS, school vaccination, adult vaccination, perinatal hepatitis B prevention, etc.).

• Provide trainings, job aids, and follow-up support to providers that explain:

◦ How to use CDC’s vaccine order management system or recipient vaccine ordering system for immunization inventory and ordering.

◦ Vaccine ordering policies and requirements, including CDC’s inventory-on-hand and supporting documentation for vaccine orders.

◦ How to properly store and handle publicly-purchased vaccines, using CDC’s Vaccine Storage and Handling Toolkit.

◦ CDC’s vaccine purchase policies, including contract restrictions.

• Manage the Vaccine Tracking System (VTrckS) access for jurisdictional staff, including:

◦ Removing, within 24 hours, 100% of the users who no longer need access.

◦ Identifying and maintaining a designated proofing agent (DPA).

• Support the integrity and viability of federal vaccine inventory by applying the National Center for Immunization and Respiratory Diseases’ (NCIRD) policy on recipient-supported vaccine depots.

• Maintain immunization information system (IIS) capabilities to support Immunization Programs:

◦ Operate and maintain the IIS according to CDC IIS Functional Standards by conducting routine assessments (e.g., Measurement and Improvement (M&I), IIS Quarterly Report [IISQR], IIS Certification) within the timeframe appropriate for each assessment as defined in the CG.

▪ Maintain and enhance the vaccine ordering, inventory management, and vaccine accountability functionality in the IIS to support national vaccine programs.

▪ Use Clinical Decision Support for Immunization (CDSi) guidance and test cases to ensure IIS evaluation and forecasting is compatible with Advisory Committee on Immunization Practices

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 16 https://www.cdc.gov/vaccines/hcp/downloads/storage-handling-toolkit.pdf https://www.cdc.gov/vaccines/hcp/storage-handling/?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html https://www.cdc.gov/iis/functional-standards/resource.html https://www.cdc.gov/iis/functional-standards/resource.html

(ACIP) recommendations. Update the IIS platform within 45 days of any new CDSi guidance.

▪ Evaluate IIS capabilities and plan activities to optimize for scalability and performance, minimize systems downtime, and ensure uninterrupted immunization data flow in alignment with CDC requirements by meeting the current published version of the Functional Standards.

▪ OPTIONAL: Enhance recipient-developed IIS platform by adding a new functionality to automate the Vaccine Tracking System (VTrckS) External Information System (ExIS) interface to upload vaccine orders (and other transactions) to VTrckS, as applicable.

Recipients that are planning to transition to a CDC-funded technology partner platform within the next two years should not focus on this activity.

• Maintain diverse and qualified staff and partners to effectively implement and administer the program.

◦ You must have at least the following staff:

▪ 1 full-time program manager.

▪ 1 full-time Vaccines for Children (VFC) coordinator (except for recipients that do not receive VFC funding).

▪ 1 full-time IIS manager.

▪ 1 person responsible for managing the Vaccine Spend Plan.

◦ You may also want to include the following staff:

▪ Administrative Support.

▪ Adult Immunization Coordinator.

▪ Data Analyst.

▪ Fiscal Manager.

▪ Grants Manager.

▪ Health Communicator/Educator.

▪ Health Equity Coordinator.

▪ IIS Data Quality Specialist.

▪ IIS Interoperability Specialist.

▪ Immunization Quality Improvement for Providers (IQIP) Coordinator.

▪ Perinatal/Maternal Immunization Coordinator.

▪ Program Evaluator.

Step 1: Review the Opportunity 17

▪ School Vaccination Coordinator.

▪ Vaccine Confidence Strategist.

▪ Vaccine Preventable Disease Epidemiologist.

• Conduct and track vaccine provider site visits per CDC guidance.

• Maintain an effective Immunization Quality Improvement for Providers (IQIP) Program to strengthen provider vaccination practices and reduce barriers and missed opportunities for vaccination of children and adolescents.

◦ Partner with a minimum of 25% of VFC-enrolled providers to implement the 12-month IQIP process to increase vaccine uptake.

◦ Collaborate with providers to implement two quality improvement (QI) strategies. You must select one of the following strategies to implement:

▪ Strengthen vaccination communications to address vaccine hesitancy.

▪ Provide strong vaccine recommendation.

◦ Complete the IQIP process with a minimum of 85% of VFC-enrolled providers who receive an IQIP site visit within 12 months.

◦ Collaborate with IIS staff to ensure provider-level vaccination coverage assessment capability for quality improvement projects.

◦ Report all IQIP program data to CDC within 10 days of every provider-level encounter.

• Meet monthly with fiscal staff to develop, track, monitor and forecast budgets, including funds provided to subrecipients or contractors. Ensure expenditures are budgeted appropriately by funding source.

• Complete reports and submit by deadlines outlined in the Reporting Section.

• Implement the following Immunization Programs:

◦ Vaccines for Children Program (VFC) required activities:

▪ Recruit and enroll provider locations.

▪ Manage vaccine ordering, inventory maintenance, and storage and handling.

▪ Conduct site visits to ensure provider compliance.

▪ Monitor for fraud and abuse.

▪ Implement written policies and procedures to govern the VFC program.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 18 https://www.cdc.gov/iqip/php/about-for-providers/index.html https://www.cdc.gov/iqip/hcp/strategies/index.html https://www.cdc.gov/iqip/hcp/strategies/index.html

▪ Note: The VFC Operation Guide provides the program requirements, supplemental information, and best practices.

◦ Adult Immunization Program required activities in Domains 1 and 2 of the Adult Immunization Framework located in VFC CAMP Knowledge Center.

Adult Immunization Program Expansion

You must maintain and enhance the Adult Immunization Program development and capacity by implementing the Adult Immunization Program Framework (“Framework”). The Framework package provides guidance, supplemental information, and best practices for implementing activities aimed at developing or maintaining an Adult Immunization Program.

You may be engaged in activities at different maturity levels (i.e., Levels 1 - 4) across the domains. Activities may not necessarily fall into a single level of maturity, and you will not be expected to complete Levels 1 through 4 within each domain before progressing to the next domain. However, proposed work plans and activities should prioritize addressing activities in lower levels first, if not already completed.

CDC recognizes the funding in this NOFO is not adequate to build and maintain a comprehensive adult immunization program. You should plan strategically to focus on activities in Domains 1 and 2.

Required activities (years 1 and 2)

• In the first three months of each budget year, you are required to assess your current adult immunization program by completing the Adult Immunization Program Framework Checklist.

• You will determine program gaps from responses to key questions in Domain 1 (Organizational Goals and Priorities) and Domain 2 (Organization Capacity) of the Adult Immunization Program Framework Checklist.

• Based on the identified gaps in Domains 1 and 2, you are required to develop the next steps and procedures to advance to the next maturity level within that Domain, including figuring out the process of what would be required to do that activity.

Domain 1: Organizational goals and priorities

• Develop and share a mission statement.

• Review identified goals, objectives, performance indicators, and activities.

• Identify and engage policymakers to support adult immunization goals, objectives, performance indicators, and activities.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 19 https://www.cdc.gov/vaccines-for-children/downloads/operations-guide-508.pdf

Domain 2: Organizational capacity

• Put in place an organizational structure to support an adult immunization program.

• Provide internal capacity-building opportunities for adult immunization program staff.

• Identify and use diverse sources of funding (i.e., federal, state, local, other funds) to support adult immunization.

Optional activities (years 3 to 5)

Continue to address identified gaps and complete at least 1 activity from each domain:

Domain 3: Adult provider networks

• Review and calculate the number of adult providers and adult patients in your jurisdiction.

• Examine, evaluate, and update existing adult vaccine provider formal agreements or enrollment forms.

• Review and evaluate existing systems for adult providers to order vaccines, report inventory, and track returns and wastage.

Domain 4: Provider compliance

• Examine and improve existing adult vaccine provider enrollment processes and enrollment site visit protocols.

• Examine and improve adult vaccine provider compliance program site visit processes and protocols.

• Review storage and handling processes for adult vaccines and assess compliance with CDC standards.

• Develop and implement quality improvement initiatives for adult vaccine providers.

Domain 5: Data monitoring and evaluation

• Review and improve processes to strengthen adult vaccine provider onboarding to the IIS.

• Develop or improve a plan to increase provider reporting of adult vaccines to the IIS.

• Develop or improve IIS data quality plan specific to adult populations.

• Develop or improve systems to monitor the overall adult vaccine program, including adult vaccine providers.

Step 1: Review the Opportunity 20

Domain 6: Provider and partner education

• Disseminate and provide guidance on new and existing resource and training opportunities to adult vaccine providers.

• Provide training and technical assistance opportunities for providers on the utilization of the IIS.

• Engage and collaborate with organizations, coalitions, and trusted messengers to improve resource sharing and capacity, and implement innovative approaches to enhance vaccine information, access, and outreach.

• Review and implement the CDC Success Framework for Adult Immunization Partner Networks.

Strategy 2: Increase vaccine access

To ensure access to vaccines, you will need to:

• Implement the Vaccines for Children (VFC) program.

• Identify and maintain a network of providers to administer Section 317-and state- or local-funded vaccines to eligible populations.

You will be required to ensure that all communities and populations have equitable access to vaccines by completing the following activities:

• Recruit and maintain a network of public and private vaccination providers to equitably administer VFC, Section 317, and state-funded (if applicable) vaccines to eligible adult and pediatric populations according to ACIP/CDC recommendations. You must:

◦ Complete an assessment of all healthcare providers in the jurisdiction.

◦ Develop activities to maintain the current providers and enroll new providers. Examples of providers to enroll include:

▪ Primary care providers.

▪ Federally qualified health centers (FQHCs).

▪ Rural health clinics (RHCs).

▪ Retail pharmacies.

▪ School-based providers.

• Expand the network of prenatal or maternal providers and birthing hospitals (centers) in VFC and adult programs. You must:

◦ Identify and enroll at least 30% of birthing hospitals (centers) in the VFC program.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 21 https://www.cdc.gov/success-framework/php/adult-imz/?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/adults/success-framework-imz-partners.html https://www.cdc.gov/success-framework/php/adult-imz/?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/adults/success-framework-imz-partners.html

◦ Offer all age-appropriate VFC vaccines, including nirsevimab, to VFC-eligible newborns before hospital discharge.

◦ Collaborate with health system and providers to identify 80% of pregnant persons that are hepatitis B surface antigen (HBsAg) positive and provide the following case management to their infants:

▪ Provide postexposure immunoprophylaxis (hepatitis B and hepatitis B immune globulin) within 12 hours of birth to 98% of identified infants.

▪ Complete the hepatitis B vaccine series (all valid doses) by 12 months of age for 90% of identified infants.

▪ Provide post vaccination serologic testing as recommended by ACIP to a minimum of 75% of identified infants.

• Engage American Indian/Alaska Native (AI/AN) communities and other tribal partners to assure vaccine access and improve vaccination coverage within the jurisdiction’s AI/AN population. You must:

◦ Enroll Tribal health organizations, Urban Indian Organization Health Centers, and Indian Health Service providers in VFC and adult programs.

◦ Provide sufficient vaccine supply to AI/AN-serving facilities.

◦ Educate all providers and AI/AN communities on VFC eligibility and access.

◦ Develop and implement culturally appropriate confidence and demand communication strategies.

Strategy 3: Improve vaccination equity

You will need to implement and evaluate two interventions to improve vaccination coverage, reduce vaccination coverage disparities, and increase equitable vaccine distribution and administration. You may implement and evaluate these interventions at the same time or sequentially. Evaluation-related guidance, standard tools and templates, and examples of data sources can be found in the CG.

You will be expected to complete the following activities:

• Use qualitative and quantitative data to identify communities, populations, or geographic areas with low vaccination coverage or at high risk for VPD outbreaks, focusing on disparities or inequitable access.

Examples include:

◦ Consistently lower routine childhood vaccination rates for one or more vaccines compared with national estimates.

Step 1: Review the Opportunity 22

◦ Experience with a recent vaccine-preventable disease outbreak (since 2018).

◦ Vaccination coverage that has not met Healthy People 2030 goals despite public health efforts.

◦ Geographic area with a high Social Vulnerability Index.

• Provide justification for selection of two populations of focus and develop strategies and activities to implement the following two interventions, one for each population.

◦ Increase vaccine confidence and demand by identifying and working with trusted community messengers. (For additional details, please see Promote Vaccine Confidence and Demand section.)

◦ Increase access to vaccination by establishing additional or alternative vaccination providers (e.g., pharmacy enrollment into the VFC Program, mobile/temporary clinics, non-traditional settings). (For additional details, please see Vaccine Access section.)

• Evaluate each intervention using templates and tools provided in the CG.

The evaluation is required to include process measures and estimates of the costs to implement the intervention. Optional elements to include in the evaluation include the following.

◦ Outcome measures.

◦ Estimate of any benefits, such as number of additional vaccine doses administered or increase in vaccination coverage that resulted from the intervention.

Strategy 4: Promote vaccine confidence and demand

Community engagement and partnerships are essential to maintain and increase vaccination coverage across the lifespan. Providing accurate and consistent messages from trusted messengers about vaccination to all populations is critical to:

• Educate providers, partners, and consumers.

• Address vaccine equity issues by building vaccine confidence and demand.

Trusted messengers are people seen as credible sources of information by specific populations and can include doctors, community and faith-based leaders, and local celebrities.

Complete the following required activities to promote vaccine confidence and demand:

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 23 https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination https://www.atsdr.cdc.gov/place-health/php/svi/index.html

• Strengthen existing partnerships and engage with new partners, including trusted messengers.

• Disseminate resources to providers to ensure they are equipped to discuss vaccine concerns confidently and make recommendations.

• Disseminate and promote inclusive and accessible educational materials and outreach messages through a variety of channels (e.g. television, radio, billboards, print, digital, websites, and social media).

◦ Recipients are encouraged to use CDC-developed materials that can be modified, such as Back to School, National Immunization Awareness Month, and National Influenza Vaccination Week.

◦ Communication and print resources can be found at Communication and Print Resources | CDC.

Strategy 5: Enhance data and evaluation

Data quality is the key to successfully reaching programmatic goals, effectively monitoring immunization coverage, identifying areas for improvement, and responding to vaccine-preventable disease (VPD) outbreaks.

Access to timely data is used to evaluate the immunization program and provide the evidence needed to:

• Manage programs more effectively and efficiently.

• Assess and improve existing activities.

• Plan and implement new activities.

• Understand reasons for performance.

• Demonstrate value.

• Ensure accountability.

To support data collection on disease trends and vaccine uptake, engage in various surveillance and reporting activities:

Vaccine Adverse Event Reporting System (VAERS)

Surveillance of vaccine safety issues is essential. VAERS analyses can trigger investigations of possible relationships between a vaccine and adverse events. VAERS is also an acceptable reporting tool for vaccine administration errors, even in circumstances where no adverse event occurs. You play a critical role in this process. You will need to:

• Submit, facilitate the submission of, or follow up on VAERS reports as requested.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 24 https://www.cdc.gov/vaccines/communication-resources.html https://www.cdc.gov/vaccines/communication-resources.html

• Collaborate and educate healthcare providers to ensure their awareness of VAERS, the importance of reporting adverse events after vaccination to VAERS, and how VAERS data can help patient understanding of vaccine safety.

National Immunization Surveillance

Immunization Information Systems (IIS) Required Activities

• Meet CDC requirements for data quality. High quality data measurements are found in the IIS Data Quality Blueprint.

◦ Assess key attributes of IIS data quality and leverage CDC data quality reports to identify strengths and weaknesses (e.g., completeness, timeliness). Implement solutions to address weaknesses.

◦ Identify, assess, and plan to incorporate data from available sources to improve demographic record completeness and validity (e.g., provider enrollment information, vital records, newborn screenings, driver’s license data, the jurisdiction’s Health Information Exchange).

◦ Identify and resolve duplicate and fragmented patient records and vaccination events.

◦ Submit quarterly routine vaccination data to CDC and collaborate with CDC in pre- and post- submission quality control activities to verify results.

◦ Use an electronic tool to verify validity of addresses in the IIS or validate accurate assignment of address to an individual to improve demographic records. Ensure residential addresses are standardized and validated as United States Postal Services’ addresses to meet these goals:

▪ Year 1: Provide baseline percentage of records in the IIS with validated USPS addresses.

▪ Year 5 end: Achieve 95% record validity.

◦ Participate in and meet CDC public health surveillance system requirements.

◦ Complete CDC and Office of the National Coordinator of Health IT’s (ONC) IIS Data Quality Certification requirements, once available. Use an ONC public health IT certified IIS platform, once available.

◦ OPTIONAL: Participate in Privacy Preserving Record Linkage (PPRL) to ensure a consolidated vaccination record for each person in the IIS and submit PPRL data as part of routine data submission.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 25 https://www.cdc.gov/vaccines/programs/iis/downloads/Data-Quality-Blueprint-508.pdf#:~:text=Immunization%20Information%20Systems%20%28IIS%29%20Data%20Quality%20Blueprint%20The,focus%20on%20improving%20IIS%20data%20throughout%20the%20lifespan.

◦ OPTIONAL: Provide data quality feedback and recommendations for improvements to providers and staff annually.

• Maintain IIS’s interoperability in accordance with current technology standards to improve data completeness and increase efficiencies by completing the following activities.

◦ Maintain current bidirectional connections.

◦ Provide a baseline of the number of providers with interoperable interface connections to the IIS in Year 1.

◦ Increase the number of additional providers with interoperable interface connections to the IIS in Years 2 – 5.

◦ Align recipient’s IIS Health Level 7 (HL7) Implementation Guide (IG) with the National HL7 IG, except for jurisdictional policies preventing alignment, by the end of Year 5.

◦ Maintain bidirectional data exchange that conforms to the latest HL7 standards.

▪ Validate data exchange through American Immunization Registry Association’s (AIRA) Measurement and Improvement Initiative (M&I).

▪ Submit the most recent M&I report for baseline measurement during Year 1.

▪ Achieve validation within all interoperability focused content areas during Years 2 – 5.

⁃ Transport Basic.

⁃ Submission Basic.

⁃ Submission Basic and Acks.

⁃ Query Basic.

⁃ Submission Complete.

⁃ Query Complete.

⁃ Transport Complete.

◦ Participate in the Immunization (IZ) Gateway for interjurisdictional data exchange, data exchange with multijurisdictional providers, and with CDC in all use cases, as appropriate by jurisdictional policies.

◦ Enroll and onboard providers to exchange vaccination data with the

IIS.

▪ Provide a baseline for the percentage of providers in queue for enrollment and onboarding, as well as set a timeline for onboarding completion during Year 1.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 26 https://aira.memberclicks.net/measurement-improvement https://aira.memberclicks.net/measurement-improvement https://aira.memberclicks.net/measurement-improvement

▪ Reduce the percentage of providers in queue for enrollment and onboarding during Years 2 - 5.

◦ OPTIONAL: Standardize provider enrollment and onboarding, including participation in the HL7 IG digitalization project to document local HL7 IG into Implementation Guide Authoring and Management Tool (IGAMT).

◦ OPTIONAL: Monitor, maintain, and provide feedback on existing interfaces, including providing monthly error report to providers.

◦ Support and inform provider and partner efforts to improve immunization rates using IIS data.

◦ Maintain IIS query capacity to generate vaccination coverage and line list reports based on user-defined query parameters including, at minimum:

▪ Patient age group, as calculated by date of birth range.

▪ Race and ethnicity.

▪ Geographic area (e.g., ZIP Code).

▪ Recipients of specific vaccines.

▪ Required activities:

⁃ Year 1: Maintain capability to generate vaccination coverage and line list reports.

⁃ Year 2: Establish baseline in provider-generated reports.

⁃ Years 3 to 5: Collaborate with CDC to improve capacity to generate vaccination coverage and line list reports.

◦ Provide Immunization program and IIS staff access to analyze and use IIS data to support coverage rate improvement and inform interventions based on user-selected criteria.

▪ IIS staff, non-IIS immunization program staff, and providers use IIS to produce provider-level coverage assessments.

▪ Providers and jurisdictions use IIS to support reminder recall and other activities to improve coverage by generating:

⁃ Provider-level reminder recall reports at least annually.

⁃ Jurisdiction-level reminder recall reports at least annually.

◦ OPTIONAL: Provide technical help to healthcare providers on generating coverage estimates to inform vaccination efforts.

• Collaborate with other jurisdictions and technology partners to support IIS consistency and standardization:

Step 1: Review the Opportunity 27

◦ Share effective strategies, costs for system enhancements, platform upgrades, enhancements, and defect patches with peers.

◦ Leverage peer activities and lessons learned to meet IIS functional standards.

◦ Use available CDC-shared services, where appropriate, to ensure standardization and create efficiencies.

▪ Create a standard structure for planning, managing, and overseeing IIS technology solutions over the entire life cycle using IT governance and project management best practice.

▪ Develop appropriate deliverables and artifacts for each phase.

• Support emergency response activities to assess vaccination coverage and identify populations to prepare for and respond to outbreaks and other public health emergencies.

◦ Enroll and rapidly onboard providers in response-related vaccination programs and IIS.

◦ Require all registered providers to submit test messages once every 6 months, indicating response readiness.

◦ Assess the proportion of providers that comply with the provider agreement:

▪ Report data to the IIS within established timeframes.

▪ Test and maintain response capability in the IIS, ancillary, and CDC systems by submitting of data in accordance with CDC requirements for public health response.

• Contribute to the development of accurate national coverage assessments, by submitting record-level data and aggregate data.

◦ Collect, store, and submit to CDC all required vaccine administration data elements.

◦ Submit an executable CDC Data Use Agreement within the first 3 months of Year 1.

◦ Submit redacted data to CDC to support IIS data quality improvement, estimate national coverage, respond to ad hoc inquiries, and monitor disease outbreak responses and trends in vaccine administration across the lifespan.

◦ Participate in CDC efforts to improve IIS data quality and report progress as required through the submission of record-level data and aggregate data.

Step 1: Review the Opportunity 28

Immunization Information Systems (IIS) – National Immunization Survey Integration Project (NIS)

You will need to participate in the integration of IIS data with CDC’s (NIS). This will help strengthen vaccination surveillance systems by leveraging rich data sources to estimate vaccination coverage.

Complete the following activities:

• Identify and implement steps to increase the percentage of IIS records for children ages 0 through 17 years with at least one current telephone number.

• Monitor the percentage of IIS records for children that have at least one current telephone number.

• Develop, implement, or maintain data use agreements (DUA) that will allow CDC’s NIS contractor to conduct the NIS by using selected patient information from children in the IIS (e.g., age) to more efficiently sample households.

◦ Obtain recipient-specific approvals needed for data sharing (e.g., IRB, legal review).

• Establish protocols to share selected IIS data with the NIS contractor and share IIS data quarterly with the NIS contractor once the DUA is signed.

Vaccine-Preventable Disease (VPD) Surveillance

• Implement, maintain, and evaluate vaccine-preventable disease surveillance systems.

• Investigate and document cases or outbreaks of VPDs that are nationally notifiable and reportable in the jurisdiction, ensuring that appropriate clinical specimens are tested.

• Collect relevant epidemiologic information in accordance with the CDC Manual for the Surveillance of Vaccine-Preventable Diseases.

• Implement appropriate public health activities for the control and prevention of cases or outbreaks of VPDs that are nationally notifiable and reportable in accordance with the CDC Manual for the Surveillance of Vaccine-Preventable Diseases.

• Collaborate with appropriate staff to submit timely and complete data to appropriate public health authorities for case and outbreak surveillance of VPDs that are nationally notifiable and reportable in the jurisdiction.

◦ Notify CDC immediately about cases by phone or email and electronically transmit complete case notifications and supplemental

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 29 https://www.cdc.gov/surv-manual/php/?CDC_AAref_Val=https://www.cdc.gov/vaccines/pubs/surv-manual/index.html surveillance information to CDC via the National Notifiable Diseases Surveillance System* (NNDSS) within 1 month of diagnosis for:

▪ Congenital rubella syndrome (CRS).

▪ Diphtheria.

▪ Measles.

▪ Polio.

▪ Rubella.

▪ Novel influenza A.

▪ Pediatric (<18 years of age) influenza deaths.

◦ Collect and electronically transmit complete case notifications and supplemental surveillance information to CDC via NNDSS* within one month of diagnosis for:

▪ Haemophilus influenzae.

▪ Meningococcal disease.

▪ Mumps.

▪ Pertussis.

▪ Invasive pneumococcal disease.

▪ Tetanus.

▪ Hepatitis A.

▪ Hepatitis B.

▪ Varicella.

• Assess timeliness and completeness of each case or outbreak investigation, reporting, and notification for VPDs that are nationally notifiable and reportable in the jurisdiction.

• Monitor the quality of VPD surveillance by reviewing surveillance data and surveillance indicators** to identify problems and strategies to resolve the problems, in accordance with the CDC Manual for the Surveillance of Vaccine-Preventable Diseases.

*Jurisdictions other than the 52 specified in NNDSS (i.e., 50 states, New York City, and Washington, DC) may be approved by NCIRD to transmit case or outbreak data to CDC via other methods (e.g., CSV file, phone, fax, email).

**VPD Surveillance Indicator Reports are created by NCIRD for the 50 states, New York City, and Washington DC, as those are the jurisdictions specified in NNDSS. Jurisdictions that do not receive jurisdiction-specific surveillance indicator reports from NCIRD are required to conduct and document internal surveillance data reviews.

Step 1: Review the Opportunity 30

School Vaccination Assessment

Complete the following activities:

• Assess kindergarten (school-entry) vaccination coverage and exemption levels, in accordance with state vaccination and assessment requirements and report data to CDC annually. These data, broken out by school type including homeschool, should include:

◦ Number of students enrolled in any…