Stockbridge-Munsee Community COVID-19 Vaccine Distribution Priorities and Plan

This Plan is based on the approach outlined in the COVID-19 Vaccination Program Interim Playbook for Jurisdiction Operations (Version 2.0; referred to as “Playbook”) issued by the Centers for Disease Control and Prevention (CDC). The Tribe agreed to comply with the Playbook in the vaccine distribution agreement with Indian Health Service (IHS). Changes required by federal law are incorporated automatically.

 
The CDC recognizes that supplies of the vaccine will, at least initially, be limited. Therefore, its Playbook provides for a phased approach for vaccine distribution based on the amount of vaccine available and prioritized need for the vaccine. The Playbook also allows jurisdictions to prioritize additional critical populations for vaccination.  

ESSENTIAL POPULATIONS 
Essential Populations have highest priority for vaccination and are part of Phase 1 vaccination distribution under the Playbook. This includes healthcare personnel and other critical infrastructure workforce members, persons in long-term care facilities, persons with underlying medical conditions that make them more at risk of severe COVID-19, and persons 65 years or age and older. The Tribe has integrated vaccination of these Essential Populations in its distribution plan.  

CRITICAL POPULATIONS 
The CDC recognizes that tribal communities can be at increased risk of acquiring or transmitting COVID-19.1 In order to help control this risk, the Tribe identifies the following groups as critical populations. Vaccination of these Critical Populations will be prioritized once the Essential Populations are vaccinated.  

•    Stockbridge-Munsee tribal members – based on their status as persons who are the core of this tribal community. While this includes all tribal members, the focus will be on people served through the Stockbridge-Munsee Health and Wellness Center (Health Center).
•    People who are part of the household of Stockbridge-Munsee tribal members –based on their status of also being part of this tribal community and an exposure risk for tribal members. Again, the focus is on people served through the Health Center.
•    IHS beneficiaries served by the Health Center – based on their status as persons who are also part of tribal communities and have an existing relationship with the Health Center.
•    Employees of the Stockbridge-Munsee Community – based on being a possible exposure risk for tribal members.

The Stockbridge-Munsee Community intends to move into vaccination for the Critical Populations under its Distribution Plan once the Essential Populations are vaccinated. 

DISTRIBUTION PLAN 
There are 3 phases of COVID-19 distribution. Each phase identifies priorities for vaccination under that phase. Phase 1 is the initial distribution when there are limited supplies. Phase 2 is when there are larger supplies. Phase 3 is when there are supplies enough for the entire U.S. population.  
In addition to the overall priorities identified in this Plan, the Tribe also prioritizes providing people with their 2nd shot in a two-shot vaccine series. As timely 2nd shot is required to make the vaccine effective, the completion of the series is prioritized over providing additional people with their 1st vaccination shot. 
As the COVID-19 vaccine is perishable and has a short shelf-life, the Health Center may vary from the distribution priority if necessary to ensure that vaccine supplies are used while effective. The identified priority of distribution shall be followed as much as possible.

PHASE 1-A 

Consistent with the Playbook, the initial distribution of the vaccine will be provided to persons in Phase 1-A. Vaccination may be staged to ensure that operations are not adversely impacted.  

•    Healthcare personnel who provide direct care, as well as cleaning/maintenance staff with responsibilities in patient areas, at the Health Center
•    Tribal EMS personnel
•    Long-term care facilities – Ella Besaw Center residents and employees
•    Occupational Health employees

PHASE 1-B

Once the initial Phase 1-A populations are vaccinated, the Tribe will expand vaccination to the people who are the rest of the Tribe’s Essential Populations and then to the Tribe’s Critical Populations. The Tribe recognizes the importance of protecting both vulnerable individuals as well as ensuring that tribal operations are maintained. To ensure both, vaccine allocations will be distributed with 50% going to essential populations and 50% to essential workers for the first delivery of the Pfizer vaccine (which was the vaccine approved and delivered 1st). For the first delivery of the Moderna vaccine as well as the subsequent vaccine deliveries, the allocations will be distributed with 80% of doses going to essential populations and the remaining vaccine doses (~20%) allocated to essential workers.  Once essential workers are vaccinated, then 100% of the allocation goes to essential populations in the order identified until Phase 1-B vaccination list is complete.  

•    Essential Worker Populations – Priority is based on the order identified. Vaccination may be staged to ensure that operations are not adversely impacted.

o    Emergency response – law enforcement and volunteer firefighters
o    On-site staff at the Health Center (in addition to staff under Phase 1-A)
o    Medical transport and Elderly transport employees

o    Food packaging and distribution workers – both employees working with Food Distribution and Elderly’s meal delivery
o    Housing maintenance employees
o    Head Start employees
o    IT technicians (frontline staff)
o    Utility and Roads employees
o    Casino security and housekeeping employees
o    Housekeeping Staff to include the following positions: Housekeeping Coordinator, Housekeeping Supervisor, Housekeeper, Room Attendant and Hotel Maintenance Technician
o    C-Store employees
o    Stockbridge-Munsee leadership (Tribal Council, Chief Judge and the COVID management team)

•    Essential Population – Persons at higher risk

o    Tribal members who are active Health Center patients and are residents of long-term care facilities not located on the Tribe’s reservation
o    Active Health Center patients with medical conditions who possess risk factors for severe COVID-19 illness. Within this category, patients with multiple risk factors will be vaccinated first with older patients vaccinated before younger patients in each group. The following parameters were used as risk factors for this assessment.

    Lung disease, including chronic obstructive lung disease (COPD), cystic fibrosis, pulmonary fibrosis, and moderate to severe asthma
    Heart disease, including heart failure, coronary artery disease, and hypertension
    Chronic kidney disease
    Chronic liver disease
    HIV
    Transplant of any sort
    Any sort of cancer excluding skin cancer
    Diabetes (patients treated as if have 2 risk factors for the assessment of multiple factors for severe COVID-19 illness)
    Obesity (BMI equal or greater than 30)

o    Community members 65 years of age or older (with older persons vaccinated earlier)
o    Other active Health Center patients 65 years of age or older (with older persons vaccinated earlier)

Critical Population – Stockbridge-Munsee tribal members. Priority is based on the order identified under Phase 2.

PHASE 2 

The Tribe will move to Phase 2 vaccination when it begins receiving larger supplies of the vaccine. Phase 2 will begin with vaccination of any persons who are part of the Essential Populations that have not yet been vaccinated and then move to Critical Populations.

•    Essential Populations.  Vaccination prioritized as identified in Phase 1.
•    Critical Population – Stockbridge-Munsee tribal members.  Vaccination prioritized in order identified (with older person is each group vaccinated earlier). Members age 65 and older are covered as part of the Essential Populations.

o    Ages 50 to 64
o    Ages 35-49
o    Ages 19-34
o    Ages 0-18 – once a vaccine is approved for use by children

•    Critical Population –Households of community members age 65 and older
•    Other Critical Populations.

o    Individuals who are part of the household of Stockbridge-Munsee tribal members
o    IHS beneficiaries served as active patients at the Health Center
o    Employees of the Stockbridge-Munsee Community

    Critical services such as payroll, finance, and other critical internal services that are necessary for operations to continue
    Employees who work directly with the public daily or frequently
    Employees who interact with larger numbers of employees daily or frequently (e.g., directors, managers)
    Employees who work with other people less frequently are lower priority for vaccination

•    Existing active patients of the Health Center 

PHASE 3

Vaccine supply is adequate to serve all people who want vaccination. However, distribution will remain prioritized based on Essential Populations and then Critical Populations based on staffing capacity to provide vaccination through the Health Center. 

Once Essential and Critical Populations are served, then vaccination will be available to any other patients served through the Health Center and the general public.