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Challenges With Vaccination Data Hinder State and Local Immunization Program Efforts To Combat COVID-19


Many State and local immunization programs reported having incomplete individual-level data for the more than 250 million COVID-19 vaccine doses administered by Federal agencies and retail pharmacies that receive vaccines directly from the Centers for Disease Control and Prevention (CDC). These programs rely on individual-level data in their immunization databases to manage vaccination campaigns.


Successful national vaccination campaigns and routine vaccination efforts depend on complete and timely vaccination data being available to State and local immunization programs. CDC relies on State and local immunization programs to monitor vaccination coverage and to plan strategies to increase uptake among communities with low coverage. To fulfill this important role, immunization programs need complete and accurate individual-level vaccination data from all providers.

Comprehensive data are important for State and local immunization programs; however, two key types of providers are not required to submit individual-level data to immunization programs' databases: Federal agencies and retail pharmacies that partner with the Federal government (to which we refer as retail pharmacy partners). Combined, these two types of providers have already administered over 250 million COVID-19 vaccine doses.


In December 2021 we administered a survey to 56 State and local immunization programs that have immunization databases. We asked immunization programs whether they receive COVID-19 vaccination data from Federal agencies and retail pharmacy partners; whether they experience challenges in obtaining complete and accurate data; and how these challenges impact their vaccination campaigns, if at all.


State and local immunization programs reported experiencing challenges in obtaining data for their immunization databases both from Federal agencies that provide vaccinations and from retail pharmacies that receive vaccines from CDC. As of December 2021, nearly all State and local immunization programs reported that they were not receiving individual-level data on vaccinations from at least one of the three Federal agencies with the largest vaccination programs: the Department of Veterans Affairs (VA), the Department of Defense (DoD), and/or the Indian Health Service (IHS). Most programs reported that they received data from retail pharmacy partners, but the data were often incomplete, inaccurate, or delayed. Federal agencies and retail pharmacy partners are not required to submit vaccination data to immunization programs.

Immunization programs said that without complete individual-level vaccination data, they struggled to accurately measure vaccination coverage and to target outreach to unvaccinated and vulnerable populations. Because State and local immunization databases contain data on all types of vaccinations, if left unresolved, these challenges will likely hinder the ongoing COVID-19 vaccination campaign, responses to future public health emergencies, and routine vaccination campaigns (e.g., flu shots).

State and local immunization programs said that they need help from CDC to obtain comprehensive vaccination data. Immunization databases are operated by 64 separate States, cities, and territories, with varying policies and technological capabilities. Federal agencies and retail pharmacy partners agreed to submit COVID-19 vaccination data either to State and local immunization databases or directly to CDC. CDC reported that it was determined that Federal agencies would transmit data directly to CDC only, rather than to immunization databases, because of policy and technical challenges that could not be resolved in the necessary timeframe. Retail pharmacy partners often do not share these challenges, and CDC reported encouraging them to submit data directly to immunization databases. The Federal government set up systems outside of State and local immunization databases to help share data that CDC receives with immunization programs, but the data it shares are aggregated, and programs reported that these aggregate data were not sufficient to comprehensively monitor their vaccination campaigns. To meet this need in the long term, CDC established and is working to set up the Immunization Gateway (IZ Gateway)—a data-exchange system intended to connect Federal agencies with immunization programs—but programs reported that it has been delayed. Given the complexity of collecting and sharing data across the many different stakeholders that make up the Nation's public health system, CDC has publicly called for updated data authority to better address public health concerns. However, there are steps CDC can take in the interim to help address immunization program needs.


We recommend that CDC (1) work with State and local immunization programs, and retail pharmacy partners, to mitigate reported data gaps and timeliness challenges and (2) provide educational outreach to ensure that State and local immunization programs are aware of existing tools to address vaccination campaign needs. CDC nonconcurred with our first recommendation and concurred with our second recommendation.