COVID-19 Vaccine: What Public Health Jurisdictions and Dialysis Partners Need to Know

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The federal government is partnering with dialysis organizations, local and state jurisdictions to increase access to COVID-19 vaccines for patients and healthcare personnel in outpatient dialysis clinics. This partnership complements existing jurisdictional efforts to ensure equitable and effective access to COVID-19 vaccines and will increase availability of COVID-19 vaccines for patients in dialysis clinics. These patients are disproportionately affected by COVID-19 and are at high risk of severe illness from COVID-19.

Vaccinating Dialysis Patients and Healthcare Personnel Is Critical

  • In 2021, more than 550,000 people will receive dialysis treatments at approximately 7,000 dialysis clinics in the United States.
  • Dialysis patients are at high risk for serious illness and death from COVID-19. People on dialysis who get COVID-19 have a 50% hospitalization rate and a 20%–30% mortality rate.
  • Dialysis clinics serve patients whether they have COVID-19 or not, and people receiving dialysis cannot always be adequately distanced from one another during treatment. This creates a high-risk environment for other patients and healthcare personnel and underscores the importance of vaccination to protect everyone in dialysis clinics.
  • Chronic kidney disease disproportionately affects racial and ethnic minority groups, including Black or African American, Hispanic, and American Indian or Alaska Native people; 34% of patients on dialysis are Black and 19% are Hispanic.

Dialysis Partnerships Support Rapid Vaccine Delivery

The Centers for Disease Control and Prevention (CDC), in collaboration with the American Society of Nephrology and the Renal Healthcare Association, has developed a plan to help increase access to COVID-19 vaccines for patients receiving dialysis and their healthcare personnel.

Two large dialysis partner organizations, DaVita Inc. and Fresenius Medical Care North America, have enrolled as COVID-19 vaccination providers to increase access to COVID-19 vaccines across dialysis clinics nationwide. DaVita and Fresenius operate approximately 83% of dialysis clinics in the United States. These organizations have extensive reach across the country and have operational, logistical, IT infrastructure, and cold chain and pharmaceutical delivery capacity to serve as capable vaccination providers.

This partnership also supports the delivery of vaccines to other smaller clinics not owned by DaVita or Fresenius. DaVita and Fresenius are registered under a network administrator agreement and are supporting the delivery of vaccine doses to smaller dialysis organizations and independent providers that join these networks. In consultation with CDC, dialysis partners developed a strategy to equitably distribute vaccine across dialysis clinics. CDC is monitoring distribution of vaccine to help ensure fair access.

Additional strategies for distributing federally allocated vaccines to clinics owned by smaller organizations and independent providers are also under consideration.

Federal Effort Supports Vaccination in Dialysis Clinics

A specific federal allocation of COVID-19 vaccines is being directed toward the dialysis vaccination effort. Distribution of federally allocated doses for dialysis clinics started the week of March 29, 2021. The distribution will begin with DaVita and Fresenius facilities. As additional dialysis organizations and independent providers enroll in the network administrator agreement, they will be eligible to receive federal allocation of vaccine.

How Ordering and Distribution Work

  • Dialysis organizations track how many patients and staff at each clinic have not yet received a COVID-19 vaccination.
  • Using this information, enrolled dialysis centers can order vaccine for their clinics using the Vaccine Provider Ordering Portal (VPoP).
    • Federal allocations for dialysis clinics are shipped directly to the ordering clinics.
    • Dialysis clinics may act as a central redistribution location for multiple sites and or receive their own allocation of vaccines for individual site use.

How Dialysis Clinics Report Data

All dialysis clinics receiving federal allocations are required to report inventory and wastage to VPoP and patient administration information to the jurisdiction’s immunization information system (IIS).

DaVita and Fresenius also report administration data for the clinics they operate directly to CDC. Clinics not operated by DaVita or Fresenius only report vaccine administration data to their jurisdiction’s IIS.

Accessing Data Reported by Dialysis Clinics

  • This federal effort uses a redistribution model to reach dialysis clinics with varying numbers of patients and healthcare personnel.
  • Jurisdictions are able to view vaccine orders, shipments, deliveries, and patient administration data in Tiberius for dialysis clinics receiving direct shipments of vaccine from the manufacturer.
    • This information is not visible in Tiberius for dialysis clinics receiving redistributed vaccine from other dialysis clinics.
  • Jurisdictions have access to patient administration data submitted by all dialysis clinics in their jurisdiction through IIS reporting.
  • The VPoP feed provides clinic-level inventory numbers that update daily for all dialysis clinics.

Impact of Federal Dialysis Vaccination Effort on Jurisdiction Vaccination Plans

The federal allocation of COVID-19 vaccines provided for this effort is separate from jurisdictions’ weekly allocations and will be deployed in coordination with jurisdictions. Dialysis clinics that receive a federal allocation will vaccinate any patients or healthcare providers who have not yet been vaccinated in accordance with jurisdictional priority groups.

CDC supports optimizing the use of all COVID-19 vaccine. The Advisory Committee on Immunization Practices recommends expanding vaccine availability to broader population groups when vaccine supply at a certain location is in danger of being unused. Dialysis clinics should use this guidance when making plans to ensure no dose is wasted. Providing vaccine to all eligible patients and staff at one time decreases the possibility of wastage and may be easier for a facility to implement successfully.

Ongoing Jurisdiction Support for Dialysis Clinics Is Important

Jurisdictions should be aware that the size of this federal allocation is limited. While this effort will leverage a variety of strategies, not all dialysis clinics will receive vaccines, and clinics receiving vaccines might get them at different times.

After this effort has concluded, it is anticipated that dialysis clinics might have ongoing needs for small allocations of COVID-19 vaccines. It is critical for jurisdictions to maintain contact with local dialysis clinics to understand their ongoing efforts to provide COVID-19 vaccinations to patients and healthcare personnel and to provide support as needed.

If your jurisdiction has already allocated vaccine doses for dialysis patients and healthcare personnel, you should continue executing vaccine distribution plans to additional populations according to federal and local guidelines. Continuing to leverage partnerships with dialysis clinics will help protect people at high risk in your jurisdiction.

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