Of note, VDH issued an update on September 16 addressing:

• the CDC up-to-date definition for COVID-19 vaccination; and
• FAQs on the bivalent vaccine and up-to-date definition.

VDH prepared this information in response to VHCA-VCAL’s request to the agency for clarification about the bivalent vaccine.

VDH COVID-19 Bivalent Vaccine Update & FAQs
To remain up to date with COVID-19 vaccination, the Centers for Disease Control and Prevention (CDC) recommends that people ages 12 years and older receive one updated Pfizer or Moderna bivalent booster after completing all primary series doses. Remaining up to date with COVID-19 vaccination has important implications for long term care facility staff and resident safety, as well as implementation of prevention measures such as routine testing and resident quarantine recommendations.

Pharmacies are actively working on increasing access to bivalent boosters, but it may take some time to get staff and residents up to date. 

For now, to aid with implementation of testing and quarantine recommendations, long term care facilities may continue to consider residents and staff up to date if they have received all the recommended and currently available COVID-19 vaccine doses they are eligible for until the updated COVID-19 bivalent booster vaccine is available.

Outlined below are frequently asked questions (FAQs) that provide further guidance. 

VDH Frequently Asked Questions 

What has changed with COVID-19 vaccines?  
Previously, the COVID-19 vaccines (monovalent) contained only the original or “parent” strain of the virus that causes COVID-19 infection.

The newly approved bivalent COVID-19 vaccines will target the original or “parent” strain, as well as the strains that are circulating now (BA.4 and BA.5 subvariants of the Omicron variant).

What are the current COVID-19 vaccination recommendations?

• Being Up to Date with COVID-19 vaccination goes a step beyond being Fully Vaccinated to include receiving the most recent booster dose recommended.
• Based on the newly available bivalent booster doses from Pfizer and Moderna, everyone ages 5 years and older who is eligible is now recommended to receive one booster dose:
  • People ages 12 years and older who received a primary series, including those who received a monovalent booster dose(s), are now recommended to receive one bivalent booster dose.
• See the CDC COVID-19 Vaccination Schedule. 

What are the current COVID-19 vaccination recommendations for someone who was recently infected with COVID-19?

• If you already had COVID-19 and recovered, you should still get a COVID-19 vaccine. You should wait until you are recovered and have completed your isolation period.  
• You may consider delaying your next vaccine (primary dose or booster) by three months from when your symptoms started or, if you had no symptoms, when you received a positive test.

What is the current availability of the new bivalent vaccines?

• To date, CDC has made approximately 35 million doses of bivalent vaccines (~30 million Pfizer and ~5 million Moderna) available for ordering and has shipped more than 20 million doses to more than 35,000 administration sites in all states and territories.
• This week, CDC is making an additional 13 million doses of Pfizer’s bivalent vaccine available for ordering, resulting in a total of approximately 43 million available Pfizer doses. There is plenty of Pfizer vaccine, however the Moderna vaccine is currently limited. 
• If a facility ordered Moderna bivalent vaccines, it is likely that only a portion of the order will be fulfilled. 
• Moderna continues to ramp up production, thus additional supply is anticipated towards the end of September or early October. The CDC recommends that vaccinating providers order and utilize Pfizer doses as much as possible in the meantime.

How does my LTCF obtain the new bivalent vaccine?

• LTCFs are recommended to use their regular facility-pharmacy operations to acquire the COVID-19 vaccine for their residents and/or staff. LTCFs should maintain open and constant communication with their contracted pharmacy providers to discuss meeting COVID-19 vaccine needs moving forward, including boosters.

What is VDH doing to help connect LTCFs to the new bivalent vaccines?

• The VDH Pharmacy Team is working to improve access to boosters in LTC settings. The team is working to identify facilities that need assistance in securing COVID-19 bivalent boosters. Facilities that order and offer vaccination by other means should utilize their standard channels. Facilities that otherwise do not have access to COVID-19 bivalent boosters and require assistance with obtaining vaccine may reach out to COVIDPharmacySupport@vdh.virginia.gov.

How can a LTCF access COVID-19 vaccine for their residents and staff if the facility does not have a pharmacy agreement in place?

• Facilities are encouraged to consider enrolling as a vaccine provider to be able to order and administer vaccines to staff and residents themselves. This will allow facilities to vaccinate residents and staff in a more timely manner. For more information, visit the VDH Provider Enrollment Process Flow & Checklist.
• If enrolling as a vaccine provider is not an option, you can consider identifying a pharmacy to contract with if your current pharmacy is not able to meet your needs.
• LTCFs may also submit an off-site clinic request with pharmacies who may be able to assist facilities with their vaccination needs. For more information, visit the CDC pharmacy partner contact information page.

Will CVS and Walgreens be offering bivalent booster vaccines to LTCFs as previously provided through the Federal pharmacy partnership program? 

• The Federal pharmacy partnership program will not be reinstated by CDC for COVID-19 bivalent booster assistance. However, CDC has partnered with various pharmacies to ensure LTCFs are able to access the COVID-19 vaccine. For more information, visit the CDC pharmacy partner contact information page. If you require further assistance in coordinating boosters for your facility, please contact your local health department or email COVIDPharmacySupport@vdh.virginia.gov. 

How will the VDH Office of Licensure and Certification (OLC) be surveying nursing homes with respect to the new up to date definition? 

• Until CMS releases updated guidance for surveyors, current survey procedures remain unchanged. That is, OLC will not be surveying to compliance with testing and quarantine requirements based on the revised up to date definition at this time. 

Where can I obtain more information?

• The VDH COVID-19 Vaccination Toolkit for Long-Term Care Facilities was updated September 16, 2022 to reflect recent changes.
• CDC guidance about how to stay up to date with your COVID-19 vaccines.