Toolkit and Resources

The CDC recommends that everyone 6 months and older should get an updated 2024-2025 COVID-19 vaccine.

Thank you for enrolling in the COVID-19 Vaccine Program. We appreciate all your hard work to help vaccinate people in Washington.

You can use the COVID-19 vaccine program provider checklist (PDF) to guide you through the program requirements and processes. If you have any questions, please contact us at covid.vaccine@doh.wa.gov.

Forms and Processes

Transfers

Vaccine Depots

Wastage

Education Materials

Print Materials for Vaccination Clinics
Communication Toolkits
Patient Education Resources

Printable Resources

Web Resources

Resources for Providers

Conversation Guides

More COVID-19 Vaccine Information

Washington Guidance Statements

Additional Booster Doses Now Authorized for Use

People over the age of 50, and certain immunocompromised individuals, may now receive an additional booster dose of mRNA COVID-19 vaccine if 4 months or more have passed since their last booster dose. Following FDA’s regulatory action, the Western States Scientific Safety Review Workgroup has weighed in to align with updated Centers for Disease Control and Prevention recommendations on additional booster doses.

Providers in Washington state may immediately begin offering a second booster dose to eligible people to help prevent severe disease, hospitalization and death.

Updates for additional booster dose recommendations are as follows:

  • A second booster dose of mRNA COVID-19 vaccine (Pfizer or Moderna) may be administered to individuals 50 years of age and older at least 4 months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine.
  • A second booster dose of the Pfizer-BioNTech COVID-19 vaccine may be administered to individuals 12 years of age and older with certain kinds of immunocompromise at least 4 months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine. These are people who have undergone solid organ transplantation, or who are living with conditions that are considered to have an equivalent level of immunocompromise.
  • A second booster dose of the Moderna COVID-19 vaccine may be administered at least 4 months after the first booster dose of any authorized or approved COVID-19 vaccine to individuals 18 years of age and older with the same certain kinds of immunocompromise.
  • Additionally, based on newly published data, adults who received a primary vaccine and booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least 4 months ago may now receive a second booster dose using an mRNA COVID-19 vaccine.

Thank you for your work in keeping all eligible adults, adolescents, and children 5 and older up to date on their COVID-19 vaccines, which now includes getting additional boosters when eligible. Many people in Washington still have not gotten their original booster shot, so please continue to encourage all eligible patients to get a booster dose of COVID-19 vaccine.

(Guidance updated: March 6, 2022)

Additional COVID-19 Vaccine Doses for Immunocompromised Patient 

On August 13, the U.S. Food and Drug Administration (FDA), Advisory Committee on Immunization Practices (ACIP), and Western States Scientific Safety Review Workgroup recommended a third primary series dose of the Pfizer-BioNTech and Moderna COVID-19 vaccines for certain immunocompromised groups. These groups are more likely to get severely ill from COVID-19 and may benefit from an additional dose. This includes people who:

  • Are receiving active cancer treatment for tumors or cancers of the blood
  • Received an organ transplant and are taking medicine to suppress the immune system
  • Received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system
  • Have moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Have advanced or untreated HIV infection
  • Are receiving active treatment with high-dose corticosteroids or other drugs that may suppress the immune response.

In January 2022, the FDA and Centers for Disease Control and Prevention (CDC) expanded the recommendation for additional doses for people who are immunocompromised to include those 5 years and older.

While the vaccines are 90 percent effective against most coronavirus variants, studies show that immunocompromised individuals do not always build strong immunity. The third dose is not considered a booster dose, but an additional dose for those who did not develop adequate immunity with the two-dose series.

Here's what you should do for your patients who are moderately to severely immunocompromised:

  • If your patient got an mRNA vaccine (Moderna or Pfizer), they should get an additional dose at least 28 days after their second dose. Use the same vaccine brand if possible. If you don't have the same brand available, it is OK to use the other mRNA vaccine brand.
    • Your patient may also get a booster dose at least 5 months after getting the additional (third) dose.
  • If your patient got the Johnson & Johnson (Janssen) vaccine, they should not get an additional dose of Johnson & Johnson or a dose of an mRNA vaccine at this time.
    • However, your patient should get a booster dose at least two months after getting their initial Johnson & Johnson dose.

Please do not administer any doses of vaccine beyond the doses recommended by the Advisory Committee on Immunization Practices (ACIP), even if your patient requests it. If you have questions about patient vaccinations, contact the Clinical Immunization Safety Assessment (CISA) Project to discuss options.

You can read more about considerations for an additional dose of COVID-19 vaccine, including a list of immunocompromising conditions, in the Centers for Disease Control and Prevention's interim clinical considerations.

You can also see:

(Guidance updated: January 10, 2022)

Bivalent boosters recommended for ages 5 years and older

Bivalent COVID-19 booster vaccines are now available for a wider age range. On October 12, 2022, the U.S. Food and Drug Administration issued emergency use authorizations for bivalent COVID-19 boosters for children 5 years old and up. Following this, the Centers for Disease Control and Prevention has recommended bivalent COVID-19 boosters for children 5 years old and up. Also, adolescents between ages 12 and 17 now have an additional brand option for their bivalent booster.

The Pfizer-BioNTech bivalent vaccine is now available as a booster for ages 5 years and up, rather than age 12 and up. The Moderna bivalent vaccine is now available as a booster for ages 6 years and up, rather than age 18 and up. The CDC’s Advisory Committee on Immunization Practices recommends that people aged 5 years old and older also receive these boosters.

The FDA also removed the authorization for monovalent mRNA vaccines in these age groups. You may now only provide bivalent vaccines to the eligible age groups. The monovalent mRNA vaccines are still authorized for use as a primary series for people ages 6 months and up.

Here’s what you should know:

  • You should still use the monovalent vaccines for primary series and use the bivalent vaccine as a booster only.
  • Do not get rid of monovalent stock as that vaccine is still needed for primary series doses.
  • The updated bivalent boosters are expected to provider better protection against COVID-19 caused by the omicron variant.
  • The bivalent vaccines, also known as omicron boosters, contain two strains: one component of the original strain of SARS-CoV-2 and a second component from the BA.4 and BA.5 lineages of the omicron variant. The monovalent COVID-19 vaccines previously administered since December 2020 only contain the original strain.
  • The benefits of vaccinating children far outweigh the risks. The potential for a serious side effect or reaction to the vaccine is far less than the risk of serious outcomes or death from COVID-19 disease.
  • Children can also get long COVID or Multisystem Inflammatory Syndrome in Children (MIS-C) from mild or asymptomatic disease. We can protect children from these serious outcomes by protecting them with COVID-19 vaccination and a booster.
  • You can give any COVID-19 vaccine at the same time as most vaccines, such as a flu shot or other recommended childhood vaccines.
  • The updated bivalent boosters for this age group will potentially be available as early as next week.
  • Children under age 12 will get a smaller dose than adolescents and adults do.
  • The bivalent booster is recommended 2 months after any previous dose of COVID-19 vaccine or booster.
  • Variations and/or updates to an already tested and authorized vaccine can be authorized by the FDA similar to how they approve updated flu vaccines every year. See the FDA’s news release for more information on how they determined the safety of this vaccine.
  • Find more information about vaccinating youth on our Vaccinating Youth web page.

(Guidance released: October 13, 2022)

Booster Doses Recommended for Ages 5-11

On May 19, the CDC’s Advisory Committee on Immunization Practices (ACIP) expanded the recommendation for a booster dose of COVID-19 vaccine to everyone age 5 years and older at least 5 months after completing their primary series. Children who are immunocompromised should receive their booster at least 3 months after their primary series. A booster shot will help provide continued protection against severe disease in these populations who are especially at risk for severe COVID-19. Previously, boosters were only recommended for ages 12 and up.

The Western State Scientific Safety Review Workgroup also voted to recommend booster doses for everyone 5 years and older. As of May 19, 2022, enrolled providers may administer COVID-19 boosters to anyone who qualifies.

Remember that COVID-19 can be a serious disease in kids. The data presented at ACIP on May 19, along with existing data, show that there can be very significant outcomes. In addition to poor outcomes from the disease itself, children in this age group get long COVID or MIS-C even from mild or asymptomatic disease. We can protect young Washingtonians from these serious outcomes by protecting them with COVID-19 vaccination and a booster.

Considerations for administering booster doses to children

  • Please also continue to offer the primary series vaccination to as many people as you can. Many children in Washington still lack their first or second dose of COVID-19 vaccine.
  • COVID-19 primary and booster doses can be coadministered with other vaccines, such as other recommended childhood vaccines that may be overdue or that patients need for school or child care requirements.
  • The booster dose must be given at least 5 months after the patient completes the primary series, the same as other age groups.
  • The potential for a serious side effect or reaction to the vaccine is far less than the risk of serious outcomes or death from COVID-19 disease. The benefits of vaccinating children far outweigh the risks.

The CDC also strengthened their booster dose recommendations for some other groups. The updated booster dose recommendations are as follows:

  • Children ages 5-11 should receive a booster dose five months after completing their primary vaccine series of Pfizer-BioNTech vaccine.
  • Everyone 12 and older should receive a booster dose five months after completing their primary vaccine series of Pfizer or Moderna, or two months after receiving the single-shot Johnson & Johnson (J&J) vaccine.
  • Everyone 50 and older should receive a second booster dose four months after receiving their first booster dose.
  • Individuals 12 and older who are moderately or severely immunocompromised should receive a second booster dose four months after receiving their first booster dose.
  • Those 18 and older who received a primary vaccine and booster dose of the J&J vaccine four months ago can receive a second booster dose of an mRNA COVID-19 vaccine.

More information

  • The U.S. Food and Drug Administration authorized the use of Pfizer COVID-19 vaccine for boosters in ages 5-11 on May 17. Read their news release here.
  • In authorizing this use, the FDA determined that the benefits of receiving the COVID-19 vaccine currently outweigh any known or potential risks posed by the vaccine itself.
  • The Washington State Department of Health will continue to monitor ongoing developments related to COVID-19 and vaccine availability, as well as the status of any boosters as they become available for new age ranges.
  • Find more information about providing COVID-19 vaccine, including a guide to vaccinating youth, at www.doh.wa.gov/Covid19VaccineProvider.
  • There are no supply concerns and plenty of pediatric COVID-19 vaccine available in Washington. If your clinic doesn’t have enough, there are ways to quickly order more, or get a transfer from another provider or depot.
Booster Vaccine Doses

An additional dose is for patients who completed the initial vaccine series but didn't have a strong enough immune response. A booster dose is for patients when it's likely that their immunity after the initial vaccine series waned over time.

The Centers for Disease Control and Prevention (CDC) and the Western States Scientific Safety Review Workgroup recommend a booster dose for everyone 12 years and older.

Who can receive additional doses:

  • You should administer a booster dose of Pfizer COVID-19 vaccine to anyone 5 years and older.
  • You should administer a booster dose of Moderna COVID-19 vaccine to anyone 18 years and older.
  • You should administer an additional dose of an mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna) to people who qualify for it because of immunocompromise, for a total of three doses in the primary series, as described in this guidance.
  • You should administer a booster (fourth) dose to anyone who received an additional dose of an mRNA COVID-19 vaccine due to moderate to severe immunocompromise state.

Who cannot receive additional doses at this point in time:

  • You may not administer a booster dose to anyone age 11 years or younger.
  • You may not administer a booster dose of Moderna or Johnson & Johnson COVID-19 vaccine to anyone 17 years or younger.
  Who Gets It When to Get It

Additional dose

People who are immunocompromised and got an mRNA COVID-19 vaccine.

See the Centers for Disease Control and Prevention's (CDC) interim clinical considerations for a list of immunocompromising conditions.

 At least 28 days after your second dose of mRNA COVID-19 vaccine.

Booster dose

 People 18 years and older who got the Johnson & Johnson COVID-19 vaccine as their primary series. At least two months after your first dose.

People 12 years and older who got the Pfizer-BioNTech COVID-19 vaccine as their primary series.

At least five months after your second dose.

For patients who are moderately to severely immunocompromised, at least five months after the patient's additional (third) dose.

People 18 years and older who got the Moderna COVID-19 vaccine as their primary series.

At least five months after your second dose.

For patients who are moderately to severely immunocompromised, at least five months after the patient's additional (third) dose.

Patients may get the same or a different vaccine for their booster dose than they received for their primary series. However, patients ages 17 and younger may only get the Pfizer vaccine for their booster dose because it's the only COVID-19 vaccine authorized for this age group.

Please do not administer any doses of vaccine beyond the doses recommended by ACIP, even if your patient requests it. Also, please do not administer any doses of vaccine to someone outside of the recommended age range for that vaccine.

Tips and considerations to prepare for administering booster doses

  • Please continue vaccinating as many people as you can with their primary series of COVID-19 vaccine but prepare your clinic or facility to offer booster doses as well.
  • Plan for an increase in vaccine demand.
    • You may want to hold on-site or off-site vaccine clinics. If you hold on off-site clinic, please review our Off-Site Vaccination Clinic Guidelines.
    • Continue to track and report your vaccine inventory. You may need to adjust your ordering pattern. Remember to check the Vaccine Advertisement page of the Washington State Immunization Information System (WAIIS) to see if other providers in your area have vaccine available. See the search and advertise COVID-19 vaccine guide (PDF) for instructions.
  • The Moderna booster dose (0.25mL) is half the dosage of one primary series dose (0.5mL). You will use the same vials of Moderna for both primary and booster doses. Do not puncture the vial more than twenty times. The stopper may disintegrate if it is punctured more. Due to the risk of contamination, do not use an adapter to keep the vial top accessible to obtain more doses. This may increase the risk of contamination and impact safety for all doses obtained from the vial.
  • The Moderna booster dosage is always 0.25mL, regardless of whether the patient received the Moderna vaccine for their primary series.
  • Update your vaccine appointment scheduling system or webpage to include additional doses.
  • Consider offering co-administration of other routine vaccines, like seasonal flu, if you have capacity. This makes it easy for patients to stay up to date with their immunizations.
  • People are still considered fully vaccinated two weeks after their second dose in a two-dose series or two weeks after a single-dose vaccine.
  • Reach out to patients who are due for another dose.

Resources

(Guidance updated: January 10, 2022)

CDC Endorses 2023-2024 COVID-19 Vaccines for Use; New Vaccines Arriving Soon

Following FDA regulatory action, the CDC has recommended updated 2023-2024 COVID-19 vaccines for everyone 6 months and older that target the omicron subvariant XBB.1.5. Bivalent COVID-19 vaccines are no longer authorized or available in the United States. The new COVID-19 vaccine recommendations are as follows:

  • Children 6 months – 4 years old who are unvaccinated should complete a multidose initial series (2 doses of Moderna or 3 doses of Pfizer-BioNTech 2023-2024 COVID-19 vaccine). 
  • Children 6 months – 4 years old who were previously vaccinated are eligible to receive 1 or 2 doses of a 2023-2024 COVID-19 vaccine (timing and number of doses to administer depends on the previous COVID-19 vaccine[s] received).
  • Anyone aged 5 years and older regardless of previous vaccination is eligible to receive 1 dose of a 2023-2024 COVID-19 vaccine at least 2 months since the last dose of any COVID-19 vaccine.

It is expected that 2023-2024 COVID-19 vaccines will begin arriving in Washington state in the next several days. Supply may be limited for some time as the new distribution mechanisms with commercialization of COVID-19 vaccines are initiated. COVID-19 vaccines will be provided through the Childhood Vaccine Program, Adult Vaccine Program/Bridge Access Program, and through commercial purchase for those with insurance. Please help your patient populations and communities understand these considerations and thank them for their patience. 

All children 18 years of age and under have access to COVID-19 vaccines via the Childhood Vaccine Program at no cost to the patient. Under- and uninsured adults can access COVID-19 vaccine via the Bridge Access Program, which includes partnership with CVS, Walgreens, other pharmacies across Washington and additional Adult Vaccine Providers. Updates to Vaccines.gov will be made in the coming weeks to include all locations of the Bridge Access Program.

The Washington State Department of Health (DOH) is working with providers to identify and address barriers to accessing vaccines. DOH is working with the Center of Disease Control (CDC) and others to elevate anticipated challenges for smaller providers who may be burdened in purchasing COVID-19 vaccines, including advocating for smaller order size requirements. DOH is also working with local health jurisdictions and partners to better understand gaps in access across the state to inform both distribution of vaccine and communication efforts to promote uptake of COVID-19 vaccine.

CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines page is expected to be updated soon to provide further clinical guidance on vaccine administration under the updated recommendations. Clinical data demonstrates efficacy for co-administration with flu and COVID-19 and flu and RSV, for those who are eligible. Primary care providers are encouraged to help patients determine whether they should receive multiple vaccines at once or should stagger administration. Overall, it is recommended that anyone who is eligible should receive all applicable respiratory disease vaccines this fall for optimal protection. The original Novavax COVID-19 vaccine is currently available for those aged 12 and older, but an updated version that targets the omicron subvariant is currently being evaluated and may be available later this year.   

DOH is currently reviewing and updating our webpages and supporting resources to reflect these new recommendations. Thank you for your continued partnership in providing COVID-19 vaccines to eligible children, adolescents, and adults in Washington State. Please reach out to us at COVID.Vaccine@doh.wa.gov with any questions you have.

(Guidance updated: September 13, 2023)

CDC Investigating Possible Safety Signal for Pfizer Bivalent Booster

On January 13, the U.S. Centers for Disease Control and Prevention announced they will be investigating a preliminary safety signal for one of the COVID-19 bivalent booster vaccines.

This safety signal was detected by only one of many safety systems; other safety systems, databases, and countries are not seeing the same link, nor has it been seen in other brands of COVID-19 vaccine.

The signal is unlikely to represent a true clinical risk. Please continue vaccinating patients with the bivalent COVID-19 vaccine when they are due.

Here is more detailed information:

Picking up the signal

  • CDC’s Vaccine Safety Datalink (VSD), one of several vaccine safety monitoring systems in place in the United States, has picked up a signal indicating a potential risk of ischemic stroke in adults over 65 who received the Pfizer-BioNTech COVID-19 bivalent booster.
  • There is no signal for the Moderna COVID-19 bivalent booster.
  • U.S. government agencies use multiple, complementary safety monitoring systems to help detect possible vaccine statistical signals as early as possible and to know when or if to investigate a possible issue. VSD, the system that picked up this signal, is one of these.
  • As a response to this signal in the VSD, the CDC worked with the U.S. Food and Drug Administration to further investigate this potential side effect in other safety monitoring systems (such as VAERS) and clinical databases (including those for Medicare, the VA, Israel, and some European countries). No clinical risk of ischemic stroke has been identified in other sources.
  • Other countries have not observed an increased risk for ischemic stroke with bivalent vaccines.
  • Pfizer-BioNTech’s global safety database also does not indicate a signal for ischemic stroke with this vaccine.

What does this mean for clinicians?

  • Overall, the totality of the data suggests it is very unlikely that the signal in VSD represents a true clinical risk. In the spirit of transparency, CDC wanted to share this early information with the public.
  • No change in vaccination practice is recommended. CDC continues to recommend that everyone ages 6 months of age and older stay up to date with COVID-19 vaccination; this includes individuals who are currently eligible to receive an updated (bivalent) vaccine.
  • Public health supports the continued assessment of vaccine safety. The finding from the Vaccine Safety Datalink shows that the system is working, and we are being vigilant in detecting any adverse health outcomes associated with the COVID-19 vaccine. 

What’s next?

CDC and FDA will continue to evaluate additional data from the VSD and other vaccine safety systems. These data and additional analyses will be discussed at the upcoming January 26 meeting of the FDA’s Vaccines and Related Biological Products Advisory Committee.

(Guidance released: January 18, 2023)

CDC Vaccine Recommendation for Pregnant People

On August 11, the Centers for Disease Control and Prevention (CDC) announced it is strengthening its recommendation for COVID-19 vaccination during pregnancy, based on new safety data about the COVID-19 vaccines. The CDC recommends COVID-19 vaccination for all people 12 years and older, including people who are pregnant, breastfeeding, or who might get pregnant now or in the future.

A rise in COVID-19 cases, increased circulation of the highly contagious Delta variant, vaccine hesitancy, and the risk of severe COVID-19 illness for pregnant people make vaccination more urgent than ever.

Growing evidence about the safety and effectiveness of COVID-19 vaccination during pregnancy demonstrates that the benefits of getting a COVID-19 vaccine outweigh any known or potential risks. New findings from CDC's v-safe pregnancy registry suggest that getting an mRNA COVID-19 vaccine during early pregnancy does not increase the risk for miscarriage. In this study, the cumulative risk of miscarriage after mRNA COVID-19 vaccine was similar to previously published estimates. These early findings are reassuring and can help guide discussions with your pregnant patients about COVID-19 vaccination. Furthermore, previous findings from three safety monitoring systems did not find any safety concerns for pregnant people who were vaccinated late in pregnancy, or for their babies.

Actions Requested of All Health Care Providers

We ask you to join us in the Power of Providers Initiative by committing to seek, ask, vaccinate and empower (save) your patients or customers around COVID-19 vaccine.

  • Seek: Seek your patients' COVID-19 vaccination status.
  • Ask and educate: If your patient isn't vaccinated, ask them about the vaccine and offer education if they're unsure.
  • Vaccinate: If your patient agrees to vaccination, provide them with a COVID-19 vaccine or a referral to a location that provides COVID-19 vaccination.
  • Empower: Empower your patients to share their vaccination status with the community.

Please see the CDC Update on COVID-19 Vaccination during Pregnancy: Key Messages and Talking Points for Partners for more information.

(Guidance released: August 11, 2021)

Check expiration dates

Please be sure to regularly check your vaccine lot numbers and confirm their expiration date. Do not administer expired vaccine or diluent.

You can check the expiration dates for your lot numbers through the Centers for Disease Control and Prevention's (CDC) COVID-19 vaccine lot number and expiration date file. CDC updates the file daily. The report is available only for public health, healthcare, and pharmacy organizations for vaccine administration, inventory, and reporting purposes. CDC will not grant access for personal use or to confirm validity of vaccination.

If you have a lot of inventory that is close to expiring, we encourage you to use the Vaccine Advertisement feature of the Washington State Immunization Information System. You can use this guide to walk you through the process.

If you have expired vaccine, please follow the vaccine wastage guide to report and dispose of waste.

Update December 20, 2021

  • The Food and Drug Administration (FDA) extended the expiration date for Pfizer orange and gray cap vaccine to 9 months (while held at ultra-low temperature frozen).

(Guidance updated: December 20, 2021)

Considerations for Vaccinating Minors

Everyone ages 5 and up is eligible for COVID-19 vaccination. For minors (anyone less than 18 years old), there are special considerations for COVID-19 vaccination, especially regarding parental/guardian consent. We would like to provide additional information for providers to consider when determining who can provide consent for vaccination of a minor and which minors can consent for themselves without parent or guardian approval.

The Washington State Department of Health cannot provide legal advice. If you have questions on how to implement anything in these considerations, please consult with your legal counsel. Creating and implementing these policies is the responsibility of the health care provider.

Vaccines available for minors

  • The Pfizer COVID-19 vaccine is the only vaccine available for those under 18. It is currently authorized for emergency use in those 5 to 15 years old and fully approved (under the name Comirnaty) for those 16 years old and up.
  • Moderna vaccine and Johnson & Johnson (Janssen) COVID-19 vaccines must not be provided to anyone under 18 years old at this time.
  • However, if a minor was inadvertently vaccinated with Moderna as a first dose, the U.S. Centers for Disease Control and Prevention recommends they still receive the second dose of Moderna on time to complete the series. If this occurs, this is considered an administration error and should be reported to the Vaccine Administration Error Reporting System (VAERS). Prior to booster dose administration, review the vaccine administration error guidance document for other information.
  • If a minor inadvertently received a dose of Johnson & Johnson vaccine, they are considered fully immunized and should not receive additional doses of any vaccine presentation. If this occurs, this is considered an administration error and should be reported to the Vaccine Administration Error Reporting System (VAERS). Review the vaccine administration error guidance document for other information and next steps.
  • Booster doses are only authorized for people 12 years and older. People ages 17 and younger may only get the Pfizer COVID-19 vaccine for their booster dose.
  • If your clinic supplies more than one vaccine presentation, make sure they are kept separate and well marked so they cannot be mixed up.

Make it easy to book appointments for minors

  • Providers should clearly state during the scheduling process, on the online registration form, and at the vaccine clinic site whether Pfizer vaccine is available for adolescents (purple cap for 12 years and older) and pediatrics (orange cap for 5 to 11 years).
  • Indicate during registration how you require a parent or guardian to consent to the minor's vaccination, but do not make parent consent a required field to book the appointment. Minors who are able to consent to their own vaccine will be unable to make an appointment with you.

Situations needing consent of an adult to vaccinate a minor

Treat consent for COVID-19 vaccination the same as you would for other recommended vaccinations for adolescents, such as Tdap and meningococcal vaccine.

Parent or guardian consent

  • Parent or guardian consent is required for most medical services for minors, including COVID-19 immunization and other immunizations.
  • The following adults are authorized to consent for a minor:
    • The parents of the minor
    • An appointed guardian or authorized legal custodian
    • A person authorized by the court to consent to medical care for a child in out-of-home placement (see chapter 13.32A or 13.34 of the Revised Code of Washington)
    • An individual to whom the minor's parent has given a signed authorization to make health care decisions for the minor patient
    • A competent adult relative who is responsible for the health care of the minor patient, or a competent adult who has signed and dated a declaration (see RCW 9A.72.085) stating this
    • A school nurse, school counselor, or homeless student liaison for a homeless youth or young adult who is not under the supervision or control of a parent, custodian, or legal guardian, and is not in the care and custody of the Department of Children, Youth and Families
  • When parent or guardian consent is required, obtain and document their consent for each dose. Your organization must determine what it accepts as consent. For instance, is verbal consent enough or will you require written consent? Check whether your organization already has policies in place for minor consent. If they do, follow the guidelines. If there are not existing guidelines in place, discuss with your legal counsel to draft guidelines. DOH cannot offer legal advice in this matter.
  • Mature minors, emancipated minors, and married minors are exempted from this rule and do not need parent or guardian consent. See the next section for more information.
  • When a minor is exempted from parental/guardian consent, document the reason for the exemption for each dose.

Additional information

  • Youth in foster care: Primary care providers and vaccination sites may be asked to vaccinate youth in foster care, and youth will arrive with caregivers with the Youth and Parent Consent forms. See the Washington State Department of Children, Youth & Families (DCYF) COVID-19 vaccination guidance for children and youth in care (PDF) for more information.
    • If a biological parent does not consent for a youth to receive the vaccine, or if a court order is needed, providers may also be asked to determine if a youth is healthy enough to receive the COVID-19 vaccine. This consultation can occur in an office visit or by telehealth. A provider's recommendation on a Visit Summary will be accepted by DCYF as documentation.
  • Homeless minors: If a minor has been identified by their school as homeless under the McKinney-Vento Act, the minor may access routine non-emergency medical care with the consent of the school homeless youth liaison, school nurse, or school counselor. Some homeless minors may qualify to provide their own consent; see the next section for details on which situations these include.
  • EUA Fact Sheet: When administering a vaccine that has Emergency Use Authorization to a minor, the EUA Fact Sheet must be given to the parent, guardian, or other adult who may consent to the vaccination.

Situations where the minor may consent to their own care

Mature minors may not require parent or guardian consent

  • Washington state has a “Mature Minor Doctrine” established by Smith v. Seibly in the Washington Supreme Court in 1967. This doctrine allows some providers to determine whether a minor has the capacity to understand the proposed health care service or treatment and is sufficiently mature to make their own health care decisions.
  • Health care providers are responsible for determining whether or not the Mature Minor Doctrine applies in each situation. Criteria that may be used in this determination include: age, intelligence, maturity, training, experience, economic independence, general conduct as an adult, and freedom from the control of parents/guardians.
  • Your organization or local health district may have guidelines and recommendations around how to apply the Mature Minor Doctrine. Learn these policies. If they don't cover immunizations or if you do not have policies covering this doctrine, consult your legal counsel to draft standards for your organization.
  • Examples of applying the Mature Minor Doctrine:
  • When you use the Mature Minor Doctrine to waive the requirement for parent/guardian consent, clearly document the decision process and rationale.

Emancipated minors do not require parent or guardian consent

  • An emancipated minor is someone who is 16 or 17 years old who has been legally declared an adult by the court system.
  • An emancipated minor can give informed consent for all health care services, including immunization, without the need for parent or guardian approval.
  • Emancipated minors can show you their status with one of the following:
    • Certified Decree of Emancipation
    • Washington State driver license that says they are emancipated
    • Washington State ID card that says they are emancipated
  • Your organization should have a policy on what to do regarding proof of emancipation.

Married minors may not require parent or guardian consent

  • A minor who is married to an adult or to an emancipated minor is considered an adult and can give informed consent for all health care services, including immunization, without the need for parent or guardian approval.

We hope this gives you a good outline for how to approach vaccinating people under age 18. If you have further questions about how to approach this issue, please refer to the reference links, or consult with your organization's legal counsel.

(Considerations updated: December 9, 2021)

COVID-19 Vaccine Requirements for Health Care Workers

On August 9, Gov. Jay Inslee announced a COVID-19 vaccine requirement for most state employees, private health care and long-term care workers. On August 18, he expanded the proclamation to include all employees working for public and private K-12 schools, childcare, early learning, and higher education. Other employers may also choose to require the COVID-19 vaccine. Here's a few things to know:

  • If your employer requires the COVID-19 vaccine, reach out to your employer or human resources office to find out what to do to prove your vaccination or see if they have an opt-out policy.
  • The Department of Health is not involved in the employer's or college's/university's policy.
  • K-12 school employees can see the Washington Office of Superintendent of Public Instruction's (OSPI) COVID-19 vaccination requirement FAQ for more information on their policy.
  • Patients may reach out to you about getting an exemption from the vaccine requirement. They do not need to get an exemption form from the Department of Health (DOH) for the COVID-19 vaccine. DOH does not have exemption forms for the COVID-19 vaccine. The Washington state Certificate of Exemption (COE) is only used by parents/guardians wanting to exempt their child from the immunizations required for children in K-12 schools, preschools, or child care. The COVID-19 vaccine is currently not required, so it is not included on the COE. Any DOH Certificate of Exemptions including COVID-19 vaccines are fake.

Resources

(Guidance updated: August 18, 2021)

Emergency Vaccine Use Plan

The Department of Health knows there may be emergency situations where you need to administer the vaccine as soon as possible to avoid wasting doses. We encourage you to create an emergency vaccine use plan to help you quickly reach people who are currently eligible for vaccine in a way that follows Washington's principles and criteria for equitable prioritization.

Develop a plan

Your emergency vaccine use plan should ensure that any extra vaccine doses go first to people who are most impacted by COVID-19.

  • Review your health records to find the most vulnerable people.
    For example: patient who are people of color, over the age of 75, eligible for Medicaid or uninsured, over the age of 65 with significant comorbidities, people with disabilities, and people with limited English proficiency.
  • Connect with community partners.
    Community partners may be able to help you reach currently eligible populations. This could include senior centers, faith-based organizations, mutual aid groups, social services agencies, refugee and immigrant services organizations, community health worker networks, etc.

Develop a waitlist

Currently, there is more demand for vaccine than we have supply in the state. A waitlist can help you quickly reach the next person eligible for vaccine in an emergency or once you have doses available.

A waitlist should prioritize people who have access barriers or live in an area with a high social vulnerability index.

You can refer to the Washington Tracking Network COVID-19 social vulnerability index to look at maps by socioeconomic determinants, race and ethnicity, language, housing type, transportation, and disability. You can also use the No Kid Hungry Averaged Eligibility Map to look at free and reduced price lunch eligibility in your local schools.

Please make sure your facility has an equitable emergency plan in place following these guidelines. If you need help, contact us at covid.vaccine@doh.wa.gov.

(Guidance updated: May 4, 2021)

Equity Strategies and Resources

Minimum standards

We ask that all providers assess their current practices for language access, accessibility for people with disabilities, and demographic data reporting. Most providers already meet these standards. All providers are asked to assess their accessibility for people with limited English proficiency and people with disabilities by April 2, 2021 and work on areas that need improvement. We are here to provide support and technical assistance. You do not need to submit any proof of assessment and compliance efforts to the Washington State Department of Health. We will reach out to proactively support overcoming access barriers if we hear of them by community members.

  • Language access
  • Access for people with disabilities
  • Reminder: Please collect patient race, ethnicity, and language data. This information should be self-report and is very important for understanding the populations we are and are not effectively reaching with the COVID-19 vaccine. Patients do not have to provide this information.

Pro-equity strategies

These pro-equity strategies have emerged directly from communities disproportionately impacted by COVID-19 and partners. These strategies are highly recommended to support equitable access. We will add additional strategies and resources to our COVID-19 Vaccine Equity & Engagement webpage and would appreciate hearing about your success stories implementing these or other pro-equity strategies. Email equity@doh.wa.gov to share your success stories and best practices.

  • Reach out proactively to eligible patients, especially patient's from highly impacted communities.
  • Reinforce messaging that people are eligible for vaccine regardless of their immigration status or insurance status. If you are required to ask for a social security number, share transparently that it is not required and no personal information will be shared.
  • Use our Equitable Vaccine Site Placement Planning Tool in planning mobile and community pop-up sites.
  • Meet people where they are: “Vaccines going to people, not people going to vaccines”
    • Consider community centered vaccination sites where people feel safer.
    • Employer-based vaccine sites to save eligible employees time.
    • Provided alternative and extended hours.
  • Implement community-based scheduling by:
    • Offering community specific days or hours for appointments.
    • Holding a set of appointments for phone-based scheduling. Recommendation: Consider holding 20-30% for phone-based scheduling.
    • Holding a percent of appointments for scheduling by community partners. Recommendation: Consider holding 20-30% for community-based scheduling.
    • Developing a separate online scheduling link to improve community access (e.g. offer a Spanish-only link to address language barriers).
  • Partner with and activate community health workers to assist with culturally responsive and linguistically appropriate vaccine outreach and access needs (i.e. education, interpretation, scheduling appointments).
  • Co-host vaccine education and clinic events with trusted community leads, community organizations, and faith-based community centers.
  • Have an equity-informed extra doses plan.
  • Use the Washington Tracking Network, Information by Location Mapping Tool: COVID-19 Social Vulnerability Index to identify priority community areas for mobile and community pop-up sites.
  • Implement “past tier” catch-up days or times to ensure access for harder to reach groups who were eligible in previous tiers.
  • Plan proactive efforts to reach communities who are likely to be missed by traditional channels.
  • Review Washington State Hospital Association's Equity in Vaccine Strategies.
  • Search DOH COVID-19 materials by language and the Partner Toolkit for vaccine education materials you can use.
  • More pro-equity strategies and resources will continue to be added to our COVID-19 Vaccine Equity & Engagement webpage.

(Guidance released: March 12, 2021)

FDA Limits Use of J&J Vaccine, DOH Rescinds Standing Orders

On May 6, 2022, the U.S. Food and Drug Administration limited the authorized use of the Johnson & Johnson (Janssen) COVID-19 vaccine, otherwise known as the J&J vaccine. Their analysis shows the risk of certain side effects warrants limiting the vaccine. Read their full statement. The uses now authorized by the FDA are limited to:

  • People age 18 years and older who cannot be given or cannot access another COVID-19 vaccine
  • People age 18 years and older who choose to receive the J&J vaccine because they otherwise would not get a COVID-19 vaccine.

DOH has rescinded standing orders for J&J

The Washington State Department has rescinded the Janssen COVID-19 Vaccine (Johnson & Johnson) Statewide Standing Orders for administering the vaccine to persons 18 years of age and older, dated May 6, 2022, effective immediately.

Washington State has sufficient supply of other COVID-19 vaccines to ensure availability. There could be situations where the J&J vaccine is still the best choice based on the individual’s preference, but due to the need for additional screening, education, and documentation of the individual’s decision, the Washington State Department of Health is removing the state standing orders for J&J COVID-19 vaccine. If you have standing orders from DOH, they are no longer valid.

If you wish to still administer J&J, you must do so under your internal ordering process, which could include your own standing orders.

Please continue providing patient education about the COVID-19 vaccine and ensure people have a choice of vaccine based on the FDA information.

Standing orders from the Washington State Department of Health are available for the Moderna and Pfizer COVID-19 vaccines. That link also includes CDC standing orders templates for all vaccine brands if you need to create your own.

Report illness or reactions following vaccines

And as a reminder, please report any COVID-19 vaccine reactions a patient may have. It’s thanks to your diligent reporting that the FDA and other safety monitoring groups can catch signals that allow them to make adjustments such as this to protect people’s health.

Research continues to show that vaccination against COVID-19 has saves lives. Thank you for your work in keeping all eligible adults, adolescents, and children 5 and older up to date on their COVID-19 vaccines, which includes getting boosters of Pfizer or Moderna when eligible.

FDA Authorizes 2023-2024 COVID-19 Vaccines; Discontinue Use of Bivalent mRNA Vaccines

The Food and Drug Administration (FDA) issued emergency use authorizations (EUAs) and approvals for both the Moderna and Pfizer-BioNTech COVID-19 2023-2024 mRNA vaccines today. The mRNA vaccines approved and authorized today “support the change to the 2023-2024 formula and non-clinical immune response data on the updated formulations including the XBB.1.5 component.” The approvals and EUAs allow updated 2023-2024 Moderna and Pfizer COVID-19 mRNA products to be administered to individuals 6 months of age and older, pending CDC approval.

Immediate Action: Bivalent Moderna and Pfizer-BioNTech COVID-19 vaccines are no longer authorized for use in the United States. 

  • Please report unused bivalent mRNA vaccines as wastage and update your inventory in the Washington State Immunization Information System (WAIIS).
  • Unused bivalent Moderna and Pfizer-BioNTech COVID-19 vaccines should be discarded according to local medical waste guidelines.
  • Ordering for bivalent products in the WAIIS is no longer available.

Next Steps: The Advisory Committee on Immunization Practices (ACIP) met September 12, 2023, at 7:00 am PDT to discuss their recommendations for who should receive the vaccines. The meeting was open to the public. Providers cannot begin administering updated 2023-2024 vaccines until the CDC Director endorses the ACIP recommendations.

Initial supply and availability of 2023-2024 COVID-19 vaccines may be limited and vary by location compared to earlier vaccine releases. Please help your patient populations understand these considerations and thank them for their patience.

Thank you for your continued partnership in providing COVID-19 vaccines to eligible children, adolescents, and adults in Washington State. The COVID-19 Vaccine Program will provide another email message tomorrow following the ACIP meeting with additional information. Please reach out to us at COVID.Vaccine@doh.wa.gov with any questions you have.

(Guidance released: September 11, 2023)

FDA Authorizes Novavax COVID-19 vaccine 2023-2024 Formula; Deauthorizes Original Novavax Formula

On Tuesday, October 3, 2023, the U.S. Food and Drug Administration amended the emergency use authorization (EUA) of the Novavax COVID-19 Vaccine, Adjuvanted, for use in individuals 12 years of age and older to include the 2023-2024 formula. The 2023-2024 formula Novavax COVID-19 Vaccine, Adjuvanted, “supports the change to the 2023-2024 formula and non-clinical immune response data on the updated formulations including the XBB.1.5 component.” The amended EUA allows the updated 2023-2024 Novavax COVID-19 Vaccine, Adjuvanted, product to be administered to individuals 12 years of age and older.

Novavax COVID-19 Vaccine, Adjuvanted (2023–2024 Formula) is authorized for use in individuals 12 years of age and older as follows:

  • Individuals aged 12 years and older who are moderately or severely immunocompromised, not vaccinated, and are unable or choose not to get an updated Pfizer-BioNTech or Moderna COVID-19 vaccine, can consider Novavax COVID-19 vaccine.
  • Individuals previously vaccinated with any COVID-19 vaccine: one dose of Novavax COVID-19 Vaccine, Adjuvanted (2023–2024 Formula) may be administered at least two months after the last dose of COVID-19 vaccine.
  • Individuals not previously vaccinated with any COVID-19 vaccine: two doses of Novavax COVID-19 Vaccine, Adjuvanted (2023–2024 Formula) may be administered three weeks apart.
  • Immunocompromised individuals: an additional dose of Novavax COVID-19 Vaccine, Adjuvanted (2023–2024 Formula) may be administered at least 2 months following the last dose of a COVID-19 vaccine (2023–2024 Formula). Additional doses of Novavax COVID-19 Vaccine, Adjuvanted (2023–2024 Formula) may be administered at the discretion of the healthcare provider, taking into consideration the individual’s clinical circumstances. The timing of the additional doses may be based on the individual’s clinical circumstances.
  • Fact sheets can be found here:

Immediate Action:  The original monovalent Novavax COVID-19 vaccine is no longer authorized for use in the United States. 

  • Please report unused original Novavax vaccines as wastage and update your inventory in the Washington State Immunization Information System (WAIIS).
  • Unused original Novavax COVID-19 vaccine should be discarded according to local medical waste guidelines.
  • Ordering for the original Novavax product in the WAIIS is no longer available.

Note:  This vaccine is automatically included within the recent updated Advisory Committee on Immunization Practices (ACIP) COVID-19 recommendations and the ACIP will not need to vote on this vaccine.

Initial supply and availability of 2023-2024 COVID-19 vaccines may be limited and may vary by location compared to earlier vaccine releases. Please help your patient populations understand these considerations and thank them for their patience.

Thank you for your continued partnership in providing COVID-19 vaccines to eligible children, adolescents, and adults in Washington State. Please reach out to us at COVID.Vaccine@doh.wa.gov with any questions you have.
(Guidance released: October 4, 2023)

Masks at Vaccination Sites

We have heard from some individuals visiting COVID-19 vaccination sites that they have been turned away because they are not wearing a mask. Masks are required at vaccination sites, but they alone are not to be the basis for turning people away.

We believe in wearing masks, watching our distance, and washing our hands in order to help prevent the spread of COVID-19. The scientific evidence backs this up; however, we don't want to challenge individuals or turn them away from getting a vaccine if they are not engaging in preventative measures. If they want a vaccine, please give them a vaccine. Don't hesitate, vaccinate!

Please encourage mask wearing, but also find a way to vaccinate every individual who has an appointment at your vaccination site. Explore options to safely vaccinate those who aren't wearing masks. Please do not bring negative attention to them. They may have valid reasons for not wearing a mask. It is not your responsibility to find out why they are not wearing a mask.

If individuals are unmasked, consider the following:

  • Politely ask them, “Are you able to wear a mask?” If they say no or I forgot, tell them it's okay and that you have processes in place for individuals without masks.
  • Have disposable masks on hand to give to individuals who forgot their masks.
  • Ask them to wait in a different area from those who are wearing masks.
  • Ask that they wait in their car and a provider will come to their car to administer the vaccine.
  • Ask that they wait in their car, send them a text when it's their time to get vaccinated, and have them go to a designated area where you are vaccinating unmasked individuals.

If you would like assistance for how to implement the above suggestions, need disposable masks, or would like to talk about other options, please contact covid.vaccine@doh.wa.gov. Thank you again for all the hard work you are doing to get vaccines into arms. We know that trying to vaccinate as many people as possible is no easy feat, but you are doing incredible work and saving lives!

(Guidance released: April 26, 2021)

Moderna Vaccine Now Available for Children 6 to 17 Years of Age

Following ACIP’s vote June 23, 2022, the Western States Scientific Safety Review Workgroup has weighed in to align with the updated Centers for Disease Control and Prevention (CDC) recommendation for use of Moderna COVID-19 vaccine in children ages 6 years – 17, giving more vaccine options for children and adolescents. Moderna's vaccine is already available for people ages 6 months through 5 years and 18 and older.

Providers who have received supply may immediately begin administering Moderna vaccine to children 6 to 17 years of age.

Updates for Moderna recommendations are as follows:

  • Children ages 6-17 receive a 2-dose primary series of Moderna COVID-19 vaccine
    • Dosage for children ages 6-11 administered as a two-dose series at 50 micrograms per dose
    • Dosage for children ages 12-17 administered as a two-dose series at 100 micrograms per dose
  • Note: Moderna is not authorized by the FDA for booster use at this time for those less than 18 years of age. FDA discussions on booster use are expected to be held this summer.
    • The Moderna booster vial dose can now also be used for the Moderna COVID-19 vaccine primary series for children ages 6-11.

Thank you for your work in keeping all eligible adults, adolescents, and now children 6 months and older up to date on their COVID-19 vaccines, which now includes additional vaccine options for families to consider. Many young people in Washington are also eligible for a booster shot, so please continue to encourage patients ages 5 years and older to get a booster dose of COVID-19 vaccine.

(Guidance released: June 28, 2022)

Monovalent (current) COVID-19 vaccine boosters no longer authorized for people ages 12 and up

On August 31, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations (EUAs) of the two mRNA COVID-19 vaccines to authorize a new, bivalent formulation of the vaccines for use as a single booster dose in people ages 12 and up. The Centers for Disease Control and Prevention (CDC) has not yet recommended this booster, so you may not administer this new bivalent booster (also called an omicron booster) yet.

The FDA also removed an authorization: The current (monovalent) mRNA COVID-19 vaccines are NO LONGER authorized for use as boosters in people ages 12 years and older. As of today, you may no longer administer the current mRNA (Moderna and Pfizer) COVID-19 doses as boosters to this age group. You may still use this vaccine as a booster for people ages 5 to 11. Also, the current vaccines remain in use as doses for the primary series, so you may continue administering primary series doses the same as you have been.

You must reschedule or cancel any appointments for monovalent boosters for those ages 12 and up. You may reschedule these appointments for times when you will have the new bivalent booster available.

We expect more information about a recommendation for the new booster after the Advisory Committee on Immunization Practices (ACIP) meets September 1 and 2. After that, we will let you know the details of the new recommendations.

Here are a few things to keep in mind for now.

Recommendations

  • ACIP is scheduled to discuss and vote on a recommendation for the new booster on September 1 and, if needed, September 2. The Western States Scientific Safety Review Workgroup then will meet to approve the recommendations for use in Washington state.
  • Individuals 18 years of age and older are eligible for a single booster dose of the bivalent Moderna COVID-19 vaccine if it has been at least two months since they have completed primary vaccination or have received the most recent booster dose with any authorized or approved monovalent COVID-19 vaccine.
  • Individuals 12 years of age and older are eligible for a single booster dose of the bivalent Pfizer-BioNTech COVID-19 vaccine if it has been at least two months since they have completed primary vaccination or have received the most recent booster dose with any authorized or approved monovalent COVID-19 vaccine.
  • Do not toss your current primary series products.

Ordering

  • Please order lean and order frequently for all formulations of COVID-19 vaccine you carry, including the new bivalent booster.
  • Keep your quantities and record-keeping up to date.
  • Ordering for bivalent boosters reopened in the WAIIS today. Orders will be reviewed beginning Thursday, September 1.
    • At this time, we are spending down remaining doses from wave 2’s allocation, but hopeful to receive additional doses to fulfill as many orders as we can.
  • Routine vaccine ordering will begin the week of September 5.
    • Please note the office will be closed and no vaccine orders will be delivered on September 5 itself in observance of Labor Day.
  • If you have more doses of primary series or monovalent booster doses than you anticipate needing, you can post them to the advertisement page in WAIIS for redistribution.

Vaccine information

  • The bivalent (meaning two strains) vaccines, also known as omicron boosters, contain two strains: one component of the original strain of SARS-CoV-2 and a second component from the BA.4 and BA.5 lineages of the omicron variant. The monovalent (meaning one strain) COVID-19 vaccines previously administered since December 2020 only contain the original strain.
  • The updated bivalent boosters are expected to provider better protection against COVID-19 caused by the omicron variant

Research continues to show that vaccination against COVID-19, including boosters, saves lives and the new boosters will provide even more protection against omicron variants. Thank you for your work in keeping individuals up to date on their COVID-19 vaccines. We will be sending out more information after the ACIP meets.

(Guidance released: August 31, 2022)

Monovalent Moderna and Pfizer-BioNTech COVID-19 vaccines are no longer authorized for use

The CDC issued a news release recommending the use of bivalent Moderna and Pfizer-BioNTech products to simplify COVID-19 vaccine recommendations, and allow older adults and immunocompromised adults to get a second dose of bivalent vaccine. 

The CDC recommendations allow providers to immediately begin administering vaccines according to the newly amended Emergency Use Authorizations (EUA) for bivalent Moderna and Pfizer BioNTech products. 

  • Allow for an additional bivalent vaccine dose for adults 65 years and older. 
  • Allow for an additional bivalent vaccine dose for certain people who are immunocompromised. 
  • Everyone 6 years of age and older receives one bivalent mRNA COVID-19 vaccine. 
  • Individuals 6 years and older who have already received a bivalent mRNA vaccine do not need to take any action unless they are 65 years or older or immunocompromised.
  • For young children, multiple doses continue to be recommended and will vary by age, vaccine, and which vaccines were previously received. 

The fact sheets for Healthcare Professionals, Recipients, and Caregivers were updated for Pfizer-BioNTech COVID-19 Vaccines and Moderna COVID-19 Vaccines.

The CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines page will be updated soon to provide further clinical guidance on vaccine administration under the updated recommendations.

Washington State Department of Health webpages and COVID-19 vaccine resources are being reviewed and will also be updated soon to reflect these changes.

Monovalent Moderna and Pfizer-BioNTech COVID-19 vaccines are no longer authorized for use in the United States. We thank you for your support in updating your inventory in the Washington State Immunization Information System (WAIIS) and discarding unused vaccines according to your local medical waste guidelines.

Please use “Category – Expired, Reason – Open Multidose Vial” when updating your inventory and to report wastage in WAIIS.

Thank you for your continued partnership in providing COVID-19 vaccines to the eligible children, adolescents, and adults in Washington State. Please reach out to us at COVID.Vaccine@doh.wa.gov with any questions you have.

MyIR COVID-19 Vaccination Certificates

Washington state COVID-19 vaccination certificates are now available through MyIR Mobile. Patients can register at www.MyIRmobile.com to access their COVID-19 vaccination record. For those seeking school vaccination certificates, the new MyIRmobile website allows access to those as well through the old wa.MyIR.net system until full integration with MyIRmobile is completed next month.

Along with the debut of this enhanced website, the Washington State Department of Health is also launching an initiative to remind people to properly retain and protect their Vax Card (CDC COVID-19 Vaccination Record Card) and inform people how they can obtain official vaccination records if that card was misplaced, or even disposed of. Additionally, many businesses and organizations across Washington state are offering incentives for those who provide proof of vaccination status with verified records.

Please see below for a list of acceptable verifying documents. We also have flyers available for distribution in English and Spanish, with additional languages pending. DOH will be launching our public awareness messaging on May 17 and encourage you to share this information with your partners, clients and community members. Thank you for helping Washington stay safe and healthy!

What counts as an official record of vaccination?

The following are examples of official records of vaccination:

  • Lifetime immunization record/CDC COVID-19 vax card
  • Washington State Immunization Information System printout
  • MyIR printout (either screenshot or Certificate of Immunization Status)
  • MyIR Mobile Certificate of COVID-19 Vaccination
  • Verified electronic medical record printout from your medical provider

(Guidance released: May 14, 2021)

No Interval Between COVID-19 and Other Vaccinations

Providers can now administer COVID-19 vaccines and other vaccines to patients without waiting 14 days. Previously, the Advisory Committee on Immunization Practices (ACIP) recommended COVID-19 vaccines not be given within 14 days of any other vaccination. In the ACIP meeting on May 12, 2021, the committee voted to remove this spacing recommendation based on further COVID-19 vaccination data. All people needing COVID-19 vaccination can now receive other vaccines on the same day or within days of each other.

This means that anyone, both children and adults, can get other vaccinations on the same day they receive their COVID-19 vaccination.

This is especially important for children and adolescents who need to catch up on their required child care or school immunizations, as they can get many or all of their vaccinations in one visit, depending on the clinical spacing of the other vaccines for which they're due. This also means adults can get other vaccinations while they get their COVID-19 vaccination, including flu (influenza), Td/Tdap (tetanus, diphtheria), and shingles vaccines.

We recommend health care providers share this message with families and patients to reduce the need for multiple clinic visits. In addition, now is a good time to send out reminder/recall notifications to children and families who are behind on their required immunizations. We expect health care providers will have more immunization appointments the closer we get to the 2021-22 school year, and scheduling these appointments ahead of time with families will reduce stress and improve the health of people in Washington.

(Guidance released: May 19, 2021)

Novavax COVID-19 Vaccine Available for Ordering and Administration

On July 19, 2022, the CDC’s Advisory Committee on Immunization Practices (ACIP) and the Western States Scientific Safety Review Workgroup voted to recommend the Novavax COVID-19 Vaccine, Adjuvanted for individuals 18 years and older. The U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the vaccine primary series last week. The Novavax vaccine provides another option for adults who are not vaccinated against COVID-19. The Novavax standing order is available.

Here’s what you should know:

  • The Western States Scientific Safety Review Workgroup concluded that Novavax COVID-19 vaccine is safe and effective to be administered to people ≥ 18 years of age.
  • Providers are authorized to administer Novavax per the ACIP recommendations as soon as it is available for order in Washington state.
  • The Novavax COVID-19 Vaccine is a two-dose primary series. The second dose is administered three weeks after the first dose.
  • In studies, the vaccine was 90.4% effective in preventing mild, moderate, and severe COVID-19.
  • While new to the United States, the Novavax COVID-19 Vaccine has been used safely in other countries for months. It was authorized for emergency use by the World Health Organization in December 2021.
  • It contains the SARS-CoV-2 spike protein and Matrix-M adjuvant. An adjuvant increases a vaccine’s ability to stimulate the body’s immune system to fight off disease (to improve vaccine effectiveness).
  • Common side effects include swelling, redness and tenderness at the injection site, fatigue, muscle pain, headache, joint pain, nausea/vomiting, and fever.
  • An ongoing, randomized, blinded, placebo-controlled study on participants 18 years of age and older assesses the vaccine.
  • As with mRNA COVID-19 vaccines, Novavax recipients may have an increased risk of myocarditis (inflammation of the heart) and pericarditis (inflammation of the outer lining of the heart), usually within 10 days of vaccination. This has only been reported in men and the benefits of vaccination far outweigh the risks.
  • Report any vaccine administration errors and patient side effects or reactions on VAERS.
  • The FDA and CDC will continually monitor vaccine safety.
  • Learn more about the vaccine approval process.

Novavax vaccines are available to order now in the Washington State Immunization Information System (WAIIS). Washington state received a limited number of Novavax doses, and we ask that providers review the following before placing an order:

  • The Federal Government has asked that this product be used to vaccinate patients who have not yet received any COVID-19 vaccine doses. 
  • Not all orders in the WAIIS will be approved. We have an extremely limited number of doses available, and it is not clear if we will receive more. We will be using Vaccine Depot resources to help connect on increasing access to the vaccine. 
  • WAIIS orders are 100 doses minimum – a box of 10 vials with 10 doses in each vial. 
  • Once the vial is punctured, it must be used within 6 hours. Please keep this in mind when scheduling appointments for first and second doses. 
  • At time of order, order enough vaccine for first and second doses. For example, if you order 100 doses, 50 doses are for the first vaccine, and 50 doses are for the second vaccine. 100 doses = 50 patients (first and second dose). 
  • Please order based on demand to reduce wastage. Second-dose appointments should be scheduled at the time the first dose is administered.

Want to learn more about how to integrate COVID-19 vaccines into your clinic workflow and hear from other providers on how they talk to skeptical patients? An upcoming two-part COVID-19 vaccines webinar series is for you.

Research continues to show that vaccination against COVID-19 saves lives and the newly authorized Novavax vaccine will offer even more choices to your patients to protect them. Thank you for your work in keeping individuals up to date on their COVID-19 vaccines.

(Guidance released: July 29, 2022)

Novavax Booster Guidance

Novavax COVID-19, adjuvant booster vaccines will be available soon for adults age 18+. On October 19, the U.S. Food and Drug Administration revised the emergency use authorization for the Novavax COVID-19 vaccine. The revised EUA authorizes the use of the Novavax vaccine booster dose for adults. Following this, the Centers for Disease Control and Prevention has signed a memo allowing the monovalent Novavax booster for adults age 18+ who have completed the primary series vaccination but have not previously received a COVID-19 booster.

The Novavax booster will offer an option for additional protection to patients who cannot or will not receive an updated mRNA booster.

The Novavax booster should be administered 6 months after the primary series doses are completed. As the Novavax vaccine was first available in July of this year, your patients will not be eligible for the Novavax booster dose until early 2023.

Here’s what you should know:

  • Novavax COVID-19 boosters are available for adults 18+ if they have completed primary series vaccination but have not previously received a COVID-19 booster—and if they cannot or will not receive an updated mRNA booster. 
  • The Novavax COVID-19 booster will have the same vial with the same formula and dosage as the Novavax COVID-19 primary series.
  • It contains the SARS-CoV-2 spike protein and Matrix-M adjuvant. An adjuvant increases a vaccine’s ability to stimulate the body’s immune system to fight off disease (to improve vaccine effectiveness).
  • This booster is a monovalent vaccine, not a bivalent (or omicron) vaccine such as the mRNA options.
  • As with mRNA COVID-19 vaccines, Novavax recipients may have an increased risk of myocarditis (inflammation of the heart) and pericarditis (inflammation of the outer lining of the heart), usually within 10 days of vaccination. This has only been reported in men and the benefits of vaccination far outweigh the risks.
  • Report any vaccine administration errors and patient side effects or reactions on VAERS.
  • The FDA and CDC will continually monitor vaccine safety.
  • Read our step-by-step guide to find out more about how a vaccine gets authorized or approved in the U.S.

(Guidance released: October 20, 2022)

Ordering

You must use the Washington Immunization Information System (WAIIS) to place vaccine orders. As a reminder, you should:

  • First check the Vaccine Advertisement page in the WAIIS to see if other providers in your area have vaccine available.
  • If you don't find vaccine in your area, then you can submit a vaccine order through WAIIS. Ordering is open seven days a week, and DOH will approve orders within 24 hours Monday through Friday.
  • Order from one order set called “COVID 001.”
  • Maintain up to two weeks of inventory so you are prepared for any vaccination opportunities.
  • Click submit on your order. Saving your order does not mean it is submitted.

You can refer to the COVID-19 vaccine provider schedule (PDF) for a visual of the ordering cycle. Visit the vaccine management page for more information on ordering, storage, handling, and distribution.

DOH makes allocation decisions entirely based on individual provider requests for vaccine.

Local health jurisdictions: Please continue to share your community vaccine priorities with DOH. DOH will approve orders based on provider request and LHJ recommendations. Using this method, DOH will be able to distribute vaccine to the communities that need it most, while also providing extra doses to providers who continue to see higher need for vaccine.

In order to ensure providers across the state have doses available to vaccinate their community members, DOH is also offering flexibility to certain providers with throughput and usage. This includes providers who serve smaller communities, support equity efforts, and/or reach special populations, such as hospitals that transfer patients to long-term care facilities. We want to make sure vaccine is available to these groups when they need it.

(Guidance updated: July 8, 2021)

Pediatric COVID-19 Vaccine Authorized for Children Ages 5 to 11

On November 2, the CDC's Advisory Committee on Immunization Practices (ACIP) and the Western States Scientific Safety Review Workgroup voted unanimously to recommend the Pfizer-BioNTech COVID-19 vaccine for ages 5 to 11. This is a much-anticipated step in our state's efforts to prevent the spread of COVID-19. Thanks for all the work you've done preparing for this next step.

Here's what you should do:

  1. You can now order and administer the Pfizer-BioNTech pediatric vaccine to children ages 5 to 11. You must order the pediatric formulation because it is different than the existing formulation: it needs dilution, and children get a smaller-size dose. You cannot give the formulation approved for adolescents and adults to anyone age 11 and under.
  2. Consider offering special clinic hours (like evenings or weekends) to make it easier for parents and guardians to come and get their child vaccinated.
  3. Make it easy for the child to get their second dose on schedule. Schedule the child's second-dose appointment while they're getting their first dose.
  4. Encourage parents and guardians to add their child on v-safe and answer the health check-ins. This information helps CDC monitor the safety of COVID-19 vaccines in almost real time.
  5. Continue to check back on DOH's webpages for updates and new materials:

Here's what you should know:

  • Data showed that COVID-19 vaccines for ages 5 to 11 are not only effective, but safe, and adverse events are rare.
  • Initially the COVID-19 vaccine for children may be limited as supply builds. Supply is expected to level off and reach a consistent cadence within a few weeks.
  • The pediatric vaccine (orange cap) has the same ingredients as the adolescent/adult version (purple or gray caps), but it's one-third of the dosage. This vaccine needs diluent, which will be provided with the ancillary supplies.
  • The minimum order size is 100 doses. Connect with depot sites if you need smaller quantities.
  • We know vaccination is the best protection available and want to be sure all children in Washington state can be served. While we recognize not all parents or guardians may choose vaccination immediately, we'll work with health care providers, community partners, schools, and other partners to support parents in their decision-making.

If you aren't ready to start vaccinating yet, here's what you can do to prepare:

  1. Make sure you have enough of the current vaccine on hand. This will help you vaccinate families together, as any children ages 12 to 17 and any adults still need the current vaccine type and dosage. Connect with depot sites if you need smaller quantities.
  2. The pediatric vaccines will come in a different vial, so prepare space in your freezer to store them and you'll be ready to order as soon as they're available. Also prepare storage for diluent.
  3. Establish methods to ensure your staff will provide the correct vaccine and dosage, as the vaccine is not the same as the one for ages 12 and up and needs dilution.
  4. Read through DOH's materials on vaccinating youth. There are tools on that page that will help you navigate vaccinating minors, such as myocarditis information, Q&A on vaccinating children, handling consent, and more.
  5. Check to make sure you have appropriately sized emergency equipment, including respirator masks and pediatric-dosed epinephrine autoinjectors (epi pens). Order these supplies if you are low or out.
  6. If you have pediatrician colleagues who have not yet enrolled as a COVID-19 vaccine provider, please encourage them to do so. Direct them to www.doh.wa.gov/Covid19VaccineProvider.

For more information, you can also see:

(Guidance released: November 3, 2021)

Pfizer and Moderna COVID-19 Vaccines Now Preferred

The two mRNA COVID-19 vaccines are now clinically preferred over the Johnson & Johnson COVID-19 vaccine.

On December 16, 2021, the Advisory Committee on Immunization Practices unanimously voted to update their COVID-19 vaccine recommendations. They now recommend that Pfizer/Comirnaty and Moderna COVID-19 vaccines should be given instead of the Johnson & Johnson (Janssen) vaccine, when possible and appropriate. The language states: “mRNA COVID-19 vaccines are preferred over the Janssen COVID-19 vaccine for the prevention of COVID-19 for all > 18 years of age.” People who are unable or unwilling to receive an mRNA vaccine will continue to have access to the Janssen vaccine.

The Centers for Disease Control and Prevention has endorsed that recommendation; find the CDC's statement here. The Western States Scientific Safety Review Workgroup also concurred, meaning this is now the recommendation in Washington state. Janssen will continue to be available, but you are recommended to provide one of the other two vaccines instead when possible. The United States has more than a sufficient supply of mRNA vaccines to handle any increase in demand.

New risk information led to change

This change is because a new analysis shows that the risk of a blood clotting condition after the Janssen vaccine is higher than previously presented (though it's still rare). In light of the new information, the CDC did a risk-benefit analysis showing that the mRNA vaccines by Pfizer and Moderna are safer and more effective than the J&J vaccine.

This set of slides shows the Janssen data presented to the ACIP.

This set of slides shows the CDC's risk/benefit assessment.

During the meeting, new data was presented about thrombosis with thrombocytopenia syndrome, or TTS. TTS is a rare, but serious, condition involving blood clots and a low blood platelet count that's seen in some people who received the Janssen vaccine.

The good news is the risk is still rare. TTS has happened in both men and women, and the most at-risk group is women 30-49. For that group, the rate is about 1 case per every 100,000 doses of the vaccine. There have been 9 confirmed deaths, mostly in women, all after the first dose of the Janssen vaccine. There have been 54 cases of TTS out of 14 million doses of J&J given overall.

Because other vaccines are available to protect against COVID-19, ACIP voted for a preferential clinical recommendation, meaning that Janssen can still be used but mRNA vaccines should be given instead whenever possible.

The Western States Scientific Safety Workgroup believes vaccine providers should continue to make the Janssen vaccine available to people who cannot or prefer not to receive an mRNA vaccine after they have been educated about the Janssen vaccine's risks, as the benefits of receiving the vaccine outweigh the known risks compared to not receiving a COVID-19 vaccine.

Updated fact sheet for people who had TTS after Janssen dose

The U.S. Food and Drug Administration also updated their Emergency Use Authorization for Johnson & Johnson this week to say that anyone who got TTS after a dose of Janssen vaccine should not receive any further doses of that brand. Instead, if they come in for a booster, provide them with one of the two mRNA vaccines.

(Guidance released: December 17, 2021).

Pharmacies Urged to Offer COVID-19 Vaccine to Everyone Eligible

Pharmacies Urged to Offer COVID-19 Vaccine to Everyone Eligible (PDF)

Preliminary Safety Signal for one of the COVID-19 Bivalent Booster Vaccines

On January 13, the U.S. Centers for Disease Control and Prevention announced they will be investigating a preliminary safety signal for one of the COVID-19 bivalent booster vaccines.

This safety signal was detected by only one of many safety systems; other safety systems, databases, and countries are not seeing the same link, nor has it been seen in other brands of COVID-19 vaccine.

The signal is unlikely to represent a true clinical risk. Please continue vaccinating patients with the bivalent COVID-19 vaccine when they are due.

Here is more detailed information:

Picking up the signal

  • CDC’s Vaccine Safety Datalink (VSD), one of several vaccine safety monitoring systems in place in the United States, has picked up a signal indicating a potential risk of ischemic stroke in adults over 65 who received the Pfizer-BioNTech COVID-19 bivalent booster.
  • There is no signal for the Moderna COVID-19 bivalent booster.
  • U.S. government agencies use multiple, complementary safety monitoring systems to help detect possible vaccine statistical signals as early as possible and to know when or if to investigate a possible issue. VSD, the system that picked up this signal, is one of these.
  • As a response to this signal in the VSD, the CDC worked with the U.S. Food and Drug Administration to further investigate this potential side effect in other safety monitoring systems (such as VAERS) and clinical databases (including those for Medicare, the VA, Israel, and some European countries). No clinical risk of ischemic stroke has been identified in other sources.
  • Other countries have not observed an increased risk for ischemic stroke with bivalent vaccines.
  • Pfizer-BioNTech’s global safety database also does not indicate a signal for ischemic stroke with this vaccine.

What does this mean for clinicians?

  • Overall, the totality of the data suggests it is very unlikely that the signal in VSD represents a true clinical risk. In the spirit of transparency, CDC wanted to share this early information with the public.
  • No change in vaccination practice is recommended. CDC continues to recommend that everyone ages 6 months of age and older stay up to date with COVID-19 vaccination; this includes individuals who are currently eligible to receive an updated (bivalent) vaccine. 
  • Public health supports the continued assessment of vaccine safety. The finding from the Vaccine Safety Datalink shows that the system is working, and we are being vigilant in detecting any adverse health outcomes associated with the COVID-19 vaccine. 

What’s next?

CDC and FDA will continue to evaluate additional data from the VSD and other vaccine safety systems. These data and additional analyses will be discussed at the upcoming January 26 meeting of the FDA’s Vaccines and Related Biological Products Advisory Committee.

(Guidance released: January 18, 2023)

Prioritize Vaccinations Over Waste Reduction

We have heard that some providers are turning people away at the end of the day to avoid opening a new vial for just a few doses. Please do not turn anyone away because you are worried about waste. Even if someone comes in at the end of the day or you only have one patient, start a new vial to get them vaccinated. While we appreciate your efforts to minimize waste, it is more important to vaccinate as many people as possible.

We want to make sure anyone who wants the vaccine can get one. If that requires opening a new vial, that is ok. There are other ways to minimize end-of-day waste. For example, you can:

To further reduce waste, make sure to follow proper storage and handling procedures. For more information on minimizing waste and what to do if you have waste, see our general vaccine wastage guidance.

Remember to keep equity in mind when distributing vaccine, including extra doses. To make sure you are meeting minimum equity standards and to learn how to improve, visit our equity resources and strategies guide.

If you would like assistance or have questions about these suggestions, please contact covid.vaccine@doh.wa.gov.

(Guidance updated: July 21, 2021)

Proof of Citizenship

Social security numbers, documentation are not needed

Regardless of citizenship or immigration status, all people should get vaccinated. That means people who are not documented U.S. citizens can get vaccinated. You do not need to ask for proof of citizenship or a social security number from anyone getting the COVID-19 vaccine. If you do ask, vaccine patients do not need and are not required to provide this information. You can still get reimbursed through the Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program without this documentation.

Please make sure patients understand that they do not need a social security number or proof of citizenship to get the vaccine.

Everyone can receive the vaccine, at no cost, regardless of their immigration status. This helps reduce fears related to:

  • Immigrations and Customs Enforcement
  • Deportation due to immigration status
  • Public charge concerns
  • Government authorities with access to personal information

This helps us best serve undocumented, immigrant, and refugee communities who are disproportionally impacted by COVID-19.

See these tips for addressing vaccine hesitancy for immigration related concerns.

Thank you for helping us ensure equitable distribution and improve vaccine access in Washington.

(Guidance updated: June 7, 2021)

Race and Ethnicity Data

It is important to gather accurate race and ethnicity data

The COVID-19 pandemic affects everyone, but it does not affect everyone equally. A primary goal of Washington's vaccine allocation and prioritization is to be equitable in our approach. One way we can achieve this is by getting vaccine as quickly as possible to communities that face the highest rates of disease and death from COVID-19.

Data from cities across the United States show that communities disproportionally impacted by COVID-19 are not the ones getting the vaccine. Instead, it is the more affluent and less at-risk communities who have been able to access vaccine first. Our communities here in Washington state have called for increased transparency about who is getting vaccinated.

We are pleased to share that DOH has started to analyze race and ethnicity data of vaccine recipients submitted so far. These data will help us identify gaps in vaccine access and find ways to more equitably distribute vaccine. Sharing these data helps us and providers stay accountable for reaching our equity goals. You can read the reports on the COVID-19 data dashboard, or from below:

All COVID-19 vaccine providers are required to collect race and ethnicity data at the point of vaccination and report it as accurately as possible along with other metrics. Please gather and enter this information every time you vaccinate someone and when you report your site's vaccine data. Not only is it required, this information is key to helping us understand where we can do better. When you collect this information from your patients, you are helping to ultimately serve your community in a more equitable way.

For more information, see the COVID vaccine provider reporting page. If you need support collecting these data or need ideas for integrating it into your data collection protocol, contact us at covid.vaccine@doh.wa.gov.

(Guidance released: February 11, 2021)

Risk of Guillain-Barré after J&J vaccination

The US Food and Drug Administration (FDA) updated the Emergency Use Authorization (EUA) fact sheets on the Johnson & Johnson (Janssen) COVID-19 vaccine on July 8, 2021, to add a warning about the possible increased risk of a rare neurological complication known as Guillain-Barré syndrome within 42 days of receiving this vaccine. Guillain-Barré syndrome is a neurological disorder in which the body's immune system damages nerve cells, causing muscle weakness and sometimes paralysis.

The FDA posted a statement giving details about the safety signal observed and outlining the actions they're taking. The FDA lists the chance of getting this syndrome as “very rare.” Based on an analysis of Vaccine Adverse Event Reporting (VAERS) data, there have been 100 preliminary reports of Guillain-Barré syndrome following vaccination with the Janssen vaccine after approximately 12.5 million doses administered.

The CDC updated their Adverse Events webpage to add statistics about this issue and discuss how it's being monitored. We expect the Advisory Committee on Immunization Practices (ACIP) to review the data on this rare occurrence at their next meeting July 22. Given the increasing COVID-19 variant infections and higher risk for spread of the virus, continued vaccination is critical to prevent increased spread of disease.

In December 2021, CDC and DOH recommended the mRNA COVID-19 vaccines (Pfizer or Moderna) over the Johnson & Johnson vaccine due to the rare risk of blood clots (called thrombosis with thrombocytopenia syndrome, or TTS) and nerve damage (called Guillain-Barré syndrome).

Clinical guidance

Please offer patients either Moderna or Pfizer COVID-19 vaccine. It is important to continue protecting people against COVID-19.

People who have previously had Guillain-Barré syndrome may receive any of the COVID-19 vaccines.

Please discard any existing Johnson & Johnson EUA fact sheets you may have printed. When vaccinating patients with Johnson & Johnson, make sure you give them the most updated EUA fact sheet for recipients, which includes a description of what symptoms they should watch for. If a patient calls you with any of the following symptoms within 42 days of receiving this vaccine, please advise them to seek medical attention right away:

  • Weakness or tingling sensations, especially in the legs or arms, that's worsening and spreading to other parts of the body
  • Difficulty walking
  • Difficulty with facial movements, including speaking, chewing, or swallowing
  • Double vision or inability to move eyes
  • Difficulty with bladder control or bowel function

Other resources

(Guidance updated: December 27, 2021)

Second and Third Dose Reminders

Goals for second- and third-dose vaccinations

  • It's important to prioritize vaccine series completion. Providers who administer first doses need to plan and invite individuals receiving first-dose vaccine to return for their second and third doses.
  • Help ease patient anxiety by scheduling second- and third-dose appointments at the time of their first dose. You can also provide information from the CDC about series completion and timing for doses.
  • Providers should offer second- and third-dose (for those who qualify for a booster or additional dose) vaccinations, even if you did not administer the first or second dose to the person, if you have the vaccine available. Series completion is a priority.
  • We are asking all providers to help support second- and third-dose vaccinations. This could mean scheduling events specifically for additional doses and reserving a portion of your inventory for those who cannot return to where they received their first or second dose.

How to support individuals who get their doses from different providers

When a patient comes in for a booster dose or an additional dose, check their record in the IIS to see which vaccine they received for the primary series. Review their vaccination card to double-check, or if the record is not in the Washington Immunization Information System (WAIIS) to validate.

For additional doses, use the same vaccine brand as the patient's initial vaccine series, if possible. If you don't have it available, the other mRNA vaccine brand may be used.

For booster doses, patients 18 years and older can get the same or a different COVID-19 vaccine than the vaccine they received for the primary series. However, people ages 17 and younger may only get the Pfizer COVID-19 vaccine for their booster dose.

Recommended steps for a patient's first-dose appointment

  • Encourage your first-dose patients to come back to you for their second and third doses, which streamlines the process.
  • Schedule the second- and third-dose appointments while they're in getting their first dose.
  • Remind your first-dose patients to bring their vaccination card back with them.
  • Ensure you enter all required information into the WAIIS when giving the first dose.

Second-dose appointment delays

The second dose should be administered as close to the recommended interval as possible. The important limitation is to ensure that doses are not administered earlier than recommended.

If you've had to delay patient second doses, that's OK. Administer the second dose as soon as possible after the recommended number of days have passed since the patient's first dose (21 days for Comirnaty/Pfizer, 28 days for Moderna). If the patient misses that window and the second dose is administered beyond these intervals, there is no need to restart the series. Just complete the series at that time.

Please encourage your first-dose patients to return to you for their second dose.

Booster dose timing

Like the second dose, you should aim to administer booster doses as close to the recommended interval as possible.

  • Pfizer-BioNTech: five months after second dose
  • Moderna: five months after second dose
  • Johnson & Johnson: two months after first dose

How to place a vaccine order

You can order COVID-19 vaccines through the Washington State Immunization Information System (WAIIS). Before ordering, please check the Vaccine Advertisement page in the WAIIS to see if other providers in your area have vaccine available. If you don't find vaccine in your area, then you can submit a vaccine order through WAIIS. Ordering is open seven days a week, and DOH will approve orders within 24 hours Monday through Friday.

(Guidance updated: January 10, 2022)

Transportation Requirements for Satellite, Temporary, or Off-Site Clinics

If you are having a satellite, temporary, or off-site clinic, you must follow all requirements outlined in the off-site vaccination clinic guidelines (PDF) and submit your request to us at least 24 hours before your clinic. We are not allowing any exceptions.

The requirements are in place to make sure that we administer viable vaccines. The mRNA vaccines are very fragile and transporting them increases the risk that they could be damaged due to a temperature excursion or too much shaking. We do not have enough data from stability testing to allow flexibility in the storage and handling guidelines, especially during transport.

Transportation Requirements

Vaccines must be transported in one of the following containers with a digital data logger:

  1. A portable vaccine refrigerator, OR
  2. A qualified container and pack-out

A qualified container is a container specifically designed, tested, and certified to hold the appropriate temperatures by testing labs. Here is an example:

Vaccine cold storage conatiner
Vaccine cold storage conatiner

Temperature Excursions

After your clinic, you must download and check the digital data logger temperature data. If a temperature reading is outside the recommended range, follow the steps outlined in the COVID-19 vaccine temperature excursion guide and report the wasted or expired doses in the Washington Immunization Information System.

Emergencies

You can ONLY use another transport system in an emergency like a power outage, natural disaster, or equipment failure. The COVID-19 pandemic does not count as an emergency in this situation.

If you have an emergency, you can transport vaccines using the conditioned water bottle transport system. It is never acceptable to use food and beverage coolers.

General Transport System Recommendations Emergency Transport Transport for Off-Site Clinic, Satellite Facility, or Relocation of Stock
Portable Vaccine Refrigerator, Freezer, or Ultra-cold Freezer Yes Yes
Qualified Container and Packout Yes Yes
Conditioned Water Bottle Transport System (PDF) Yes No
Manufacturer's Original Shipping Container Yes (last resort only) No*
Food/Beverage Coolers No No

*The original shipping container for ultra-cold COVID-19 vaccine can be used for transport.

Source: Centers for Disease Control and Prevention (CDC) Storage and Handling Toolkit (PDF), page 55.

(Guidance released: March 8, 2021)

Updated Novavax Guidance Statement

On August 19, 2022, the U.S. Food & Drug Administration authorized the emergency use of the Novavax COVID-19 Vaccine in individuals 12 through 17 years of age. They analyzed the vaccine in this age group and found it to be safe and effective. The vaccine was previously authorized for individuals 18 years and older. 

The Centers for Disease Control and Prevention (CDC) has also agreed that Novavax’s COVID-19 vaccine may be used as another primary series option for adolescents ages 12 through 17.

The Washington State Department of Health has updated its standing orders to follow this new age recommendation. The updated standing order is available.

This broadens the choices parents have when selecting a vaccine for their adolescent. The Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines continue to be available for children ages 6 months and older. It is important to vaccinate youth against COVID-19 in order to reduce their chance of getting seriously ill.

(Guidance released: September 12, 2022)

VaccineFinder

Please publicly list your practice in order to make it easier for consumers to access vaccines and help them find vaccine.

Hub and spoke locations: For locations where a central hub manages inventory and sends vaccines to spoke sites for administration, you can now display those spoke sites on vaccinefinder.org.

In stock status: Vaccine availability status will display as “call to confirm” on vaccinefinder.org if inventory quantities are not updated in the portal within 72 hours. Even if your site's on-hand doses do not change, please submit your inventory daily to maintain the In Stock status on the public website.

Phone number requirement update: A site's phone number is only required when there is no pre-screen web address listed. Each site must have either a phone number OR pre-screen web address available to help consumers make an appointment.

VaccineFinder Resources

VaccineFinder Support

(Guidance released: May 7, 2021)

Vaccine Appointment Access

Many prospective COVID-19 vaccine patients must schedule their vaccination appointments using online portals. This process has been easier for some than for others. While English-speaking, tech-savvy individuals may be able to navigate the system, we want to help improve the experience for everyone here in Washington. Here are some tips for improving online scheduling, and for enhancing the patient's experience at the clinic itself.

Tips for improving online scheduling

  • Keep your online vaccine scheduling system up to date.
  • Allow patients to select an appointment date and time first before entering their information. It has been a frustrating user experience to enter all of their information first before seeing available times.
  • Choose the setting that holds the time slot for a short period after the patient selects it. This gives them time to fully register before losing the slot. Ten or 15 minutes is a good estimate.
  • Ensure that the vaccination website listed on https://vaccinelocator.doh.wa.gov is the correct landing page for your scheduling site. If it's not, email covid.vaccine@doh.wa.gov with an updated link.
  • Allow patients to book an open appointment without creating an account. If account creation is required, allow an open appointment to be held during the account creation process.
  • Display the type of vaccine available at your site and for each potential vaccination date.
  • Book the patient's second-dose appointment when they're in your clinic for their first dose.
  • When supply allows, offer second-dose vaccination appointments even if the patient did not receive their first dose at your facility. Series completion is a priority.
  • Include scheduling instructions and resources for non-English speaking patients.
  • Prominently display phone numbers for language assistance, such as the DOH information line 1-800-525-0127.
  • Offer your webpage and materials in other languages. Make sure the language toggle switch easy to see.
  • If you have the staffing, consider offering a phone line for patients who are not comfortable booking online.
  • Clearly state during the scheduling process, on the online registration form, and at the vaccine clinic site which vaccine presentation (brand) will be available.
  • Clearly state whether your clinic has restrictions (for example, existing patients only, age limits, only first or second doses, or other limitations)
  • If your location vaccinates people age 5 to 17 years, indicate during registration how you require a parent or guardian to consent to the minor's vaccination, but do not make parent consent a required field to book the appointment. Minors who are able to consent to their own vaccine will be unable to make an appointment with you. Read more considerations for vaccinating minors here.
  • Consider choosing not to collect insurance information during registration.

Tips for enhancing equitable vaccine distribution

  • Review guidelines and suggestions for equity strategies. Key strategies:
    • Reach out proactively to highly affected communities
    • Offer expanded evening or weekend vaccination hours.
    • Reinforce messaging that people are eligible for vaccine regardless of their immigration status or insurance status. If you ask for a Social Security number, share transparently that it is not required and no personal information will be shared.
  • If using a waitlist, review recommendations for equitable use. Rather than a first-come first-serve system, a waitlist should:
    • Prioritize people who have access barriers or live in an area with a high social vulnerability index.
    • Prioritize those who are more at risk of COVID-19.
  • If a patient arrives late for an appointment, do not withhold vaccination.
  • If a patient arrives without a mask, do not withhold vaccination. You can find a safe way to vaccinate the patient.
  • Save vaccine spots for walk-in appointments. Publicize this information within your community.
  • Include all options for consent for minors to receive vaccine and provide information for minors on how to meet those requirements. Also indicate if you are vaccinating minors who are able to consent to their own vaccination.
  • Learn more by reading the Department of Health's eight strategies for equitable COVID-19 vaccine distribution.

These tips should help your clinics and registration process run smoothly so we can protect even more people, especially those who are most vulnerable to this disease. If you need further guidance, please contact us at covid.vaccine@doh.wa.gov.

(Guidance released: June 14, 2021)

Vaccine Now Recommended for Ages 6 Months and Up

On June 18, 2022, the CDC’s Advisory Committee on Immunization Practices (ACIP) and the Western States Scientific Safety Review Workgroup voted to recommend the COVID-19 vaccine for ages 6 months and up. This is a much-anticipated step in our state’s efforts to prevent the spread of COVID-19 and protect our youngest population. Thank you for all the work you’ve done preparing for this next step. This authorization for the COVID-19 vaccine now includes:

  • A 3-dose Pfizer-BioNTech vaccine primary series for children ages 6 months – 4 years
  • A 2-dose Moderna vaccine primary series for children ages 6 months – 5 years

Initial federal COVID-19 vaccine supply for children was slightly delayed and will be limited as supply builds. Supply is expected to level off and reach a consistent cadence within a few weeks. Once you have the Pfizer-BioNTech and Moderna pediatric COVID-19 vaccines in stock, you may begin administering them to children ages 6 months and up.

Here’s what you should know:

  • Data showed that COVID-19 vaccines for ages 6 months and up are not only effective, but safe, and adverse events are rare. COVID-19 vaccines continue to undergo the most intensive safety monitoring in United States history.
  • Remember that COVID-19 can be a serious disease in kids. In addition to poor outcomes from the disease itself, children in this age group can get long COVID or MIS-C even from mild or asymptomatic disease. We can protect young Washingtonians from these serious outcomes by protecting them with COVID-19 vaccination.
  • Consider offering special clinic hours (like evenings or weekends) to make it easier for parents and guardians to come and get their child vaccinated.
  • Make it easy for the child to get their next dose on schedule. Schedule the child’s next dose appointment while they’re getting their initial scheduled dose.
  • Encourage parents and guardians to add their child on v-safe and answer the health check-ins. This information helps CDC monitor the safety of COVID-19 vaccines in almost real time.
  • Keep your clinic’s information up to date on Vaccine Locator. DOH will update Vaccine Locator’s filter option for all pediatric vaccines.
  • COVID-19 booster doses can be coadministered with other vaccines, such as the flu vaccine.
  • Ensure vaccine appointments are available to all who seek access in an equitable way. Please refer to our Equity Strategies and Resources toolkit guidance to assess, and improve, current practices for language access and accessibility for people with disabilities.

More information

  • The U.S. Food and Drug Administration authorized the use of Pfizer COVID-19 vaccine for those ages 6 months and up on June 17. Read their news release here.
  • In authorizing this use, the FDA determined that the benefits of receiving the COVID-19 vaccine currently outweigh any known or potential risks posed by the vaccine itself.
  • Find more information about providing COVID-19 vaccine, including a guide to vaccinating youth, at www.doh.wa.gov/Covid19VaccineProvider.
  • Continue to check back on DOH’s webpages for updates and new materials:
  • Sign up for the Power of Providers initiative at www.doh.wa.gov/POP for free swag and resources.
  • The Pfizer pediatric vaccine for children 6 months-4 years (maroon cap) has the same ingredients as the adolescent/adult version (purple or gray caps), but it’s one-tenth of the dosage. This vaccine needs diluent and will have the same storage and handling considerations as the orange cap Pfizer vaccine. The maroon cap pediatric vaccine may have vial and carton labels with different information than the emergency use authorization; ALWAYS review the EUA Fact Sheets prior to the preparation of the vaccine.

We know vaccination is the best protection available and want to be sure all children in Washington state can be served. While we recognize not all parents or guardians may choose vaccination immediately, we’ll work with health care providers, community partners, schools, and other partners to support parents in their decision-making.

Research continues to show that vaccination against COVID-19 saves lives. Thank you for your work in keeping all eligible adults, adolescents, and now children 6 months and older up to date on their COVID-19 vaccines.

(Guidance released: June 21, 2022)

Vaccine Stickers and Outreach Materials Available for Free

The Washington State Department of Health is excited to launch an online portal where you can order vaccine outreach materials at no cost! This site is for Washington state providers administering the COVID-19 vaccine and community-based organizations and businesses running vaccination sites. All items are available at no cost to you and delivered directly to your preferred address. To begin ordering, follow the link above and click the self-registration button. Registering will save your information so you can save time when you return.

Available materials include stickers in multiple languages, buttons for vaccine providers and event staff, thank you signage and handouts, and waiting area signage and handouts. Please order the quantity required for you immediate needs. You can come back and re-order anytime.

DOH will be approving each order before shipping. Materials are shipped by UPS Ground delivery and in-stock items should arrive 3-5 business days after placing an order. If some items are out of stock, in-stock items will ship immediately and other parts of your order will be filled when stock is available. Materials in other languages can be created upon request. Just send an e-mail to the contact listed in the portal.

Thank you. We appreciate your efforts in helping to Vaccinate WA!

(Guidance released: May 7, 2021)

Vaccine Wastage

Vaccine providers in Washington have done a great job so far reducing vaccine waste. Since we started getting COVID-19 vaccines in December, the proportion of COVID-19 vaccine waste is significantly lower than for other vaccines.

You can help us keep vaccine waste to a minimum by identifying, properly disposing of, and reporting your waste.

Identifying Waste

You should make every effort to reduce wastage in your vaccine program. However, it is important to identify doses as waste in order to make sure the vaccines you administer to patients are safe and effective. Vaccine may be identified as waste if:

  • There is a temperature excursion. You must monitor COVID-19 vaccine temperatures with a digital data logger (DDL) during storage and transport. If the DDL shows the vaccines were out of temperature range, you may need to declare them as waste. Contact the vaccine manufacturer to see if you can still use the vaccine.
  • You don't use a punctured vial in time. After you puncture a COVID-19 vaccine vial, you must use all doses in the vial within a certain timeframe (the exact time depends on the vaccine product and temperature).
  • Your syringes can't get the last dose in the vial. Pfizer vaccine vials contain six doses, but you need a low dead-volume syringe to access the sixth dose. You cannot combine vaccine from multiple vials to make a dose.
  • The vaccine is expired. You should always check the vaccine expiration date before preparing or administering vaccine.
  • The vaccine shipment arrived damaged. You should check the vaccine shipments as soon as they arrive. If the temperature went out of range or the DDL wasn't activated, you should store the vaccine, mark it as “do not use,” and contact the manufacturer for guidance.

Disposing of Waste

You should dispose of COVID-19 vaccine waste in accordance with local regulations and processes for disposal of regulated medical waste.

Reporting Waste

You should report any vaccine wastage to the Washington State Immunization Information System (WAIIS) by following the How to Report COVID-19 Vaccine Wastage guide (PDF).

Tips to Reduce Waste

You can help prevent waste from happening by:

  • Following your emergency vaccine use plan if you need to quickly administer doses of vaccine that would otherwise be wasted.
  • Advertising any doses you can't use before their expiration date on the WAIIS.
  • Contacting DOH at covid.vaccine@doh.wa.gov if you have a large number of vaccine vials that you can't use before the expiration date. We can help you transfer the doses to another facility.

For more information, see these tips on how to reduce COVID-19 vaccine waste (PDF).

Manufacturer Contact Information

You should contact the manufacturer if you have a temperature excursion to see if the vaccine is still viable.

Manufacturer Phone Number Email Address
Pfizer customer service 1-800-666-7248 cvgovernment@pfizer.com
Moderna customer service 1-866-663-3762 Not available
Janssen (Johnson & Johnson) customer service 1-800-565-4008 jsccovidtempexcursion@its.jnj.com
McKesson customer service 1-833-272-6634 snssupport@mckesson.com


For more information on vaccine storage and handling, see the Centers for Disease Control and Prevention's (CDC) Storage and Handling Toolkit.

(Guidance updated: June 29, 2021)