R 161751Z DEC 20 MID600050095828U
FM CNO WASHINGTON DC
INFO SECNAV WASHINGTON DC
CNO WASHINGTON DC
MSGID/GENADMIN/CNO WASHINGTON DC/CNO/DEC//
SUBJ/SARS-COV-2 VACCINATION AND REPORTING POLICY//
REF/C/DOC/32 CFR PART 199.21/1DEC2016//
NARR/REF A IS THE DEFENSE HEALTH AGENCY INTERIM PROCEDURES MEMORANDUM 20-004
DEPARTMENT OF DEFENSE (DOD) CORONAVIRUS DISEASE 2019 (COVID-19) VACCINATION
PROGRAM IMPLEMENTATION PROGRAM.
REF B IS THE DODI 6025.02 INDIVIDUAL MEDICAL READINESS ADDRESSING
RESPONSIBILITIES AND PROCEDURES FOR MONITORING AND ON INDIVIDUAL MEDICAL
REF C IS 32 CFR PART 199.21, CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE
UNIFORMED SERVICES (CHAMPUS)/TRICARE: TRICARE PHARMACY BENEFITS PROGRAM.
REF D IS THE FOOD AND DRUG ADMINISTRATION EMERGENCY USE AUTHORIZATION (EUA).
REF E IS THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES INTERIM
RECOMMENDATION FOR USE OF PFIZER-BIONTECH COVID-19 VACCINE UNITED STATES,
REF F IS THE DEPARTMENT OF DEFENSE CORONAVIRUS-2019 VACCINATION PLAN (DOD
COVID-19 VACCINE PLAN).
REF G IS THE US NAVY COVID-19 STANDARDIZED OPERATIONAL GUIDANCE VERSION
POC/ COVID-19 CRISIS ACTION TEAM /(703)681-1125/
RMKS/1. The SARS-CoV-2 virus and the disease it causes, COVID-19, has
disrupted Navy force mission execution and life in the United States. The
shortest path to restoring normal operations, and protecting our Navy service
members, civilians and dependents is to efficiently vaccinate a large portion
of the force. Two SARS-CoV-2 vaccines are anticipated for near term use by
the DoD. Additional vaccines may be approved for future use. The SARS-CoV-2
vaccine is a pandemic vaccine and the distribution and administration of it
will follow similar protocols established by prior influenza vaccination
seasons. DoD guidance was promulgated in reference (a) and Navy guidance
follows and is broken into the following paragraphs.
2. Policy Guidance
2.b. Emergency Use Authorization (EUA).
2.c. Recipient Awareness.
2.d. COVID-19 Mitigations Measures.
2.e. Subsequent Symptoms.
3. Operational Guidance
3.a. Commanders Critical Information Reports (CCIRs).
3.b. Vaccine Planning considerations.
3.c. SARS-CoV-2 Vaccine Priority.
3.e. Reserve Forces.
3.f. Navy Civilian Personnel.
3.g. Vaccination on the economy.
4. Medical Guidance
4.a. Partial Sequence Completion.
4.b. Side Effects.
4.c. Co-administration guidance.
4.d. Single Manufacture.
4.e. SARS-CoV-2 Vaccine Ordering and Shipping.
4.f. SARS-CoV-2 Vaccine Integrity.
4.g. SARS-CoV-2 Vaccine Administration.
4.h. Personnel Administering Vaccines.
4.i. Pre-vaccination briefing.
4.j. SARS-CoV-2 Vaccination Compliance.
4.k. Documenting SARS-CoV-2 Vaccination.
4.l. Navy Goals and Performance Standards.
4.m. Duty in a Flight Status.
4.n. Dive Status, Undersea, and Special Operations.
2. Policy Guidance
2.a. Coordination. Military Treatment Facilities
(MTFs) will coordinate the execution and administration of the vaccine with
their supported local units. MTFs will follow a detailed schema coordinated,
updated and maintained by OPNAV. MTFs will contact each supported unit /
command to validate crew complement for vaccine ordering, administration, and
scheduling. Timing of vaccinations for individual units will be based on the
vaccination schema and vaccine supplies.
While the MTFs will schedule and execute vaccination, units should also
closely track and coordinate vaccination with servicing MTFs, not just the
first injection, but also the follow-up injection at 21 or 28 days (depending
on the product) based on their schedule and in order to achieve maximum
2.b. Emergency Use Authorization (EUA). The current vaccines released under
Federal Drug Administration (FDA) EUA or Expanded Availability (EA) are
expected to receive full licensure in the future. While the SARs-CoV-2
vaccine is released under EUA/EA guidance, vaccination is voluntary for
service members. For those members that have questions or concerns about the
vaccine, they are encouraged to reach out to their medical providers for
2.c. Recipient Awareness. Administering MTF will make vaccine recipients
aware the FDA has authorized emergency use of the vaccine and ensure
recipients know potential benefits and risks and the extent such benefits and
risks are unknown.
Finally, the MTF will inform recipients of available alternatives to the
vaccine and of the risks and benefits of the alternatives. Members receiving
the vaccine will be required to sign a consent form.
2.d. COVID-19 Mitigation Measures. COVID-19 mitigation measures such as
facemasks, physical distancing, frequent hand-washing, and ROM Sequester will
remain in place until a sufficient percentage of the Navy/Unit population is
immunized and the rate of infection reduced to no longer pose an operational
risk to the force. Individuals vaccinated must still follow all the health
protection measures implemented for the Navy at-large.
2.e. Subsequent Symptoms. Vaccinated individuals who experience
COVID-19 symptoms outside the expected side effects should be tested for
COVID-19 and follow return to work guidance per reference (g).
3. Operational Guidance
3.a. The following CCIRs are established specifically for vaccine reporting
(other COVID CCIRs remain in effect). Make reports via OPREP-3 NAVY BLUE and
address all reports TO CNO WASHINGTON DC, BUMED and operational and
administrative chains of command.
3.a.1. Adverse reaction to a dose of the vaccine. Report if an individual
has a significant adverse reaction or if a large number of a vaccinated
population has minor symptoms and their duration and type are beyond what is
anticipated as described in reference (a). Significant adverse events may
include, but are not limited to, anaphylaxis or anaphylactic shock or events
described in manufacturers package insert as contraindications to additional
doses of vaccines. Information will be disseminated as any new medical data
is collected and verified by the FDA.
3.a.2. Theft, loss or spoilage of vaccine, even a single vaccine dose.
3.a.3. Vaccinated individual, regardless of the number of doses, subsequently
is diagnosed with COVID-19.
3.a.4. Negative media or public interest in the Navys vaccination process
brought to the attention of commanders. Transparent communication and
leadership is important to maintain confidence in and support for a robust
voluntary vaccination program.
3.b. Vaccine Planning considerations
3.b.1. Side effects are expected to be mild, but may be similar to COVID-19
infection as per reference (e). Side effects for a specific vaccine will be
explained by the medical provider immediately prior to administering the
vaccine. Consider critical watch station manning and mitigation strategies
when planning vaccination for operational units due to potential side
3.b.2. Timing. Current SARS-CoV-2 vaccines are two-dose series with each
vaccine separated by 21 to 28 days. Commanders must ensure second dose
timing is planned and operational commitments support prior to initiating the
3.c. SARS-CoV-2 Vaccine Priority. The basic DOD schema is:
Phase 1a: Healthcare and Emergency Service personnel.
Phase 1b.1: Critical national capabilities, Strategic and National mission
forces, National leadership.
Phase 1b.2: Personnel deploying OCONUS.
Phase 1b.3: Other critical and essential support personnel.
Note: majority of service members will fall in this category.
Phase 2: High-risk beneficiaries, as defined by the CDC.
Phase 3: Healthy population beneficiaries.
3.c.1. Phase 1a is expected to be complete early January 2021.
Phase 1b.1 is expected to take through February 2021, with phase 1b.2
overlapping with phase 1b.1 in February. These dates may change based on
3.c.2. Navy Component Commander (NCC) Fleet Surgeons and Naval Sea Systems
Command (NAVSEA) / Naval Air Systems Command (NAVAIR) Surgeons will support
planning by providing OPNAV with unit prioritization matched to the OSD
Distribution Schema. OPNAV COVID Cell will maintain and disseminate the
prioritized list for NAVMEDLOGCOM distribution and MTF planning purposes.
3.c.3. Navy Component Commanders (NCC) will provide OPNAV COVID Cell with
prioritized vaccination plans and desired timing for deploying units (Phase
1b.2). The intent is to vaccinate units deploying within the next three to
six months, but this timeline may not fit all pre-deployment operational
3.c.4. An update to reference (g) will be promulgated providing amplifying
guidance for operational units.
3.d. Reserve Forces. Reserve forces being mobilized and in the process of
activation are prioritized for vaccination with their unit per current
mobilization policy COMNAVRESFORINST 3060.7D. All other reserve forces are
Phase 3 priority and will be vaccinated according to the approved Reserve
Component (RC) COVID Vaccination Plan. Navy Operational Support Centers
(NOSCs)/Navy Reserve Activities (NRAs) will coordinate with the nearest MTF
to coordinate vaccinations during a Navy Reserve Unit (NRU) drill weekend
where possible. For vaccines that require two doses, second dose planning
with the MTF needs to be completed prior to administering the first dose.
NOSCs shall inform supported NRU leadership teams of all vaccination plans to
ensure Reserve personnel can plan appropriately for vaccination during a
drill weekend. Where an MTF is not available, members should receive their
vaccination from a civilian or local vaccination program. RC members will
provide vaccination documentation received from civilian or local vaccination
programs to NOSC medical staff for documentation in Medical Readiness
3.e. Navy Civilian Personnel. SARS-CoV-2 vaccination will be available for
all civilian healthcare personnel and Navy civilian employees per reference
3.f. Vaccination on the economy. Reference (c) authorizes retail network
pharmacies to administer vaccines. TRICARE beneficiaries may receive SARS-
CoV-2 vaccinations with no co-pay at DoD MTFs and authorized retail network
pharmacies as per reference (a). Beneficiaries are encouraged to contact the
pharmacy regarding vaccine availability.
4. Medical Guidance
4.a. Partial or Full Sequence Completion. Personnel who have received
partial or full dosing of a COVID-19 vaccine course and develop symptoms
consistent with COVID-19 outside of expected side effects time period should
be tested for COVID-19. If they test positive, follow ALNAV 096/20.
4.b. Side Effects. Side effects are expected to be mild, but may be similar
to COVID-19 infection. Side effects for a specific vaccine will be explained
by the medical provider immediately prior to administering the vaccine.
4.c. Co-administration guidance. Administration of COVID vaccines with other
vaccines must be done in accordance with the current Advisory Council on
Immunization Practices (ACIP) guidelines: https://www.cdc.gov/vaccines/
4.d. Single Manufacture. Service members should not be given SARS-CoV-2
vaccines from different manufacturers. If after one dose has been
administered and the series cannot be completed with the same manufacturer,
service members will consult with their medical provider before restarting
the series with a different vaccine.
4.e. SARS-CoV-2 Vaccine Ordering and Shipping. The SARS-CoV-2 vaccine is
centrally funded. MTFs will order vaccine for their supported commands.
The Vaccine Information and Logistics System (VIALS) will be used to track
requisitioned vaccines via Military Standard Requisitioning and Issuing
Procedures orders from requisition to receipt. MTFs may track and verify
their COVID-19 vaccine status in VIALS
4.e.1. Commanders will ensure their unit census is reported to their
supporting MTF vaccine coordinator. MTF vaccine coordinators will record the
unit name, UIC, count of personnel, and MTF that is responsible for providing
the vaccine. Commanders with their own embedded medical personnel, who
routinely order annual vaccines, will coordinate with the MTF vaccine
coordinator and, as indicated, submit the previously described data.
Counts will be summarized in VIALs and consolidated in a report through the
MTFs to NAVMEDLOGCOM vaccine coordinator as directed by BUMED. Vaccine points
of contact can be found at the VIALS helpdesk noted in 4.e.
4.e.2. The Naval Medical Logistics Command (NAVMEDLOGCOM), consistent with
reference (a) and upon direction from OPNAV N3N5 and BUMED, will submit MTF
orders and oversee distribution of SARS-CoV-2 vaccine for all Navy and Marine
Corps activities. Additional quantities required and/or changes in submitted
orders will be coordinated with the NAVMEDLOGCOM SARS-CoV-2 Vaccine Manager,
DSN: (312) 343-8054 or the Vaccine Information and Logistics System (VIALS)
helpdesk at: usn.detrick.navmedlogcomftdmd.list.vialhelp(at)mail.mil.
4.e.3. SARS-CoV-2 Vaccine Shipping. All MTFs will verify their correct
shipping address and point of contact information in VIALS to ensure prompt
delivery. Shipment locations and the method of shipment is dependent upon
the vaccine being shipped. Shipments will arrive to MTFs for administration
and, in some cases, distribution to other sites. Future vaccines may be
distributed directly to afloat medical units.
4.e.4. Vaccines are expected to be delivered incrementally over a period of
4.e.5. The Pfizer vaccine has significant storage, maintenance, and
administration requirements. Only select MTFs are authorized to receive the
vaccine. Identified sites will receive the Pfizer vaccine and function as
hubs to distribute the vaccine to smaller MTFs.
4.e.6. The other vaccine candidates are expected to be distributed and
administered similarly to the annual influenza vaccine.
4.f. SARS-CoV-2 Vaccine Integrity
4.f.1. Temperature Monitors. All SARS-CoV-2 vaccine shipments include
temperature monitors. Return temperature monitors to either the Defense
Logistics Agency Troop Support Medical (DLA-TSM) cold chain office or the
Manufacturers specific vaccine management program after receipt, per the
4.f.1.a. If the temperature monitor has not alarmed, the vaccine is ready for
4.f.1.b. If the temperature monitor has alarmed in shipment, do not
administer those vaccine doses. Segregate in an appropriate vaccine storage
refrigerator, label DO NOT USE, immediately return temperature monitor to
DLA-TSM or the manufacturer, and await DLAs disposition of the vaccine.
4.f.2. Vaccine Cold Storage
4.f.2.a. The Pfizer vaccine will be primarily stored within ultra-cold
freezers (-80C) at designated sites. Vaccine POCs will oversee receipt,
storage, access, distribution, and administration of the vaccine.
The vaccine may be shipped to external sites per reference (a).
4.f.2.b. Other vaccine candidates which require storage at -20C or 2 to 8C
will be shipped and stored in accordance with specific vaccine policy and
similarly to the annual influenza vaccine.
4.f.2.c. Vaccine transported from receiving MTF to another MTF storage and
administration is called redistribution. Redistribution requires
notification of and coordination with U.S. Army Medical Materiel Agency
Distribution Operations Center (USAMMA-DOC) per reference (f).
Specific cold storage and transportation conditions will be provided by
USAMMA DOC if not already included in reference (f).
4.g. SARS-CoV-2 Vaccine Administration
4.g.1. MTFs will use the plans and exercises practiced during previous
influenza seasons to administer COVID-19 vaccines. Review the Navy and
Marine Corps Public Health Center general standard operating procedures and
best practices to safely conduct a mass vaccination event.
These documents can be found at: https://esportal.med.navy.mil/sites/
nmcphc/pps/wppc19/COVID-19-Toolbox.aspx. The Seasonal Influenza Resource
Center available via Health.mil contains resources that can be used to assist
4.g.2. Maintain all COVID-19 mitigation measures during administration
including but not limited to, wearing masks, social distancing, frequent hand
washing, and limiting group size.
4.h. Personnel Administering Vaccines. Only trained and qualified medical
personnel, working within their scope of practice, will administer the SARS-
CoV-2 vaccine per reference (a). SARS-CoV-2 vaccination staff will complete
the CDC and manufacturer educations modules: CDC COVID-19 Vaccine Training:
General Overview of Immunization Best Practices for Healthcare Professionals
covid19/SHVA/index.asp) and the online training module provided by each
manufacturer for the products that will be administered.
4.i. Pre-vaccination briefing. In addition to informational material
provided to Service members on the vaccine, if desired, commands will
coordinate with their supporting MTF vaccine coordinator to provide an
informational brief (virtual or in-person) by a competent medical authority
on the benefits and risks of receiving the vaccine when notified they are
eligible to receive the vaccine. Ideally, this briefing would offer the
opportunity for Service members to ask questions.
4.j. SARS-CoV-2 Vaccination Compliance. Pending full licensure or
Presidential action, the SARS-CoV-2 vaccine will be encouraged.
Service members will be offered the vaccine in accordance with the priority
scheme by vaccination personnel. Navys goal will be 100 percent contact of
personnel, but under the EUA they are not required, and may not be compelled
to receive the vaccination.
4.k. Documenting SARS-CoV-2 Vaccination. All SARS-CoV-2 vaccinations,
exemptions, or declinations shall be documented in the Medical Readiness
Reporting System (MRRS). While under EUA, MRRS will record individuals who
received a vaccine, are exempt, or who were offered the vaccine but declined
to receive it as having met the vaccination requirement. If the
SARS-CoV-2 vaccine is made a readiness requirement, MRRS readiness reporting
will be updated. Active and Reserve Component Navy SARS-CoV-2 vaccination
administration will be monitored via MRRS. Designated command personnel will
access MRRS to track their personnel. Civilian vaccination administration
compliance will be monitored and tracked via AHLTA or other electronic
4.k.1. Shore-based commands or representatives may request access to MRRS
based on their unit identification code by submitting a system access
authorization request available at: //mrrs.dc3n.navy.mil/mrrs
(note: MRRS Web address is case sensitive). Point of contact: MRRS program
office and e-mail: mill_mrrs(at)navy.mil (800) 537-4617 /
(504) 697-7070/ DSN: (312) 647-7070. Ship-based commands may use Navy
Medicine Online (NMO) or Shipboard Non-Tactical Automated Data Processing
Automated Medical System (SAMS) to populate MRRS.
4.k.2. MTFs must ensure that documentation of SARS-CoV-2 vaccine
administration is coded to accurately reflect the manufacturer of vaccine
4.k.3. All personnel who receive the vaccination from a retail network
pharmacy must provide documentation of vaccination no later than the next
work day (or next drill day for Reserve personnel) to ensure vaccination is
recorded in MRRS and the EHR.
4.k.4. MRRS will be the record of unit vaccination status. Senior leader
reports of vaccination will be developed using MRRS similar to influenza
vaccination reporting. Vaccination status will also be available in ADVANA.
4.k.5. Commands will not report deferral or declination of the vaccine in
MRRS until they are given the opportunity to receive the vaccine and the
individual has been fully briefed on the benefits and risk of the vaccine.
4.l. Navy Goals and Performance Standards
4.l.1. Vaccines should be given with minimal delay. MTFs should be prepared
to begin administration of vaccine within 24 hours of receipt as per
reference (f). Active duty operational units have 72 hours (three business
days) following receipt of the vaccine to begin to administer and document
vaccination. The 72-hour requirement begins immediately only if the
temperature monitor has not alarmed upon receipt. If the temperature monitor
has alarmed, time requirement begins when the vaccine is cleared for use by
DLA-TSM. If the 72-hour requirement cannot be met, unit situation reports
(OPREP-3 NAVY UNIT SITREP) will be submitted to OPNAV, copy to BUMED and
respective Type and Fleet Commanders and Immediate Superior in Command.
Situation reports are not required if the temperature monitor is in alarmed
status and the unit is awaiting disposition from DLA-TSM.
4.l.2. Fleet and Echelon Two direct reports to the CNO will coordinate
vaccination plans for subordinate units ensuring vaccination is managed to
meet operational demands.
4.l.3. While under EUA, commands will ensure that 100 percent of personnel
are offered a vaccine when the vaccine is available. Vaccination remains
voluntary under an EUA. Commands will be considered complete after all
personnel have been recorded in MRRS as either vaccinated or declining the
4.l.4. When the vaccine is licensed, the vaccine may be required.
If the vaccine becomes required, commands will be considered complete after
90 percent of personnel have been recorded in MRRS as either being vaccinated
or having received an exemption for the vaccine.
4.l.5. SARS-CoV-2 Vaccination Performance Standards. The following goals
will be monitored:
4.l.5.a. Navy VIALS reports of shipment arrival date.
4.l.5.b. MRRS reports 100 percent of personnel vaccinated or declined
vaccination. Commands will coordinate with the servicing MTF to align
command-wide vaccinations with Navy vaccination goals.
Medical personnel at servicing MTFs will promptly report vaccinations in
4.m. Duty in a Flight Status. The NATOPS Manual (CNAF M-3710.7) requires a
12-hour grounding period following immunizations unless otherwise specified
in the current Aeromedical Reference and Waiver Guide
AeromedicalReferenceandWaiverGuide.aspx). The ARWG now includes nucleic acid
vaccines with a 72-hour grounding period after any dose.
When established SARS-CoV-2 vaccine platforms with known delivery systems
become available, previously established grounding periods in the ARWG will
apply. Navy and Marine Corps personnel in a special duty flight status may
volunteer for administration of any SARS-CoV-2 vaccine.
4.n. Dive Status, Undersea, and Special Operations. Immediately following
SARS-CoV-2 vaccination, do not conduct high-risk activities for 72-hours. To
the best extent possible, the vaccination series should be completed a
minimum of 2 weeks prior to deployment.
Commands may conduct vaccinations in cohorts to avoid reductions in readiness
due to potential side-effect impacts on an individuals ability to conduct
5. Released by VADM P. G. Sawyer, Deputy Chief of Naval Operations for
Operations, Plans and Strategy, OPNAV N3/N5.//