Which resources are available for vaccine efforts, including but not limited to distribution, incentives, and community engagement? In addition, can you summarize resources available for vaccine efforts via the Federal Emergency Management Agency?

Municipalities have multiple avenues to obtain funding for vaccination efforts, including: (i) FEMA Public Assistance (“PA”) funding; (ii) grants provided through the Centers for Disease Control and Prevention (“CDC”); and (iii) the Coronavirus State and Local Fiscal Recovery Fund (“CSLFRF”) which is provided through the American Rescue Plan Act of 2021 (“ARP”). These resources apply to vaccine incentive programs and cover costs related to local vaccination efforts.

Municipalities should strongly consider using funding from more restrictive programs such as FEMA PA before tapping into sources that provide more flexibility, such as CSLFRF funding.  FEMA PA is not capped or competitive, and thus offers an advantage to municipalities who use FEMA PA as the priority fund for any eligible activities not already funded by private insurance programs or the CDC.[1] Notably, as of November 2021, FEMA had already provided more than $6.1 billion for expenses related to COVID-19 vaccination at 100% federal cost share.[2] Note, the 100% federal cost share is in effect until July 1, 2022, and expenses incurred after this date will shift to 90% federal cost share until the end of the incident period.[3] FEMA funding may include costs for:

• Vaccination facilities, including community vaccination centers, mass vaccination sites, and mobile vaccinations, including necessary security and other services for sites.
• Medical and support staff, including contracted and temporary hires to administer vaccinations.
• Training and technical assistance for storing, handling, distributing, and administering of vaccinations.
• PPE, other equipment, supplies, and materials required for storing, handling, distributing/transporting, and administering vaccinations.
• Transportation support, such as refrigerated trucks and transport security, for vaccine distribution as well as reasonable transportation to and from the vaccination sites.
• Onsite infection control measures and emergency medical care for children and families at vaccination sites.
• Communication efforts that keep the public informed, including messaging campaigns, flyers, advertisements, websites, translation services, community engagement, and call centers or websites to assist with appointments or answering questions.[4]

If a municipality has exhausted its eligible expenditures under FEMA PA, it can then pursue other funding sources for expenditures ineligible for FEMA reimbursement.

The CDC is actively funding state, local, and territorial public health organizations responding to the COVID-19 pandemic, including vaccination efforts. The CDC has received supplemental funds through the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020; the Coronavirus Aid, Relief and Economic Security Act of 2020; the Paycheck Protection Program and Health Care Enhancement Act; the Coronavirus Response and Relief Supplemental Appropriations Act of 2021; and most recently, the ARP.[5] The CDC is awarding funding received through these congressional appropriations to jurisdictions nationwide.[6] The ARP authorizes $130.2 billion in funds specifically allocated for local governments as a separate appropriation pursuant to CSLFRF.[7]

Municipalities may focus their efforts on coordinating with their respective state public health agencies, which predominantly serve as the pass-through entity for CDC funding. Working closely with the pertinent state public health agency may help to prevent depletion of the more flexible CSLFRF funding and will allow tapping into the direct state and federal funding for specific vaccination purposes.

The ARP separately authorizes an additional $7.5 billion as funding for COVID-19 vaccine activities at the CDC.[8] The ARP has designated funds to be available to the CDC specifically for such purposes as improving nationwide vaccine distribution and delivering technical support to local governments. As defined under this authority, “technical assistance” provides a host of vaccine efforts for municipalities, including:

• distribution and administration of vaccines;
• expansion of community vaccination centers;
• deployment of mobile vaccination areas;
• enhancement of data sharing and systems that increase vaccine efficiency, effectiveness, and uptake;
• facility enhancements;
• communications with the public; and
• transportation of individuals to facilitate vaccination.[9]

The U.S. Department of the Treasury’s (“Treasury”) Final Rule specifically includes vaccination programs as an eligible use of CSLFRF.[10]

Additionally, Treasury’s Final Rule expands the enumerated uses of CSLFRF funds to fund programs that provide incentives which are designed to: (i) influence people who would otherwise not get vaccinated; or (ii) assist people to get vaccinated more quickly, so long as the costs are reasonably proportional to the expected health benefit.[11] For example, Massachusetts provided fully vaccinated residents who are 18 or older a chance to win one of five $1 million prizes, while those between the ages of 12 and 17 were eligible to win one of five $300,000 scholarship grants in order to drive increases in vaccinations.[12] In New Jersey, the Governor’s Office launched the “Shot and a Beer” program to also encourage their eligible population to get vaccinated.[13] Municipalities may consider these expanded uses of CSLFRF funds when crafting their own programs.