Report | Feb. 1, 2022

Audit of DoD Implementation of the DoD Coronavirus Disease–2019 Vaccine Distribution Plan (DODIG-2022-058)

Audit

Publicly Released: February 3, 2022

Objective

Our objective was to determine whether DoD officials effectively distributed and administered the coronavirus disease–2019 (COVID-19) vaccine to the DoD workforce in accordance with DoD guidance.

 

Background

COVID-19 is an infectious disease that can cause a wide spectrum of symptoms. On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic, and on March 13, 2020, the President declared the COVID-19 pandemic a national emergency. As of December 13, 2021, the U.S. Food and Drug Administration has approved one COVID-19 vaccine and authorized two COVID-19 vaccines for emergency use.

According to the Centers for Disease Control and Prevention, the vaccine prevents severe illness, hospitalizations, and death. Therefore, the vaccine is an important intervention to mitigate the threat of COVID-19 to the DoD workforce. The COVID-19 vaccine was originally available on a voluntary basis. However, on August 24, 2021, the Secretary of Defense announced that the COVID-19 vaccine is mandatory for all Service members and directed the Military Departments to immediately begin full vaccination. In addition, on September 9, 2021, the President mandated the vaccine for all Federal employees. During our fieldwork, the vaccine was not mandatory for the DoD workforce.

The DoD COVID-19 Vaccination Plan (the plan) served as the DoD’s integrated global response plan to distribute and administer the COVID-19 vaccine. It provided the DoD’s framework for distributing and administering the vaccine to the DoD workforce and eligible DoD beneficiaries to ensure DoD readiness and mission assurance. The plan included instructions and guidance for vaccine distribution and administration for the Military Departments, the National Guard Bureau, the Defense Health Agency, the Defense Logistics Agency, the U.S. Army Medical Materiel Agency, and military treatment facilities. As of December 8, 2021, the DoD reported it had fully vaccinated 3,049,708 individuals and partially vaccinated 702,778 individuals.

The plan included a tiered approach for vaccine administration. The DoD vaccination schema prioritized the vaccination of personnel providing medical care, maintaining essential installation functions, and those critical to national defense. It also provided elevated priority to individuals over 65 years of age, and those at the highest risk for developing severe illness.

 

Results

While the DoD strived to vaccinate its workforce against COVID-19 as quickly as possible, DoD officials did not have reliable data on which to base vaccine allocation decisions, or determine if they effectively administered the COVID-19 vaccine to the DoD workforce. Specifically, DoD officials could not definitively determine the vaccine‑eligible population at each military treatment facility and had difficulty reporting reliable vaccine administration data. In addition, the DoD also encountered the following challenges as it administered the vaccine.

  • The majority of the respondents to the survey we conducted as part of this audit responded that they did not know their tier in the schema that prioritized the DoD workforce for vaccination. In addition, military treatment facilities in close proximity to each other did not always coordinate their movement to the next schema tier.
     
  • Officials at some overseas military treatment facilities in our sample indicated they were not being allocated enough vaccine for their population that was dependent on the DoD for vaccination.
     
  • Overseas military treatment facilities in our sample were not always permitted to vaccinate local nationals who were part of the DoD workforce and worked alongside U.S. personnel.

Having accurate information regarding the population requiring vaccination and reliable vaccine administration data is necessary to support the DoD‑wide vaccination effort. Because the DoD lacked a definitive understanding of military treatment facilities’ vaccine-eligible populations, including where populations fell in the DoD’s vaccine prioritization schema, and reliable vaccine administration data, the Defense Health Agency, the Military Departments, and the National Guard Bureau may not have made the most effective allocation decisions. In addition, without reliable vaccine administration data, the DoD may not be able to determine whether it effectively administered the vaccine.

As part of the DoD COVID-19 Vaccination Plan, the DoD used a coordinated communications strategy that included media, key leaders, and digital and social media engagement to build confidence in the COVID-19 vaccine. The coordinated communications strategy was meant to encourage DoD members to voluntarily take the vaccine by explaining credible health and safety data, the benefits to both individuals and the community of receiving the vaccine, and the vaccination process. We issued an anonymous survey to the DoD workforce to assess the effectiveness of the DoD communications strategy and the respondents’ opinions related to the COVID-19 vaccine. The respondents provided positive reviews of the DoD’s communications and messaging, often stating that they had received all the information they needed to make an informed decision about receiving the COVID‑19 vaccine.

 

Recommendations

We recommend that the Defense Health Agency Director, with input from the Military Departments, the National Guard Bureau, and other stakeholders, review challenges and difficulties encountered during the distribution and administration of the COVID-19 vaccine, compile a report detailing the issues, and determine if corrective actions are necessary to support future pandemic response planning. At a minimum, the review should include the following challenges and difficulties:

  • Determining the vaccine-eligible population at each military treatment facility;
     
  • Reporting vaccine administration data;
     
  • Communicating vaccination tier eligibility;
     
  • Coordinating tier movement between military treatment facilities;
     
  • Allocating vaccine to overseas locations; and
     
  • Vaccinating local nationals who work alongside U.S. personnel at overseas locations.

In addition, we recommend that the Assistant Secretary of Defense, Health Affairs form and lead a working group consisting of DoD Components and address the issues identified by the Defense Health Agency.

 

Management Comments and Our Response

The Defense Health Agency Director disagreed with our recommendation, stating that the Defense Health Agency, in coordination with other stakeholders, prepared an after action report, which describes the challenges and difficulties that occurred during the distribution and administration of the COVID-19 vaccine.

The Director further stated that the after action report also identified recommendations for future responses to pandemics and mass vaccination efforts. The Director stated that the Defense Health Agency meets weekly with the Military Departments, the Combatant Commands, the U.S. Coast Guard, the National Guard Bureau, and the Joint Staff to standardize processes and synchronize vaccine distribution and reporting. The Director indicated that these stakeholders will address the issues listed in our recommendation in their weekly meetings and that lessons learned from these meetings will improve planning and execution of future pandemic responses.

We acknowledge that the after action report met the intent of our recommendation for reporting vaccine administration data and allocating vaccine to overseas locations. However, the after action report did not address the remaining four difficulties and challenges we identified: determining the vaccine‑eligible population at each military treatment facility; communicating vaccination tier eligibility; coordinating tier movement between military treatment facilities; and vaccinating local nationals who work alongside U.S. personnel at overseas locations. Failure to address the difficulties and challenges encountered by the DoD while distributing and administering the COVID-19 vaccine could degrade operational readiness of the DoD and have negative health and safety consequences during future pandemics.

The after action report referred to by the Director only partially addressed the specifics of the recommendation; therefore the recommendation is unresolved. We request that the Defense Health Agency Director reconsider his position on our recommendation and compile a report that details the four remaining challenges and determine if corrective actions are necessary to support future pandemic response planning. This report can be based off the results of the weekly meetings with the Military Departments, the Combatant Commands, the U.S. Coast Guard, the National Guard Bureau, and the Joint Staff.

The Senior Official Performing the Duties of the Assistant Secretary of Defense, Health Affairs agreed with our recommendation, stating that the Office of the Assistant Secretary of Defense, Health Affairs will form and lead a working group to address the issues identified by the audit. Therefore this recommendation is resolved but will remain open. We will close the recommendations once we verify that the agreed-upon action is complete.

This report is the result of Project No. D2021-D000AH-0098.000.