Pediatricians and Connecticut Department of Public Health immunization staff used the advisory committee's first meeting to map real-world barriers to vaccine access: limited storage capacity in small practices, decreased demand for COVID-19 vaccine leading to potential wastage, and ambiguity about pharmacy authority and coverage under the PREP Act and state regulations.

Clinicians described practical limits
Dr. Katie Noble, founder of Sound Beach Pediatrics, said her practice has not stocked the COVID-19 vaccine recently and that managing cold-chain storage alongside large flu shipments is difficult: "the volume of vaccines we had to handle during flu season, limit our responsibility to storage the COVID vaccine." Dr. Maria Lopez and other pediatricians recommended planning dedicated vaccine clinics and ordering modest quantities to match expected local demand.

State immunization staff guidance
Mick, representing the state's immunization program, told pediatricians to "order small amounts" and said unused COVID and flu vaccine doses currently do not have to be replaced when received through state distribution channels: "any unused doses, you don't have to replace." Patricia from the immunizations program clarified that while VFC participants normally must follow a restitution policy (replacing wasted vaccine), the department has excluded COVID and flu formulations from that restitution policy because of unpredictable demand.

Pharmacy administration and the PREP Act
Providers expressed concern about pharmacy access if federal protections change. Pharmacist rules are set by the Connecticut Department of Consumer Protection; Commissioner Juthani summarized a DCP memo that gave pharmacies a 30-day period to follow prior ACIP guidance while awaiting CDC action. Pharmacist-clinician relationships and whether pharmacists can perform "shared clinical decision making" at point of care were noted as operational questions, particularly if federal PREP Act coverage were to be altered.

Local public-health capacity
State staff said local health departments vary widely in capacity: Connecticut has 59 local health departments and districts, many with limited clinic hours and staffing. The immunization program noted that COVID-era grants temporarily expanded local capacity but that some grants have ended or been restructured; several departments made operational cuts during funding uncertainty.

What the committee asked DPH to do
- Provide a short operational checklist for small practices on ordering, storage and planning vaccine clinics.
- Track and publish where vaccines are available to reduce the number of families who call a practice and discover the vaccine is not stocked.
- Continue outreach to pharmacists and invite the Department of Consumer Protection to brief the committee on rules for pharmacy administration.

Ending note
State immunization staff emphasized flexibility: "order small amounts," reorder as needed, and the program will work with pediatric practices to help manage supply and minimize financial risk for clinics as demand fluctuates.