Request for Immediate COVID-19 Vaccination Prioritization due to Urgent Medical Need
The COVID-19 Vaccination Plan for NIH Staff establishes a phased rollout of COVID-19 vaccines based on vaccine availability, CDC recommendations, position and work environment considerations (Return to Physical Workplace Group, exposure risk, mission-critical nature of position), and risk of complications from COVID-19 from an underlying medical condition or age. In recognition of the increased risk of complications from COVID-19 due to underlying medical conditions, the NIH created a process that allows employees to move up in priority within their designated vaccination phase based on a self-certification of certain pre-existing chronic medical conditions (COVID-19 VACCINE SELF-CERTIFICATION FORM). In response to NIH's recent call for self-certification of underlying medical conditions that make someone more vulnerable to poor outcomes due to COVID-19, many NIH workers responded and indicated their interest in moving up in priority for vaccination against COVID-19 not only within phase, but to be vaccinated immediately due to urgent medical need. Others have requested a change in priority status due to age. This individual medical need must be balanced against the goal of the vaccination program, which is to maximize the safety and continuity of the workforce, minimize the risk of work-related transmission of the SARS-CoV-2 virus that causes COVID-19, and minimize transmission of the SARS-CoV-2 virus to NIH patients. However, there are some medical situations in which vaccination is urgent, recommended by a referring physician, but unobtainable outside of the NIH due to logistical challenges in the community.
The NIH Coronavirus Response Team has evaluated the overall staff response to requests for exceptions, the general medical risks known at this time, the expected supply of vaccine to NIH, and has established that only one type of medical condition and/or circumstances will be considered at this time for an out of phase exception to the current priority process. The one exception is that the individual will soon have a severely compromised immune system that would make future vaccination against SARS-CoV-2 ineffective and where all means of vaccination outside of NIH have been exhausted. Examples of such conditions include imminent organ transplantation, imminent immunosuppression from treatment for autoimmune disease, and upcoming cancer chemotherapy. Merely having a chronic medical condition(s), advanced age, or upcoming travel or a social event that would put a person at higher risk of contracting SARS-CoV-2 is not currently grounds for an exception.
Instructions: To apply for an exception to the current priority system for vaccination at the NIH due to urgent medical need, please read and acknowledge the Privacy Act Statement and then click the link to go to the Request for Exception to the COVID-19 Vaccination Plan for NIH staff due to Urgent Medical Need form. The information you provide will be made available in a de-identified manner to members of the NIH Vaccine Prioritization Exceptions Committee (hereafter referred to as the Exceptions Committee) who have been appointed to evaluate requests for exception, but otherwise will be protected according to Privacy Act requirements. Filling out the request form, and obtaining the COVID-19 vaccine at NIH, is completely voluntary. Only fill out this form if you want to be considered by NIH for urgent prioritization of NIH's available COVID-19 vaccine. Even if you fill out this form, NIH may not be able to provide you with the COVID-19 vaccine prior to your vaccination phase as outlined in the COVID-19 Vaccination Plan for NIH Staff.
Privacy Act Statement
This statement is provided pursuant to the Privacy Act of 1974 (5 U.S.C. § 552a): The information requested on this form is authorized to be collected pursuant to 5 U.S.C. 1302, 2951, 4118, 4308, 4506, 7501, 7511, 7521 and Executive Order 10561. In addition, collection is authorized under Executive Order 12196; Public Health Emergency. Completing the form is voluntary, however declining to provide any or all the requested information may result in delay of vaccination against COVID-19 for an individual requesting prioritization due to underlying medical conditions, by the Occupational Medical Services (OMS), Division of Occupational Health and Safety (DOHS), Office of Research Services (ORS), National Institutes of Health (NIH), U.S. Department of Health and Human Services (HHS). The principal purpose for which the information will be used is to evaluate urgent medical need for immediate vaccination in cases where an individual will soon have a severely compromised immune system that would make future vaccination against SARS-CoV-2 ineffective and where all means of vaccination outside of NIH has been exhausted.
The information you provide will be included in a Privacy Act system of records, and will be used and may be disclosed for the purposes and routine uses described and published in the following System of Records Notice (SORN): 09-25-0105 Administration: Health Records of Employees, Visiting Scientists, Fellows, and Others Who Receive Medical Care Through the Employee Health Unit.
Click Proceed below to complete the Request for Immediate COVID-19 Vaccination Prioritization due to Urgent Medical Need.
Note: You have to be on the NIH intranet or VPN to access the form.