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A sort of victory: Lessons learned in the COVID-19 vaccination effort

30 June 2021

By: Bob Bennett, Chair of the Cities Today Institute; former Chief Innovation Officer, Kansas City MO; and COVID-19 Vaccine Operations Director for the Unified Government of Wyandotte County and Kansas City, Kansas

After seven months, our small team within the Unified Government Public Health Department is declaring something approaching victory in the COVID fight. In a community of 116,000 residents, our team has administered over 106,000 vaccinations to a little over 55,000 individuals.

When combined with other clinics and teams, almost 60,000 vaccine recipients are Wyandotte Countians. The COVID-19 infection rate in the county is lower than at any point in time since March 2020, and the local economy is starting to show signs of growth again.

Daily vaccination rates at the Unified Government’s (UG) public site have consistently declined over the last six weeks, indicating that most residents who desire vaccination through the Health Department have come through the line.

Given this data, it’s OK  to declare victory in this initial effort. But the victory over the virus is far from complete. Consequently, this is not the time for a parade down Central Ave and a reversion to pre-pandemic ‘normal’. Instead, it is time to look at what happened, glean lessons from it and define a ‘new normal’ in our community.

Things we did well

Equity-driven vaccine delivery. As it became obvious that a vaccine would soon become available, the UG began planning for vaccine delivery with an emphasis on equitable access based on the collective risk exposure of community members.

When the first vaccines were administered to medical staff, planning was underway for the next phase that would go to the public in January/February 2021. In addition to public health staff, the UG invited the Health Equity Task Force to bring ideas from challenged communities to the table. Weekly updates to senior citizen community groups ensured that these communities were provided with access to federal programs and informed residents who would be dependent on the local health department or other programs to get vaccinated.

Focused County Commission sessions ensured that vaccine operations procedures and patient prioritization were addressed transparently.

These meetings and engagements were not without some controversy. We made the decision to begin the first non-medical vaccinations with teachers and food service industry workers, instead of prioritizing senior citizens. CDC and Kansas guidance defined both age and profession as eligibility determinants with equal weight.

Most communities near Kansas City, Kansas chose the simpler pathway of using age to break down the line to get into vaccine sites. Our assessment of the data showed that our younger, mostly minority residents who were exposed as a part of their job duties had suffered more from the virus than seniors.

Even when we were not popular – senior citizen groups complained loudly about our decision – we were transparent. And we conducted our operations based on facts and data that showed an impact on the pandemic, instead of preening for good press.

We also used equity as a determining factor for placement of our mass vaccination sites. We chose to place the first site as closely to the geographical center of the county as we could, and we ensured that it was located near both a bus stop and multiple road networks. As we expanded to satellite facilities, access to mass transportation and proximity to population centers drove the selection of The Armory in the eastern portion of the county and a former Best Buy in the western portion.

Local government leadership. As discussed in the first report from the vaccine sites, the UG committed over one third of its CARES Act allocation to the vaccine effort.

It is important to remember that most local governments were in the midst of a budget crisis when CARES Act dollars were made available, and there were many communities that used this funding for other projects or maintaining other operations when the tax revenue funding them disappeared during the shutdown period.

Instead of acting defensively like those governments, the UG chose to attack the virus and fund education, testing and vaccination programs that required a short-term expansion of government instead of trying to ‘make do’ with whatever staff were still available.

The community validated the axiom that “leadership is action”. Instead of leading by speechmaking or tweeting, the UG committed resources and imposed change on the environment. Eventually, other organizations like local health providers, hospitals, Walmart, CVS, Walgreens and other pharmacies began to supplant the public health sites in the minds of patients. But the rapid reaction by the UG allowed for a significant reduction in COVID cases in the county and set conditions for all other providers to manage demand because the bulk of the motivated vaccine recipients had been served by late April 2021.

Operational focus. The UG approached the vaccination effort in an innovative manner compared to most local governments. Instead of simply tasking existing staff within the health department with providing vaccine, Assistant County Administrator Alan Howze directed the formation of a Vaccine Task Force that operated more like a short-term military organization than a typical public health deployment.

The team modified the Incident Command System used throughout the country to include public outreach, education, federal/state program synchronization, public communications, testing and vaccination sub-organization. Most of these teams were led by contracted staff subordinated to the health department, thereby allowing the county to have staff dedicated to the COVID fight who were responsive to a health department team that could simultaneously manage the COVID effort and other ongoing health issues in the community.

The key difference between Wyandotte County’s task force and other policy task forces around the country was the ability of the team to conduct operations, assess needs and execute changes within a clearly defined program under health department authorities. The team did not research a problem and admire a set of recommendations; they took action in the community and delivered over 105,000 vaccine doses.

Things we could have done better

Long-term transformation. The disadvantage of forming a dedicated task force to solve a single problem was that many solutions the team developed focused on the next phase of eligible vaccine recipients or recruiting the next 10,000 patients.

While efforts to upgrade the county’s woefully inefficient and somewhat dated electronic medical record system were initiated, the short-term need to register and engage residents took precedence.

As the task force begins to disassemble its organization and contract relationships, the opportunity to improve that specific digital service will be lost. Many of the federal and state funding that was made available to fight COVID was limited to short-term operations.

The permanent funding of staff or acquisition of real property was not allowed under the grant programs. Consequently, many public health organizations that achieved peak proficiency and capacity during the crisis rapidly lose that capacity as understaffed (and burned out) public health teams return to dilapidated offices without many of the tools and teammates with whom they stunted the growth of the virus.

Further complicating this regression to the pre-pandemic status quo will be the workforce change that the pandemic has driven. By retaining some of the temporary staff as replacements for those public health leaders that depart in the post-crisis phase, communities may be able to mitigate the impact of these disruptions and perhaps retain the mission focus that led to success in 2021.

Thorough debriefings of departing temporary staff and integrating the best elements of the COVID programs into day-to-day operations will also help drive long-term growth as a result of the crisis. By disassembling the task forces as deliberately as a team engaged the vaccination challenge, communities can use the post-COVID period as a new era in public health.

Multi-level messaging. Perhaps the one aspect of the pandemic from which lessons can be learned was the messaging between the federal, state and local governments and the people those governments serve.

At the national and state levels, the disease and the tools and methods used to fight it were more of a political problem than a public health challenge. Candidates and elected officials from both parties leveraged developments for political gain in electoral duels, regardless of the confusion it caused at the local level.

While some stability returned in January 2021, the political need to have success at the national level still caused problems for mayors and governors.

Beyond the soundbites, the competition among different levels of government or agencies within one level often complicated the process by which a task force could plan for the availability of vaccines in their community, establish reasonable estimates for vaccine eligibility or use common language to identify variants.

Since every year is an election year in the digital age, local government leaders must learn to simply deal with these types of challenges. State or federal legislators are barely able to complete their clearly defined duties in the current environment.

Real challenges requiring fundamental, systemic change are likely beyond them. For many of the issues impacting ‘the man on the street’, local governments are on their own.

The good news is that there are a lot of staffers and people who want to see the right things happen, and they came to the forefront during the pandemic. Local leaders will be well advised to continue to collaborate with these individuals at the expense of those who were not helpful.

Change of mission

From a political and cultural perspective, the pandemic is over here, or will be very soon.

On the day we chose to close the second of our satellite sites and reduce operations of our main COVID Clinic in Wyandotte County to three days, the Chicago Cubs played to their first capacity crowd at Wrigley Field (the Cubs beat the Cardinals, 8-5).

Across the Kansas City metro, all mask mandates are now history, and our hospitals are seeing fewer and fewer COVID patients. As of today, the UG is dissolving the task force in favor of a clinical staff that will function in a much more limited role than the team that formed in late 2020. As we close operations, I feel much like I felt during the flight home from my tours in Iraq.

The team I was privileged to lead made an impact – the images of a stadium full of happy people certainly illustrated that. But the mission feels unfulfilled; the disease has not been eradicated. Just as in Iraq, the short-term gains we made did not address the root of the problem we faced. An excellent analysis by Larry Brilliant and the Pandefense Advisory team in Foreign Affairs speaks to the long-term challenges that COVID will pose because of its worldwide persistence, regardless of how well things are going in Wyandotte County.

And while life is pretty good in KCK right now, our vaccination rates are still below 50 percent of our residents.

Despite deliberate accessibility site selection criteria, hundreds of hours of engagements, incentives, free transportation, off-peak clinic hours, and education programs, we are still struggling to get many of our most vulnerable neighbors through the door.

I admit to some frustration with those residents who failed to take advantage of the opportunity to get vaccinated. I am pleased to transition the mission back to the health department knowing that there has been a positive transformation in our community to the point where we have a chance.

And I am hopeful that the team now leading operations in the health department continues the progress we made and leads the evolution of the most innovative local government in our region.

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My City, My Life

Valérie Plante, Mayor of Montréal

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