Civic innovation lessons from the vaccine roll-out

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

All pandemics end. Many of us are working hard to hasten the end of the COVID-19 pandemic, and the vaccine distribution coupled with good public health policy are making progress. I recently explored how communities accept risk and commit to pandemic mitigation as a pathway to data-informed, efficient governance, or ‘smart cities’.

Since writing those words, our team in Wyandotte County, Kansas administered a little over 72,000 vaccinations in a community of 166,000 people. We learned how to operationalize national and state policies that have been as quick to evolve as the virus we are engaged in defeating.

As with our work in the early smart city days, we shared experiences with other communities and adapted some of our work based on lessons learned elsewhere. In our metro area, other communities have modified policies and procedures we created.

Despite numerous obstacles, local leaders across the country achieved the President’s goal of administering 100 million vaccinations in 58 percent of the time he established as a deadline.

As a result of this effort, we validated two best practices that can apply universally, and we revalidated one concept that emerged from the smart city “Wild West” era from 2011-2019.

Lesson one: Physical solutions must be sustainable

The pandemic will not end with the last inoculation at a mass vaccination site sometime in 2021, though that theme will permeate several public statements by elected officials.

Many people who suffer long-haul effects of Covid-19 will require treatment by public health department staff that have been under stress for 13 months so far. The continuous mutation of the virus may require a booster vaccination effort that mirrors the current endeavour if society is to preserve the gains we hope to achieve by the summer.

Economic recovery may lead property owners to consider returning facilities currently housing temporary vaccine clinics to their pre-pandemic business function. Dodger Stadium – three parking lots of it – is now a standing clinic. While the clinic and baseball can co-exist in limited capacity games for the beginning of the upcoming season, there may be pressure in the autumn to increase the fan participation in California.

The former Best Buy housing Wyandotte County’s western site generally hosts a Halloween Store from August to October most years, and the landlord can generate more rent from a private entity than a health department. Regardless of the infrastructure that a community chooses to host vaccination, testing and education, those buildings or spaces need to be accessible to the community through to the end of 2021. They need to have sufficient permanence to meet vaccine temperature control protocols and allow staff to function in rain, snow, sleet, extreme heat and bitter cold.

Patients will be more amenable to visiting temperature-controlled sites as well, thereby increasing vaccine adoption. Community health efforts must be planned with the 1-2 year time horizon in mind; this mission will not be accomplished with a couple of pop-up clinics in an abandoned drive-in movie theatre.

Lesson two: A public health personnel challenge is on the horizon

In the early stages of the pandemic, public health officials became the face and voice for publicizing the initial tranche of COVID-19 mitigation protocols from mask mandates and crowd limits to event cancellations. Based on a joint AP/Kaiser Health Network study, at least 181 public health leaders in 38 US states left their jobs between April 1, 2020 and Dec 11, 2020.

Further complicating the issue, many public health leaders who have remained on the job are planning on a career change once the current crisis abates because the professionals doing the work are burned out from the last year’s effort. At many vaccination sites, volunteer or community partner organizations augment a public health team in order to take some of the pressure off these teams, but that may only serve to get a community through the next six months or so.

Paradoxically, communities need to consider appointing temporary staff, under the direction of the local health department, to complete the vaccination effort while the permanent team initiates planning for the post-pandemic world which will include disease outbreaks, violent crime, STDs, lead abatement programs, the annual flu shot distribution program, WIC management and the many other problems that health departments manage.

And these programs will likely be requirements that will be undertaken by undermanned, limited experience teams that will have just emerged from a crisis period where not all health departments rose to meet the challenge. County administrators and mayors will need to be more sensitive to the composition and needs of their health department staff in their communities and commit to mentoring those teams more deliberately in order to set conditions for 2022 and beyond.

Measures to stem brain drain in these departments will likely include increased post-pandemic funding, a stand that will inevitably be controversial.

Lesson three: I get by with a little help from my friends

During my time as the Chief Innovation Officer in Kansas City, MO, we built the smartest 54 blocks in the United States at that point in time with a partnership that included Cisco, Sprint, Verizon and a host of start-up firms that worked with the market leaders including a small Chicago-based data analytics and management team, Xaqt. We found that by building a system where each partner contributed a part of the solution – that not only achieved a project objective but also allowed every partner to expand on other opportunities – resulted in the most expansive growth. In this environment, the government took on risk so private sector innovators could iterate in a live environment to create civic technology that streamlined processes or generated revenue for the city. The technique was not particularly revolutionary, it had been applied in multiple locations by the Army where interagency cooperation was the key to victory.

The vaccine problem has many similar qualities. Local health departments receive vaccines directly from manufacturers based on state-determined allocations; this requires at least three coordination points for a local health department.

The Center for Disease Control and Prevention divided the US population into five general categories of eligibility, which were amended at the state and local level depending on local priorities. This creates “the list” which determines when a person gets their vaccine. Every morning at vaccine sites, leaders from the local business groups, community interest groups, health provider networks, elected leaders, and those who want to supersede elected leaders in the next election all freely share their interpretations of the rules with the 76-year old volunteer who is trying to get people lined up for vaccine in the morning.

Simply opening the door to this cacophony is not feasible. Instead, we use digital tools to try and get people to the door in an orderly fashion. In Wyandotte County, we worked with Xaqt – my old partner from the smart city days – to manage the data about our populace so we could meet the tier requirements while accounting for vaccine equity and access. The company chose to employ telephones as part of the solution because many of the most vulnerable population do not have easy digital access and need to be engaged directly by human-to-human voice contact. Xaqt later took their technology to Fairfax County, Virginia and iterated on it again.

In New York City, both Microsoft and Google partnered with the city to manage vaccine distribution across the five boroughs and completely upgraded the city’s electronic medical record (EMR) management system. When the pandemic ends, the improved EMR system will remain and continue to serve New Yorkers (see Lesson Learned #2).

In Los Angeles, Deputy Mayor Jeanne Holm, her team, and her partners at MasterCard’s City Possible program revolutionized the means of providing direct aid to people with the Angeleno Card, another innovation that will continue in the post-pandemic world.

The future is coming tomorrow, and that is OK

My friends and I frequently get the chance to talk to brilliant, innovative technologists who have a passion for using their inventions to contribute to the public good. One friend shared his recent experience with an inventor a couple weeks ago. The technology was inspired and affordable. There were people who would benefit from its deployment. But the inventor’s plan to go to market wouldn’t work because it was based on science and electrical engineering. “What you need to do,” my friend advised her, “is to look at this technology through the prism of political science.”

As we learned in the smart city experience, the technology available to civic leaders today exceeds the ability of city staff to fund or install that which is possible right now.

But all is not lost. If a technology can do great things, it can also probably solve a problem that a mayor or manager needs to solve today. Solving that problem allows for an initial tech deployment that grows as problems are solved.

The COVID-19 mitigation experience concentrates this point. Civic technology innovations are a necessary part of the solution, but only within the context of designing long-term solutions with sufficient staffing over that time. By solving aid distribution, EMR management or appointment management, tech firms are helping to define what a 21^st-century health department should look like.

Image:  Ivan Diaz on Unsplash