Welcome back to Disaster Discourse Quarterly!
Each quarter, we feature thought-leadership from one of Hagerty’s Executives on timely emergency management topics. This quarter, our Vice President of Healthcare & University Programs, Jeff Bokser, discusses the challenges and best practices associated with the ongoing administration of the COVID-19 vaccine across America.
Additionally, this month we are introducing our new Featured Grants section! Going forward, in each monthly and quarterly edition, we will highlight federal grant opportunities state, local, tribal, and territorial governments should be aware of in the emergency management/homeland security space. In this edition of Disaster Discourse Quarterly, Featured Grants are included at the end of the article.
Vaccinating America: Ongoing Challenges and Best Practices
April 7th, 2021 | By: Jeff Bokser, Vice President, Healthcare & University Programs
COVID-19 and National Vaccine Rollout
On March 13, 2020, the United States (US) declared a public health emergency for the COVID-19 pandemic. A year later, over 546,000 Americans have lost their lives to the virus. In early December 2020, the US Food and Drug Administration (FDA) issued the first Emergency Use Authorization (EAU) for a COVID-19 vaccine. Shortly after this, the FDA released the authorization of two more vaccines. As of April 5, 2021, approximately 61.4 million Americans have been fully vaccinated.
Last December, the incoming Biden Administration set a goal of vaccinating 100 million Americans in the first 100 days in of taking office. The new Administration’s goal was met on March 22, 2021, and the target has now doubled to 200 million vaccinations. Currently, President Biden urges states to open COVID-19 vaccine eligibility to all adults in the US by May 1, 2021 with hope that the nation can get on a “path to normal” by American Independence Day, July 4, 2021. Despite these vaccination goals and milestones, rollout efforts have not reached all communities equally, with some states and territories able to vaccinate their residents at higher rates than others. Scheduling a vaccine appointment continues to be a challenge for many vulnerable populations and states continue to refine the process to offer multiple approaches to reaching these populations.
Throughout the COVID-19 pandemic, Hagerty has been working with clients nationwide to provide critical guidance and support for their response efforts. Over the past several months, this work has shifted from response to vaccination efforts. We have experienced and overcome vaccine distribution challenges first-hand and offer the following based on our applied experience and research.
Effective Rollout Efforts
Alaska has a high vaccination dispensing rate having given out approximately 21,000 does per 100,000 people. Comparatively, the state of Tennessee has dispensed roughly 11,000 doses per 100,000 people. The presents a question: Why are some states outperforming others by nearly 100 percent?
Vaccine rollout best practices can look different depending on the makeup of the respective community. While there is not a singular method for success, top-performing states and territories all have one thing in common: they utilized already established public health and healthcare infrastructure, including systems and programs that were previously successful in their own communities. For example, in states where most pharmacies are locally owned and operated, large chain pharmacies will not be the most effective vaccine access point to the population. In states with many different healthcare providers, transferring vaccine rollout to health systems may not be simple or effective. Successful vaccine rollout operations assess available resources and innovates so that strategies expand upon traditional public health infrastructure.
Below are a few key considerations and best practices for bolstering vaccine dispensing that entities involved in the process should consider as they continue to implement, iterate, and refine their operations.
1. Reliance on Strong Community Infrastructure
Establish an extensive network of community partners (e.g., community health clinics and pharmacies) prior to and during the pandemic to support response efforts. Many partners in these networks are a well-known presence in communities and can be used as foundation for the distribution of vaccines.
This Works Best When…
The state and/or local government maintains a robust community health foundation prior to the vaccine rollout. For example, Connecticut was able to use their community partnerships established during COVID-19 testing operations and transition that resource to vaccine distribution. Governments should work to establish and maintain community health partnerships to bolster current and future public health responses.
2. Implementation of the Whole Community Approach
The Indian Health Service (IHS), an agency within the U.S. Department of Health and Human Services, is responsible for providing federal health services to 2.6 million American Indians and Alaska Natives who belong to 574 federally recognized tribes in 37 US states. As citizens of the US, American Indians and Alaska Natives can participate in any public health programs available to the general population. Therefore, when determining vaccine allocation to states and jurisdictions, the US Department of Health and Human Services gave tribal health programs and Urban Indian Organizations (UIOs) an option: they could either receive vaccine allocation through their state or through their IHS area. Combine vaccine allocations received by the state or territory with the vaccine supply from the Indian Health Service (IHS) monthly has been a recipe for success in the state of Alaska. Combining these vaccine allocations in higher quantities has allowed for more efficient dispensing efforts.
This Works Best When…
States have a significant IHS presence (i.e., multiple clinics or a regional headquarters). The IHS has established a strong presence across more remote and difficult to reach areas, which benefits vaccine distribution. While this specific approach is unique and not applicable to all states, other states should consider how they can explore whole community partnerships (e.g., private companies, non-governmental organizations, or community health organizations) to assist with vaccine rollouts.
3. Utilization of Local Health Systems
Local health departments can become overwhelmed by response and do not always have the infrastructure to scale up mass vaccination efforts. In communities with robust healthcare systems, mass vaccination sites may not be necessary. Our nation is comprised of outstanding healthcare systems that have the capability to help support local vaccination efforts. Further, healthcare providers often maintain robust scheduling systems that can be modified for vaccine scheduling and withstand the surge in appointment requests from the public.
This Works Best When…
There is a smaller quantity of health systems that serve a large portion of the population. This approach ensures a blanketed amount of access throughout the state, allowing for quick and definitive decision making due to the small group size involved in dispensing planning.
4. Application of Partnerships with Large and Small Organizations
The US Army National Guard is playing a significant role in supply logistics and is partnering with independent healthcare providers, pharmacies, states, and cities for distribution. The National Guard can quickly get supplies to remote areas and independent pharmacies with a wider reach to rural communities where large pharmacy chains are not as prevalent.
This Works Best When…
Significant portions of the population live in rural areas with few healthcare access points. States can bolster their emergency response operations by combining federal and local resources.
Above All, Vaccination Programs Should Be Equitable
As COVID-19 vaccine dispensing rates have increased across the nation, and the eligible population grows every day, local and state jurisdictions struggle to ensure racial and socioeconomic equity in vaccine access. Even the highest performing jurisdictions have found that while the per-capita dispensing is outperforming other state averages, large disparities remain in vaccination dispensing rates between its wealthiest and poorest communities. For example, Washington, D.C. is currently ranked eleventh in per-capita vaccination dispensing, the two wealthiest wards have double the vaccination dispensing rates of the two poorest wards. When considering best practices in dispensing operations, it is prudent to consider access to services and equity.
Incorporating equitable strategies into overall vaccine distribution planning is the best way to ensure vaccine accessibility is equitable across all demographics in the community. Considerations for equitable access should not only be included for COVID-19 vaccine distribution but should become standard practice for all mass medical dispensing plans moving forward. It is important to address the barriers to vaccine access in low-income communities, such as limited technology and access to transportation. Strategies to address equitable vaccine access include:
- Partner with existing fixtures in the local community, such as houses of worship, to gain credibility with the residents, increase awareness, and accessibility;
- Utilize in-person canvassers to go door to door for appointment sign-up in areas with limited technology access; and,
- Prioritize appointment opportunities for residents at vaccination sites in low-income neighborhoods to limit “vaccine tourism.”
Equity in vaccine program development is also a priority of the Federal Emergency Management Agency (FEMA) and a requirement to maximize the available funding jurisdictions can receive under the Public Assistance (PA) Program. FEMA Policy # 104-21-0004, or Medical Care Eligible for Public Assistance, outlines requirements to document the equitable manner that vaccine distribution operations are conducted, including considerations for communities of color, all sexual orientations and gender identity minority groups, persons with disabilities, those with limited English proficiency, and those experiencing poverty.
Hagerty is supporting a geographically diverse, high-population state to document their efforts to incorporate equity into every step of the vaccine distribution process, per the FEMA requirement. We are capturing quantitative data on the racial and socioeconomic demographics receiving vaccine. We are also documenting the different outreach programs and public messaging used to engage different demographics. Through onsite support offered to this client, the Hagerty team is working to make the sites themselves equitable, including consideration for compliance with the Americans with Disabilities Act (ADA) and ensuring translators are available for residents who do not speak English. We are supporting the state through the entire documentation process, ensuring the state represents their efforts to make vaccine distribution equitable to the fullest extent possible.
Overcoming Vaccine Hesitancy
Vaccine acquired herd immunity can only reached if enough people are willing to get vaccinated. Current challenges include limitations in the supply necessary to meet the demand of those who want to be vaccinated across the country. However, recent reports indicate that there should be sufficient supply to fully vaccinate all adults in the US by May 2021. This raises the question: What happens when a large portion of the population remains vaccine hesitant?
A recent study from the Kaiser Family Foundation found that it is very difficult to persuade individuals who have already decided against receiving the COVID-19 vaccine. The study found the most effective argument for persuading undecided populations was to inform them that vaccines are nearly 100% effective at preventing hospitalization and death from COVID-19. Other effective tactics for overcoming hesitancy in unsure populations included offering vaccines at workplaces or during routine medical appointments. More targeted public information efforts and increased access points may be important next steps in for fighting COVID-19 and any future pandemic.
Community leaders, including faith-based and community organizations, play a vital role in vaccine distribution planning. These partners can help develop and distribute educational materials to their constituencies as well as provide emotional support and guidance to those individuals who are currently experiencing vaccine hesitancy. Additionally, community partners can develop and promote strategies and incentives to help encourage vaccinations and prevent the spread of common misinformation. Programs like these can increase community buy-in while also dispelling inaccurate information regarding vaccinations.
How Can Hagerty Support?
Vaccinating the world against COVID-19 is likely going to be a massive public health challenge. Only by sharing best practices and establishing inclusive, whole community partnerships can we successfully protect our populations against this disease. Hagerty understands that each vaccine rollout effort requires a unique culmination of support systems to develop effective dispensing strategies. Hagerty is uniquely positioned to support vaccine dispensing operations nationwide, from coast-to-coast.
Since March of 2020, Hagerty has played a pivotal role in helping state and local governments as well private organizations respond to and recover from COVID-19. As the response to the event progressed, Hagerty was called upon by clients to help them shift from preventative related measure to planning for and the administration of vaccines. Currently, Hagerty is involved in the following activities supporting vaccine distribution across the US:
- Providing site management for Points of Dispensing (PODs), including static, mobile, and drive-through sites.
- Defining vaccination reporting structures and data management processes.
- Developing vaccine equity plans and supporting vaccination programs targeting vaccine accessibility for vulnerable populations.
- Tracking and managing disaster relief grants.
Hagerty continuously works with our clients to determine the most effective and successful approach for their respective communities, and we are prepared to assist others as they undertake this critical mission.
Community Health Workers for COVID Response and Resilient Communities
This grant supports this work through training and development of community health workers and by building and strengthening community to fight COVID-19 through addressing existing health disparities in the population. The main goals of this grant will be accomplished in three areas: (1) Capacity Building; (2) Implementation Ready; and (3) Innovation. Learn More
- Funding Opportunity Number: CDC-RFA-DP21-2109
- Source: Department of Health and Human Services, CDC – NCCDPHP (via CARES Act)
- Estimated Total Program Funding: $300,000,000
- Award Ceiling: $5,000,000
- Closing Date: May 24, 2021
- Eligible Applicants: Tribal organizations, state governments, county governments
National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities
Grant provides funding for strategies to improve testing capabilities and other COVID-19 response purposes in populations at high-risk and underserved communities in urban and rural areas and advance equity by expanding state, local, territorial and freely associated state health departments capacity and services to prevent and control COVID-19 transmission. Learn More
- Funding Opportunity Number: CDC-RFA-OT21-2103
- Source: Department of Health and Human Services, CDC – OSTLTS (via CRRSAA)
- Estimated Total Program Funding: $2,250,000,000
- Award Ceiling: $50,000,000
- Closing Date: May 3, 2021
- Eligible Applicants: Special District Governments, County Governments, State Governments, City or Township Governments
HEERF – Proprietary Institution Grant Funds for Students
This funding is for proprietary institutions of higher education to be used for any component of the student’s cost of attendance or for emergency costs that arose due to coronavirus, such as tuition, food, housing, healthcare, or childcare. In making such financial aid grants to students, grantees must prioritize grants to students with exceptional need, such as students who receive Pell Grants. Learn More
- Funding Opportunity Number: ED-GRANTS-011521-005
- Source: Department of Education, via Higher Education Emergency Relief Fund
- Estimated Total Program Funding: $680,914,000
- Award Ceiling: N/A
- Closing Date: April 15, 2021
- Eligible Applicants: Public and state-controlled institutions of higher education, private institutions of higher education
Advancing Health Literacy to Enhance Equitable Community Responses to COVID-19
This grant is dedicated to improving the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate disparities and will support the identification of effective approaches for improving health outcomes with the ultimate goal of promoting dissemination, adoption and sustainability of these approaches. Learn More
- Funding Opportunity Number: MP-CPI-21-006
- Source: Department of Health and Human Services – Office of the Assistance Secretary for Health
- Estimated Total Program Funding: None
- Award Ceiling: $4,000,000
- Closing Date: April 20, 2021
- Eligible Applicants: Local Municipalities
Community Health Workers for COVID Response and Resilient Communities – Evaluation and Technical Assistance
This grant provides funds to conduct a national evaluation of the Community Health Workers for COVID Response and Resilient Communities (CCR) program and to provide training and technical assistance to recipients of this program. The program has two components: (1) to conduct a national evaluation of the CCR, and (2) to delivery training and technical assistance to recipients. Learn More
- Funding Opportunity Number: CDC-RFA-DP21-2110
- Source: Department of Health and Human Services, CDC – NCCDPHP
- Estimated Total Program Funding: $32,000,000
- Award Ceiling: $3,000,000
- Closing Date: May 24, 2021
- Eligible Applicants: State Governments, Tribal Governments and Organizations, County Governments