Blog Post: 5 Lessons Learned from the First Weeks of COVID-19 Vaccine Administration
Just over a month ago (on December 14, 2020, to be exact), Maine received its first allocation of COVID-19 vaccine. In the weeks that followed, doses of COVID-19 vaccine made their way to hospitals and FQHCs across the state, including Penobscot Community Health Care (PCHC). Located in Bangor, Maine, PCHC is the second largest Federally Qualified Health Center (FQHC) in New England and provides more than 300,000 patient visits annually. PCHC employs nearly 800 staff members, many of whom are involved in direct patient care and therefore at increased risk of contracting and transmitting COVID-19. Below are 5 Cs (communicate, categorize, be consistent, collaborate and convince) that helped PCHC vaccinate a significant portion of its staff efficiently and equitably in a matter of weeks:
COMMUNICATE: Develop a Clear, Consistent Communication Plan
We had been preparing for the arrival of COVID-19 vaccine for months, and knew that a strong communication strategy for our staff, patients and communities would be an essential piece of successful vaccine administration. Well before the vaccine arrived in Maine, our leadership team convened to develop a game plan. On the staff front, our communication plan included daily organization-wide emails, a Q&A inbox, Q&A sessions with our Chief Medical Officer and mandatory NetLearning modules, but we knew that wasn’t enough. It is imperative to get to every nook and cranny of your organization, including those in departments like facilities that don’t check email frequently, to ensure everyone has the latest information. We recognized that our strategy needed to be both digital and in-person, and that trusted messengers throughout the organization (supervisors, colleagues, etc.) would be invaluable to our communication plan.
On the patient and community side of the equation, we used social media channels and scripting for our patient services representatives (PSRs) to send a consistent message to folks who called our offices. Generally, we stuck to a few key talking points:
CATEGORIZE: Create a Prioritization System & Standby List for Staff Vaccination
Once the vaccine arrived, our goal, of course, was to vaccinate our staff as quickly as possible. While all healthcare workers in Maine fall under Phase 1a, given the limited supply of vaccine coming into the state and in turn to PCHC, we needed to prioritize the vaccination of our staff based on risk of workplace exposure and/or severe COVID-19 illness. Categorizing risk of workplace exposure, in our case, was relatively straightforward. The highest risk group included staff with significant and extended contact with COVID-19 positive patients, followed by those with significant and extended contact with PUIs (such as our swab-and-send COVID-19 testing site and walk-in care clinic), then those who had limited direct patient contact down to administrators and other staff not in patient-facing roles.
In addition to workplace exposure, we also needed to consider another dimension of risk: conditions or characteristics that put individuals at increased risk for several COVID-19 illness. For obvious reasons, this is deeply personal information that must be handled with the upmost sensitivity and respect for privacy. As an employer, we created and disseminated a voluntary employee attestation that provided staff an opportunity to voluntarily disclose that they had at least one of the characteristics or conditions, but specifically asked them not to indicate which one(s). We used the information provided to prioritize employees within their workplace risk groups. For example, an administrator who attested they were at increased risk would be prioritized ahead of other administrators, but they would not jump the line to be vaccinated before, for example, someone working at the swab-and-send site.
To ensure no dose was wasted, we created a standby list of employees who lived and/or worked nearby our vaccination site. If a vaccination appointment was canceled or otherwise became available, employees on the standby list were called in. We made the decision to schedule for only 10 doses per vial, and ensured there was a sufficient standby list in the event we were able to draw 11 or even 12 doses per vial. Throughout the process, not a single dose was wasted, a success we attribute to the careful planning and the willingness of our staff to come in on a moment’s notice. Operationally, and in the interest of fairness, we prioritized the standby list in the same way we prioritized scheduling of appointments (those with the highest risk come first).
BE CONSISTENT: Have the Same Person Draw Doses Whenever Possible.
Given the limited supply of vaccine across our state and country, it is essential to maximize the number of doses you get out of each vial. Prior to opening our vaccination clinic, we tested difference syringes and staff to see which combinations consistently drew more doses out of a vial. Once we found our winning combination, we used the same syringe type and staff to draw all of our doses, and we were able to get 11 doses out of every vial. These same individuals administered the vaccines they prepared in accordance with the CDC’s aseptic technique guidance.
COLLABORATE: Consider Collaborative Approaches to Maximizing Throughput in Your Communities
We share the Maine CDC’s goal to get vaccines into arms as quickly as possible (ideally within 2-3 days of allocation), as we understand the allocation algorithm at the federal level may reward states with the highest percentages of their allocation administered. Additionally, the state’s COVID-19 vaccine distribution plan prioritizes organizations that can demonstrate a minimum throughput of 1,000 doses per week. Accordingly, FQHCs and community hospitals across the state are engaging in regional vaccine planning conversations. FQHCs and other community partners have collaborated to lay the operational and logistical groundwork to achieve at least the minimum throughput so that vaccines can be distributed to these regional hub lead organizations and shared with partnering organizations in their community. Collaborative proposals from FQHCs and other partners to systematically vaccinate communities offer an effective and necessary alternative to mass vaccination sites, and offer several advantages including ensuring vaccine access for the state’s most vulnerable populations. It is imperative to think outside the box about how you can leverage relationships across your communities to get vaccines into arms quickly and safely.
CONVINCE: Be Prepared to Handle Skepticism & Refusal.
Those in the healthcare profession know that vaccine skepticism cannot be overlooked or underestimated as we work to vaccinate our colleagues and communities against COVID-19. It is important to approach this contentious topic with compassion and understanding, and involve into trusted messengers to help folks overcome vaccine hesitancy. We need to focus on strategies that are most effective, and according to Robert Blendon, professor emeritus of public health, policy and political analysis at Harvard T.H. Chan School of Public Health: “Waving journal studies and talking points won’t work in many communities.” A recent Kaiser Family Foundation survey indicates that more than a quarter of the public “probably or definitely would not get a COVID-19 vaccine even if it were available for free and deemed safe by scientists.”
According to former U.S. CDC director Tom Frieden, public health messages are most persuasive in the form of persuasive, personal stories from people you trust, in other words: “Trusted messengers and trusted messages.” Rather than focusing on facts, shared values can be more effective in building trust. Ambassadorship of trusted members of communities disproportionately impacted by COVID-19, including racial and ethnic minorities, can promote trust in the vaccine.
At PCHC, we had a trusted provider at our organization host a series of Q&A sessions for staff. We also shared pictures and videos of staff getting their vaccine holding up personalized “I vaccinated because” signed – which often spoke to shared values. Here are some examples:
In terms of dealing with staff refusal of COVID-19 vaccinations, the Equal Employment Opportunity Commission (EEOC) recently clarified that a COVID-19 vaccination requirement in and of itself would not violate the Americans with Disabilities Act (ADA). However, if employees have medical reasons or religious beliefs that prevent them from receiving the COVID-19 vaccine, employers could be legally required to give their employees a reasonable accommodation to continue to work (wearing a mask, working remotely, etc.). At PCHC, we are not requiring the COVID-19 vaccine, but are strongly encouraging it and have adopted a declination form so that staff understand the implications.
As I reflect on the lessons learned so far and look ahead to the several months of COVID-19 vaccinations that lie ahead, I can’t help but think that the same things that make a successful organization (clear communication, careful planning, consistency and collaboration) also apply to a successful rollout of the COVID-19 vaccine. I am thankful to my colleagues at PCHC and across the state who have worked so hard to ensure the vaccine administration process is smooth and efficient. As we work our way through Phase 1a and into Phase 1b, I challenge you all to put communication, collaboration and equity at the center of your vaccine planning conversations.