With each partnership and new location, we adjusted and made improvements to the planning and implementation process. For example, mapping was added to the site summary template to give partners a visual reference for plans that could be easily shared and interpreted. The area map included critical information on where the vaccine clinic is located, parking areas, ingress/egress, and other important details. The vaccine dispensing layout map included the clinic’s ingress/egress, registration/check-in, vaccine dispensing area, vaccine prep, observation area with supplies needed. An important addition to later iterations of mapping was an access point and pick up location for emergency medical services in the case of a serious adverse reaction. When discussing the management of adverse reactions at the site visits, several partners exhibited anxiety and avoidance, pointing to their discomfort and fear. This was especially apparent with community partners who represented communities with greater vaccine hesitancy and when discussing pediatric vaccinations. The planning tools helped facilitate these conversations and reassure partners that the planning process was to prepare them adequately for various situations, including emergencies. Mapping was also important to help partners understand and prepare for line management and crowd control. As vaccine uptake varied widely, it was important to map the various pathways and crowd management needs so partners could be prepared with a functional and sharable visual tool to support vaccine site set up, staffing needs, security concerns, and logistical considerations.
Past emergency planning scenarios assumed we would be able to safely dispense vaccination indoors, but new considerations needed to be made for safe outdoor operations (e.g., adequate lighting, inclement weather, ADA accessibility, power supply). With updated guidance from the CDC and LA County, we made changes to new sites moving from outdoor operations to hybrid outdoor-indoor operations to eventually having indoor clinics with adequate ventilation and abundant space to allow for large numbers of people to walk through. We also added other types of signage as additional vaccines became available and appointments no longer were necessary. The various types of signage, in different languages, were compiled into a list and shared with the partners, in addition to the other best practices observed at community-based clinics.
Internally, we used our early field experiences to inform the department’s planning processes as more target populations and groups became eligible for vaccines. For example, as leadership and internal workgroups emerged around new eligibility categories (e.g., food and agriculture and education), we shared the planning tools and templates that we used to support their introduction of partners and facilitation of new partnerships working in a variety of settings, such as food production, manufacturing, hotels, and schools. Several components of our toolkit, planning process, and learnings were integrated into the Education Sector’s COVID-19 Vaccine Clinic Toolkit and planning process.
System-wide improvements could be made to strengthen long-term collaboration with community health providers and partners. For example, ongoing, transparent communications proved to be an important asset in building trust with partners and contributed to the ability to reach target populations, the success of vaccination sites, and the overall partnership experience. Being available through various channels (text, email, phone, etc.) allowed partners to communicate in ways most comfortable and accessible for them. Additionally, we found that time invested in-person (e.g., staffing a vaccine clinic) made a positive impact in the strength of the collaboration, and built trust with partners. Spending time actively listening to and conversing with partners allowed them to feel that their needs were being met and advocated for. A technology platform (e.g. customer relationship management system) could be developed to maintain, track, and encourage communications with providers and partners. This would allow for continued interaction with partners, the ability to share communications across internal teams, and consistent updating of partner contact information.
A key challenge to continued program success has been accessing long-term staffing/volunteers and relying on the same few partners to continue and expand services. From this experience, we saw the need to create pathways for resources that will be available in non-emergency times. While programs exist to support staffing efforts, such as the MRC, we found that many systems and people had difficulty adapting quickly, remaining entrenched in non-emergency processes. Those programs that tended to be more heavily partnered and accessible throughout the vaccine rollout, such as CORE Response, were often formed in reaction to the COVID-19 pandemic and operated more fluidly and rapidly. We could learn from their models about how to nimbly operate, fund, and message public health staffing programs. In addition to staffing concerns, many provider partners found the billing and reimbursement process to be confusing and burdensome for vaccine. LACDPH was able to alleviate some of these concerns by giving partners access to additional state and local funding sources. For future pandemic response planning, it is essential to provide more assistance in helping partners understand billing and reimbursement systems or have mechanisms in place to streamline this process.
To ensure the practice continues to reflect ongoing and emergent community needs, partners must be given the opportunity to provide candid feedback on their experiences. Information and experience that partners bring should be valued and recognized in various ways, with an opportunity for partners to discuss challenges, successes, and lessons as part of the collaborative process. Common goals and vision should be established and shared in an ongoing way with all partners involved to foster a symbiotic relationship. Through this response, we saw first-hand the levels of exhaustion and stress, but also the tremendous personal commitment all partners made in doing work they truly believed in. When resources and personnel were exhausted, the recurring motivating factor was always the mission. Now in the second year of COVID-19 vaccinations, and recently beginning the distribution of antivirals, we are continuing to see how invaluable these community partnerships are in reaching our unique and diverse communities.