Established In 1872, the El Paso County Public Health (EPCPH) serves the residents of El Paso County. Located in the central part of the state, it is the second most populous county. The 2020 population projections from the Colorado Department of Local Affairs have El Paso County’s population estimated at 735,176. Encompassing 2,158 square miles, El Paso County Public Health (EPCPH) serves all residents of El Paso County with 158 full-time equivalent employees.

The U.S., Colorado, and El Paso County are becoming more culturally diverse. At least two-thirds, 68.6% of El Paso County residents identify as either White or Non-Hispanic White, 17.7% identify as Hispanic or Latino and 6.9% identify as Black or African American. Population growth by age group indicates that adults ages 60 years and older and adults ages 20-29 are the two fastest growing age groups, each growing their population since 2012 by 17.3 percent and 16.7 percent respectively. Additionally, there is a significant military presence with five military installations including Ft. Carson, the Air Force Academy, Schriever and Peterson Air Force bases and Cheyenne Mountain Airforce Station. Data from 2015 – 2019 indicate there are 84,343 Veterans.

Developing a unified plan to address the changing, urgent needs of the community during the pandemic required a collaborative, and highly coordinated approach. This effort was unique given the necessity to share data across sectors, share critical information, and develop a structure to respond to an ever-changing environment. The vaccine policy consortium represents the diversity of the community and exemplifies the capacity of EPCPH to convene critical partners representative of local and federal entities

The vaccine policy consortium was led by EPCPH and consisted of multidisciplinary partners from local government, emergency management, healthcare system and partners, and high-level decision makers that commit resources, provide answers, and offer solutions. The overarching goals of the consortium was to broaden the reach of the COVID-19 vaccine into the community with sustainable and equitable efforts through a coordinated effort. To ensure a coordinated and collaborative approach of remaining committed to equitable access to vaccine across El Paso County, the vaccine consortium worked to develop a three-pronged approach to vaccine equity. This strategy was jointly developed by the consortium and distributed through a joint statement to all COVID-19 vaccine providers across El Paso County.

The group forum served as a robust information sharing, as well as exchange platform which was used to strengthen coordination and communication pertaining to the COVID-19 vaccine effort and to provide an opportunity to identify and address current and emerging needs among the entities represented. This group addressed several critical efforts head on such as developing a unified strategy to advocate for increased, sustainable, and predictable vaccine supply, while remaining poised to expand capacity to dispense vaccine equitably and seamlessly as supply became available.

El Paso County Public Health (EPCPH) has engaged with the response effort to the COVID-19 Pandemic since February 2020. As the lead agency in this effort, EPCPH has been integrally involved with activities related to vaccine planning and distribution. This effort required a coordinated and flexible approach to ensure streamlined communication and information sharing with partners.

Like the pandemic itself, the development, manufacturing, distribution, and authorization of COVID-19 vaccines was unprecedented.  While COVID-19 vaccines were developed in record time, all federal regulatory steps were taken to ensure their safety and effectiveness. Planning at the local level for the administration of COVID-19 vaccines began in August 2020. EPCPH convened a multidisciplinary local vaccine planning team to develop jurisdiction-specific vaccine administration strategies based on federal and state guidance for a phased approach with limited vaccine supply. To support these planning considerations, EPCPH built strong relationships with healthcare partners and obtained early buy-in and support for the utilization of the existing healthcare infrastructure to serve as the primary COVID-19 vaccine administration strategy within El Paso County.

In December 2020, EPCPH received the first shipment of COVID-19 vaccines at UCHealth Memorial Hospital. The arrival of COVID-19 vaccines marked a monumental undertaking; vaccinate the [entire] population quickly and safely in accordance with Colorado’s phased approach.  Large hospitals and health systems, medical providers outside of large hospital systems, community health centers and pharmacy partners came alongside public health as a united front and formed the cornerstone of the local vaccine administration strategy. Healthcare partners came willing and ready to provide their resources, services, and support under a unified objective of quickly administering FDA emergency use authorized COVID-19 vaccines to the population to reduce COVID-19 related illnesses, hospitalizations, and death. Healthcare partners remained steadfast, dedicated, supportive, and flexible throughout the entire vaccine distribution and administration process despite numerous challenges associated with vaccine supply, phase changes, and population eligibility. 

Between August 2020 – December 2020, EPCPH convened a multidisciplinary local vaccine planning team, jointly led by Public Health Immunizations and Emergency Preparedness and Response (EPR), to develop jurisdiction-specific vaccine administration strategies based on federal and state guidance for a phased approach with limited vaccine supply. To support these planning considerations, EPCPH built strong relationships with healthcare partners and obtained early buy-in and support for the utilization of the existing healthcare infrastructure to serve as the primary COVID-19 vaccine administration strategy within El Paso County.

Planning groups consisted of local, regional, and state partners and subject matter experts to ensure a whole community approach to COVID-19 vaccine administration. Additionally, EPCPH volunteered to have local representation on the state vaccination planning team which greatly enhanced situational awareness and provided the most up to date state vaccination planning initiatives in real time. Some of the vaccine planning and update meetings that regularly convened throughout the response included the Vaccine Consortium.

The Vaccine Consortium was designed to represent and critical partners in the community. Recognizing the diversity of the El Paso County landscape, partners included representatives from the military, local government, non-profit agencies, public health, hospitals, and many other key partners. The development of the group focused on ensuring resources were available to all members of the El Paso County. A key piece of this effort is communicating relevant and timely information through the group and collecting critical feedback from each sector of the county to address emergent needs. For example, many seniors struggled with access to the vaccine due to issues related to technology and transportation. A strategy to address the issue was specific to eliminate barriers to access to the vaccine.

Information sharing was conducted through weekly newsletters with all partners in the consortium. The content provided critical updates related to current trends, data dashboards, and vaccine numbers. EPCPH was early in creating a vaccine dashboard and the newsletter was instrumental to let group members know how to share the information with the broader community.

Throughout the planning process, several products were developed in preparation for the commencement of vaccine operations. In August 2020, a vaccine planning document titled SCR COVID-19 Vaccine Planning Tool V1 was developed by EPCPH EPR and shared with public health agencies and emergency managers in the South-Central Region. This tool was developed to provide some high-level planning considerations and to include a checklist of planning actions that the CDC recommended in preparation for vaccine distribution.

The work of the consortium in combination with other committees contributed to the coordinated response. In November 2020, the initial draft of the El Paso County COVID-19 Vaccination Plan was completed and was released to internal and external partners. The plan was developed based on state and federal guidance that the administration of COVID-19 vaccine would be structured around a three phased approach. This approach was built on the assumption that, upon FDA authorization, initial vaccine doses would be limited and distributed in a focused manner to a targeted population (Phase 1). As the volume of available vaccine increased, distribution would expand, increasing access to the larger population (Phase 2). If the risk of COVID-19 persisted such that there remained a public health need for an ongoing vaccination program, COVID-19 vaccines would ultimately be universally available and integrated into routine vaccination programs, run by both public and private sector partners (Phase 3).

To support vaccination of the entire population through the phased approach, the primary vaccine administration strategy adopted by EPCPH and partners was to utilize the existing healthcare infrastructure. As such, this strategy relied heavily on large hospital and health systems, medical providers outside of large hospital systems, occupational health setting for large employers, community health center, pharmacy partners and local public health collectively becoming Phase 1 COVID-19 vaccine providers.

Throughout the pandemic response, EPCPH has remained committed to cross-sectoral collaboration and engagement with community stakeholders, from both the public and private sectors.  The scale and complexity of the pandemic response has required a strong and united effort amongst community partners and stakeholders to develop and implement innovative response strategies. At the local level, robust information sharing and exchange platforms have been built and integrated into EPCPH’s collaborative approach to provide partners with ongoing situational awareness and access to information to make informed decisions.

At the forefront of the vaccine administration strategy was a coordinated and collaborative approach with healthcare partners of remaining committed to equitable access to vaccine across El Paso County. A dedicated equity team spearheaded the collaboration with trusted partners and local grassroots organizations to learn more about the disparities and needs of community members most impacted by the pandemic, especially among communities of color. EPCPH was able to collaborate with trusted partners, grassroots organizations, and healthcare partners to develop strategies that would help reduce these barriers and increase access to the vaccine. Better understanding the community also directly assisted with the development of public messaging, vaccine education, and promotion from trusted sources within the community. In partnership with EPCPH, trusted partners and grassroots organizations helped educate diverse communities and address myths and misinformation about the COVID-19 vaccine. Additionally, this partnership was instrumental in making sure the equity lens was looking at all facets of community disparities to include low income, transportation, language, limited access to technology, and physical as  well as cognitive challenges.

To further strengthen coordination and communication pertaining to the COVID-19 vaccine effort across EPC and broaden the reach of vaccine into the community with sustainable and equitable efforts, EPCPH leveraged the Vaccine Policy Consortium[JL1] . The consortium served as a robust information sharing / exchange platform and consisted of multidisciplinary partners from local government, emergency management, healthcare systems and partners. Together, several critical issues were addressed head on such as developing a unified strategy to advocate for increased, sustainable, and predictable vaccine supply to El Paso County.

Collaboration with federal partners was imperative. El Paso County is home to five major military installations and both active duty and retired military members make up a large percentage of the EPC population. Due to federal reporting restrictions, data exchange with the military regarding vaccination numbers was not available to the local jurisdiction. However, significant efforts were made by EPCPH and the City of Colorado Springs to establish a civilian-military partnership that could support the exchange of aggregate data without violating federal restrictions. This ongoing data exchange was extremely helpful in providing a more accurate depiction of vaccine activity within El Paso County.

Large hospitals and health systems, medical providers outside of large hospital systems, community health centers and pharmacy partners were the cornerstone of the local vaccine administration strategy. Early in the vaccine planning process, these partners quickly came to the table as willing and robust collaborators with EPCPH. Healthcare partners came willing to provide support, resources, and services under a unified objective of quickly administering FDA emergency use authorized COVID-19 vaccines to the community to reduce COVID-19 related illnesses, hospitalizations, and death. These partners remained steadfast, dedicated, supportive, and flexible throughout the entire vaccine distribution and administration process despite numerous challenges associated with vaccine supply, phase changes, and eligibility. 

EPCPH worked closely with healthcare partners through all phases of the vaccine distribution and administration process to offer support and assistance with early Phase 1 enrollment, vaccine ordering, vaccine transfers, vaccine coordination of eligible occupational groups, Point of Dispense (POD) operations, data and analytics, and public information and messaging. Information sharing platforms were put in place to facilitate a common operating picture and to promote collaboration amongst public health and healthcare partners. Several weekly meetings were hosted by EPCPH to share and exchange information, discuss challenges, and share best practices; some of these meetings included the provider update meeting, clinical operations group meeting, pharmacy partner meeting, and the vaccine consortium meeting.

EPCPH worked closely with healthcare partners to develop a three-pronged approach to vaccine equity. This strategy was jointly developed, through the vaccine consortium to ensure a coordinated and collaborative approach of remaining committed to equitable access to vaccine across El Paso County.

First, increased accessibility to vaccine through COVID-19 providers included multiple clinic locations and operational hours to help reduce geographical barriers and allow for convenient access. Second, to help reduce barriers due to transportation and language, strategies were developed to help bring vaccines to community locations where diverse populations could be reached more effectively and conveniently. This was accomplished through mobile vaccination resources, pop-up clinics, and dedicated equity PODs. Additionally, working with trusted leaders in the community who had roles in ethnically, racially, and geographically diverse communities helped improve communication, access, and acceptance. Third, the opportunity for healthcare partners to pool resources and deliver mass vaccination events[JL1] .

Operation House Call represents an action developed through the work of multiple work groups to meet the specific needs of certain sectors of the El Paso County population and is represntative of the coordinated effort to collect critial information from partner groups about specific barrers. The implementation of Operation House Call to reduce barriers and increase access to COVID-19 vaccine for homebound populations was implemented on February 24, 2021. Described as a model practice by CDPHE, success of the program relied heavily on strong partnerships between El Paso County Public Health, the Colorado Springs Fire Department (CSFD), the Medical Reserve Corps (MRC), United Way, Community Advancing Public Safety (CAPS) Volunteers, and Matthews-Vu Medical Group. Operation House Call allowed for the fire department to retrieve vaccines from a local provider and deliver them to people across El Paso County who could not leave their homes due to severe illness and mobility limitations. The program was a grassroots effort and a partnership that saved lives across the community, as it provided homebound individuals an opportunity to receive the COVID-19 vaccine.

EPCPH continues to leverage cross sector partnerships to maintain a collaborative and sustained effort to address the health needs of El Paso County. The Vaccine Consortium is a dynamic, fluid group representative of the ongoing need to adapt to each phase of the pandemic. Once the recovery phase is underway, it is the objective to continue this work and build toward understanding how to continuously engage the entire community in the work of building a resilient and healthy El Paso Community.