Genesee County Health Department serves 400,000 people, with the major city of Flint, Michigan. Flint was the center of the water crisis in 2015, and those effects are still on-going. There has been erosion of both the economy with the Great Recession of 2008, when much of the manufacturing base was moved out of the county, as well as the faith in public health. The goals and objectives of the innovative practice was to use the community partners, many of which had been established during the time of the water crisis, to inform and control vaccine distribution with prioritization of those at highest risk. The innovation was using a "distress-index" developed during the water crisis, which was census tract based, to plan vaccine sites. Putting vaccine clinics in trusted locations throughout the City of Flint, particularly utilizing faith-based partnerships, increased vaccine uptake in areas most at risk.
With the rollout of COVID-19 vaccinations beginning in early 2021, local health departments were faced with the issue of how best to distribute these limited vaccines so that the most vulnerable and at-risk people received them first. In an area already hit hard with the departure of much of the manufacturing base, health disparities were brought to the forefront of national news with the Flint water crisis of 2015. The first wave of COVID-19 saw mortality rates highest in the same areas that had been impacted by the water crisis. To achieve our goal of minimizing further racial and economic-linked disparities, Genesee County Health Department (GCHD) used the collaborative research partnership with Michigan State University (MSU) established in response to the water crisis to frame its response to the pandemic. In early 2020, GCHD expanded the scope of this partnership to identify key pandemic-related needs. Community groups that had been established during the water crisis, again lead efforts to reach the vulnerable. Focusing on areas at highest risk in the distribution of public health resources resulted in similar case and mortality rates throughout differing socio-economic areas of the county.
When vaccines were available in early 2021, GCHD used COVID-19-specific data related to which areas of the county had suffered disproportionally higher case rates and mortality during the first wave of the pandemic. The GCHD/MSU partnership provided a geospatial tool to leverage equitable vaccine distribution. As early as January, 2021, GCHD used the “distress-index” for each census block group in Flint, developed in response to the Flint water crisis, to prioritize individuals who had signed up through senior centers, local faith-based and other community organizations, as well as online registration. Months later, when the social vulnerability index (SVI) was promoted by the CDC as a method to reduce racial inequities in distribution, it was found to mirror the “distress-index” from the water crisis. When the State of Michigan began providing ZIP-level SVI scores to guide vaccine distribution, GCHD had already been using its equity-based distribution plan using a dataset of even higher resolution (smaller census block groups vs. ZIP codes) for months. This was confirmed by cross-referencing the state’s SVI data with the Flint water crisis index.
Geospatial analysis allowed the county to prioritize vaccine appointments for residents of high-vulnerability areas. By February, trusted community and faith-based vaccine sites were established to improve access for these communities. Local community and faith leaders volunteered to host vaccine sites, schedule appointments, and provide transportation to clinics. Senior centers located throughout the county, helped register those most vulnerable. Community-based, public health navigators brought vaccines door-to-door in the most disadvantaged areas. Through these efforts the county had a marked increase in vaccination rates in targeted areas. Although there have been additional waves of COVID-19 in Genesee County, none have approached the high level of disparity that was seen in the first wave. The merger of community groups, public health and university research truly worked synergistically to counter social inequities from the pandemic.
Sometimes, and particularly in the most challenging of times, the strongest partnerships can develop in a remarkably short period of time. In the fall of 2020, new leadership was desired in Genesee County for the health department and the positions of separate medical director and health officer were merged to allow for innovative and responsive decisions, particularly in response to the pandemic. I began on January 5th in the role of medical health officer. The first and second day on this new job was so busy that the first I heard about any of the events at the US Capitol was during my first faith-based subcommittee call at 4pm. While welcomed, I was firmly told by one participant, “Do not point the blame for the pandemic at the black community for not getting vaccinated. It is not us rioting at the Capitol and not wearing masks.” It is a moment that will forever be etched in my mind. The next week on the call, I shared how impactful that statement was to me. I said that it was indeed true and I would make sure that I would do whatever I could to make sure vaccines were available to the black community, whenever they were wanting to get them. That is what began this unexpected partnership, a new white woman running the health department, and a faith-based group of Flint water crisis activists. Even with the very first lot of vaccines for distribution at the health department, I was determined to make sure access for the most vulnerable was prioritized. But most importantly, that the vaccines were brought to those who needed them the most.
One of the epidemiologists at the health department told me how they had worked with Michigan State University for data on where to set up testing sites in the community. I had heard of the work of Dr. Debra Furr-Holden at MSU, working to reduce health and social inequities. We spoke the following week. She told me that using race-only data was not going to eliminate social inequities if you offer the vaccine only to a black family living next door to a white family, both of whom had been part of the Flint water crisis. She suggested using the “distress-index” developed for the water crisis. She pointed out that the water distress-index showed the most vulnerable people who may otherwise not have access to vaccines.
With that call, and the on-going calls with the faith-based subcommittee of the Greater Flint Health Coalition, we moved forward and moved fast. By February 10th, we began the first of the church based vaccine clinics in Flint. By the end of February we were having a weekly vaccine clinic at Shiloh Missionary Baptist Church, Central Church of the Nazarene and Our Lady of Guadalupe. We added other church or community based vaccine clinics throughout the county, usually doing a total of about ten per week. The calls expanded to include other community partners, many of who did such innovative and outstanding work to improve the health of the community, but had never worked with the local public health department before. With the start of this foundation of partnership, we expanded employees at the health department to facilitate and expand other programs in the community. The employees here at the health department have been thriving even during the pandemic as they see their passion for working in the community finally come to fruition with these partnerships. In this manner, a terrible event that is still ongoing, COVID-19 pandemic, is building new partnerships for TB treatment, Fetal Infant Mortality Review which begins in February, food security programs, all of the programs that can make such a difference for the health of people in the community, but that do not have a chance to gain traction if no one knows about public health. Today I zoomed on the first call of the New Year with the City of Flint, the Greater Flint Health Coalition and so many other community partners. I was so happy to see my friends again, and honored that local public health was invited to be in on the planning for the programs using money from the recovery act in helping our community thrive.
As discussed in answers to the earlier questions, our practice worked closely with Michigan State University and was constantly monitoring and changing resource allocation week to week based on the data collected in the community and reflected in the distress index.
As we reached more of the population who were already committed to getting vaccinated, our outreach expanded. We hired community based public health navigators, people already known in their own community to provide education, answer questions, and even bring vaccines both door to door and to neighborhood parks. We used EMS to bring vaccines to homebound people. We had bilingual and ASL translators at all of our clinics, but also had specific clinics for different populations, such as the hard of hearing. We were given innovation grants from the Ruth Mott Foundation to use taxis for transportation even waiting in lines for drive-through clinics. If a problem arose, we found a way to meet that need.
The meaningful public health impact was the beginning of the re-building of trust in a community that had no reason to trust public health after the water crisis. This is already being incorporated into new programs where public health is working side by side with other leaders in the community.
Immunization
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