"Hope is on the horizon."
As the motto of the newly formed “Vaccinate West Michigan” effort, these are the words that Kent County Health Department's Deputy Health Officer Teresa Branson begins with each day.
After a year of pandemic anxiety and isolation, Branson finds hope in the promise of a vaccine, in teams of doctors and nurses on the front lines of a war against a deadly pandemic, and in other people making choices that keep themselves and others safe. She also finds hope in the magnitude of collaboration between the state and county health departments, health care providers and others in Michigan working to distribute the vaccine and prevent future outbreaks.
One of the biggest sites of this collaboration is the West Michigan Vaccine Clinic currently housed at DeVos Place in downtown Grand Rapids. The large-scale vaccination clinic can handle 20,000 patients a day and is made possible through a joint effort between the Kent County Health Department (KCHD), Spectrum Health and Mercy Health and has seen thousands receive their first COVID-19 vaccine shot
Collaboration in the face of adversity
Competing health care providers are working together in this effort for the safety of the community but supply of the vaccine does not currently meet demand. That has made cross-organization and cross-business coordination important to ensure the doses on hand make the most impact.
“This is not about market share," says Spectrum Health Chief Operating Officer Brian Brasser. "We don't want to duplicate [efforts]. We don't want to replicate. We don't want to compete; we want to serve those areas that are not being reached."
Spectrum Health and other providers are answering the universal call to serve those in the greatest need with staff and expertise, but it's the focus and oversight the Kent County Health Department brings to the table that lends a broader understanding of the various resources and the initiatives in a given community.
Kurt MacDonald, senior vice president of operations at Mercy Health Saint Mary's says he works with Kent County Administrative Health Officer Dr. Adam London and medical director Dr. Nirali Bora every day. Mercy Health is highly involved in the West Michigan Vaccine Clinic, which means MacDonald has regular planning calls with the KCHD, not just in order to understand where infection rates are in the county, but to share resources during uncertain times.
Kent County serves as an advocate for those fighting COVID-19 through vaccinations, even sharing resources when the state supply line is held up. Both MacDonald, at Mercy Health and Tasha Blackmon, chief executive officer and president of Cherry Health, say the county has consistently come through with needed supplies when the state's promised doses of the vaccine were delayed.
The linchpin here is vaccine availability, MacDonald says.
"That's where we're struggling a little bit and we're hoping that the federal government takes notice of the DeVos Place clinic. We could do 40% of the state of Michigan's goal of 50,000 a day in this one location. That's huge."
According to Keith Hustak, vice president of Advanced Practice Provider Services and Operations for Spectrum Health, there's no playbook for bringing traditional competitors together to fight a global pandemic. Every day these organizations learn new lessons about working together under pressure.
Hustak is also a founding member of the West Michigan COVID-19 Vaccine Collaborative, which focuses on vaccine distribution planning using state and county data. Members of the Collaborative learn what works and what doesn't, and when the threat has passed, they will be able to go back and see where their effort can be improved. And if we find ourselves in another health crisis of this magnitude, they'll at least have those chapters written.
The collaborative is also helping the individual providers and other stakeholders answer questions like who will run the Vaccinate West Michigan website, what information it will share and, more importantly, what happens when the next phase COVID-19 vaccination is rolled out by the state.
"The efforts of our health department colleagues and other health systems have been heroic," Hustak says. "It has not been easy either."
Dr. Nirali Bora, medical director for Kent County, says her department is gathering more data on equity in vaccinations and using that to guide new strategies and improve awareness between institutions.
"That's not something that happens often or easily," Bora says. "My hope is that something like this can continue post COVID so we can work together to address disparities."
Bora's team has put together a chart of the ZIP codes where there is greatest need for vaccination. There are some ZIP codes that already have multiple partners working to put up vaccination sites, while others have not been claimed yet. The hope is that this data will guide providers to fill in those gaps.
Addressing equity
While the vaccine is in short supply, doses of the vaccine are being sent out to the most vulnerable communities. The Centers for Disease Control and Prevention provides a Social Vulnerability Index that can help guide support to communities that need it most before, during or after disasters.
Some of the health care providers in Kent County have taken the CDC’s algorithm one step further by incorporating equitable policies. Cherry Health, for example, is looking at risk stratification for its patient population.
"We're taking a look at those individuals with high risk for complications from COVID because of their chronic diseases," Blackmon says. "Before the state even brought out the idea of a social vulnerability index, we looked at our population and decided that we were going to do risk stratification so that the people who need it most actually get it the soonest."
An individual with two or more chronic diseases might elicit a severe complication from COVID-19 and should get vaccinated before someone with fewer health complications.
"We're stratifying those groups, and then we're offering the vaccine to our patient populations based upon higher risk to low risk, which I think is awesome," Blackmon says.
The collaborative is using the same strategy, along with racial data, to guide its own planning recommendations.
"It's not just about getting as much vaccine in arms as possible," Hustak affirms. "That's a big, big part of it, but it's also focusing on our black and brown communities or our vulnerable communities. That's really what we have to focus on as a collaborative right now and that's what we're doing.
For Lori Price, chief operating officer of Metro Health, fairness and equity in vaccine distribution means some waiting for their shots will have to be put on standby.
"It's tough," Price says. "You want to give the vaccine and you want to get it out to as many people as possible but when you don't have the vaccine, you're very limited. It's frustrating because working in one of these vaccine clinics is the most rewarding thing you can do."
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Photo courtesy of the Kent County Health DepartmentDistribution and strategy
When the vaccine does arrive, it must be used immediately or stored at temperatures far below what the average clinic refrigerator can support.
"It's not something that you would walk into your physician office and they would have in the refrigerator freezer in the back of their office," MacDonald says. "Once you take it out of that refrigeration you've got a ticking clock before it has to be used. So, there are some logistics challenges and some cold chain struggles that we have."
One solution to this problem is going mobile. Pop-up clinics, vaccination vans and the county's own "strike teams," which target the deployment of medical staff and vaccine doses, are making it easier to reach people who may not otherwise be able to schedule an appointment.
Spectrum Health alone has over a dozen vaccine distribution facilities and is coordinating three different pop-up clinics in the county.
"That allows us to really focus on that ZIP code or that community in a way that is framed by an ethical framework that ensures we are being fair," Brasser says.
Mercy Health has three clinics in operation with a handful of pop-up clinics in urban areas.
"I think we're learning as we go in terms of how to do it effectively and not waste doses," MacDonald says. "That's so critical to our strategy we cannot afford to waste a dose so we're not allowing that to happen."
Metro Health is sending nursing leaders to independent living centers in Kent and Ottawa counties, as well as to Hudsonville High School. There is a vaccination clinic at the Metro Health Hospital in Wyoming, as well as the new Metro Health Community Clinic at 781 36th St, planted intentionally in an area designated medically underserved.
"It's for folks who live with vulnerabilities of financial stresses, food, worry and other daily stressors," Price says.
Cherry Health is adapting to new challenges with a vaccination van, too. The mobile approach doesn't preclude patients from registering for their vaccination, it just gets it to them quicker. Everyone who receives a vaccination is required to register in the coordinated system so providers can schedule their second dose, which is just as essential to preventing the spread of COVID-19.
"The first dose doesn't have the efficacy by itself,” Blackmon says. "They have to have both doses for it to be effective, and we encourage the second dose 28 days after the first."
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Photo courtesy of the Kent County Health Department
Providing hope
Providers are learning to creatively deal with the daily gut punch of having infrastructure and staff in place with no vaccine to stick into arms. So far, no method has proven more effective than the county's guiding message of hope. Not just hope in a new vaccine formulation from Johnson & Johnson, but hope in other people, no matter who they work for.
"I would say in my career, I've never seen something so collaborative," MacDonald says. "If you had asked me a year ago, if I'd be on a call with Spectrum Health leaders and others, working side by side to find solutions, to get volunteers signed up, to approach a strategy to get our population vaccinated, I would have been surprised to think that would happen. And now it's just naturally evolving."
The sheer speed of local response to the current vaccination phase has been "remarkable," according to Brasser.
"As we all collectively work through this, we recognize that the dynamics are changing and that's a challenge in and of itself, but it's also an opportunity," he says. "It's an opportunity to continue to innovate. It's an opportunity to continue to seek out new ways of connecting and in serving our communities."
Brasser encourages patients to "enthusiastically" get vaccinated when their turn comes, "but be patient because the demand right now is clearly very high and continue to practice those safety behaviors. We don't want to give up any of the gains we've made in our communities in fighting this virus."
The fact alone that a vaccine has been developed and is being distributed keeps Hustak looking up. Second to the vaccine, he finds hope in patience.
"We all just have to be patient with what we thought initially was going to be maybe a six-month process. It might be longer than that," Hustak says. "It's going to take us a while to get the herd immunity, simply because we don't have that vaccine so just please have patience and we'll get to you when we can. Until then, we have a lot of smart people who work on this every single day."