The pandemic has presented many challenges for local government administrators over the past months as the magnitude and persistence of the virus has dominated our consciousness and daily activities. Recent innovations of new vaccines have given our residents hope and there is a growing consensus that the global challenge of widespread vaccination is critical to defeating this enemy and regaining any sense of normalcy for our communities.
This Isn't Unprecedented
The magnitude of the task of vaccinating 330 million Americans seems overwhelming. As the vaccine supply slowly becomes more available, local managers are inevitably concerned with the effective distribution of the vaccine supplies that are available for their residents, as citizens and media second guess if government is up to the task. Yet there remains a generation among us with a circular scar on our upper arm—a reminder of how another government-conducted mass vaccination program defeated polio, an earlier deadly disease in the 1950s. History can repeat itself; government can prove worthy of the task ahead.
Local government managers can do little about the limited supply of vaccines except to lobby and advocate for the urgency of supplies, logistics, and accurate assessments of the need for vaccines for all our citizens. The distribution process will benefit from more intentional and assertive involvement of our local governments within our health care systems to assure the best process management and service delivery is utilized to distribute vaccines. Fortunately, local government managers have transferrable practices and skills that they can contribute to an equitable, efficient roll out of local community vaccination programs.
COVID vaccines represent in economic theory a scarce public resource, one with a finite supply due to limited supply chain availability and time-restricted value due to expiration.
While vaccine distribution is not a normal focus of local public managers, we routinely implement processes to secure, allocate, and control scarce public resources in our daily operations and certainly during emergency management declarations.
For example, consider post-disaster free water and ice distribution; social service food pantry operations; processes to equably allow access to community facilities such as park shelters or appointments for tee times, campsites or wedding venues in parks; capacity limitations on white-water rapids, beaches, or trail systems; and even triage of individuals in emergency medical disasters or for life-saving organ replacement in hospitals.
The critical difference in the case of mass vaccination programs is that COVID vaccines are issued free and their use is of health benefit to the entire community if the critical herd immunity levels are reached expeditiously. The “common good” of rapid deployment of free vaccines to save lives in this health care crisis, unlike most common governmental activities, serves to limit the use of market pricing or user fees and charges traditionally used to adjust demands on public resources like potable water or tennis courts.
Lessons for Handling Vaccination Programs
Recent experience shows public managers should strategically consider seven lessons we have learned from other local government service delivery practices to better handle our vaccination programs.
- Collaboration: Effective mass vaccination programs in a health crisis requires the collaboration of multiple government agencies and partnerships with the private sector and civic groups. Local government managers can facilitate this collaboration by personal example and community outreach, much like the local coordination in preparing for the Census we all use. Citizen coordinating committees can encourage and educate the public to increase participation in vaccination programs using local influencers and trusted leaders.
- Strategic Focus: Local government managers have positional authority to convene gatherings of community leaders to overcome the distribution challenges by identifying functional silos or breakdowns in community systems and to promote a shared strategy and coordinated community response. Invoking a formal all-hazards emergency operations plan or creating a temporary civic command center to centralize the vaccine response are means of developing shared strategies and metrics while coordinating diverse participation of community resources, respondents, and volunteers.
- Clarity of Message: Communication in a crisis is critical, particularly in a partisan environment that exists today. The unique community process for individual citizens to obtain the vaccines needs to be communicated accurately and clearly, through traditional and social media and release of information designed to inspire trust in the process. The loss of localized media outlets and power of social media to create disinformation needs to be directly countered by local outreach of trusted and visible community leaders.
- Resource Alignment: Assessment of your total community assets and resources is critical to assuring that appropriate strategies, staffing, and technologies are aligned with distribution goals for maximum success. Resources include not only medical facilities but also civic and private facilities that can be adapted for distribution points and corporate resources, retired medical personnel, and faith-based networks for volunteers. Healthcare and public employees are essential but not all are front line, so internal vaccine policies need to be implemented early in activation.
- Process Planning: Determine the optimal vaccine distribution process, potential weak points, and resource requirements. Distribution can be done by first come, first served or by appointment, or by a hybrid of both techniques. Reservation systems may be online or by phone and in person but potential frustration of clients needs to be recognized in each case and the technology, time required, and staffing demanded made available for optimal customer convenience and safety. Where breakdowns occur in processing, agile realignment can be implemented and reported. Is broadband available for online registration? Is public transportation available to vaccination locations?
- Accountability: Where distribution is occurring at decentralized sites or executed by multiple participating partners, an effort must be taken to establish and insure standard operating procedures, inventory audits, and chain of custody of vaccines. Written procedures remain best practice and facilitate assurance of trained staffing and that supervisory personnel adhere to them. Are CDC advisory vaccination guidelines or the proper scientific protocols being employed for safety and to prevent further spread of the virus?
- Equitable Implementation: Equitable and ethical distribution of vaccines are a moral imperative that may require that public administrators personally assure the distribution processes selected serve all neighborhoods, minorities, and special care populations. Does monitoring exist to prevent inappropriate jumping in line or encourage multiple registrations? Are vaccination facilities in minority neighborhoods?
Stewardship of Public Health
During 2020, the pandemic vividly demonstrated to a frustrated and fearful citizenry that solving complex health problems like COVID-19 requires both competent public leadership and effective management. The November election may have turned on the issue of perceptions of an inept federal response to COVID and a new President who promises to “manage the hell out” of the federal distribution process. As professional managers, we should renew our efforts to assist this national management challenge and build community capacity to see these vaccines make it “the last mile” and into the arms of all our residents.
COVID vaccine distribution remains a great challenge but this is not the last public health emergency we are likely to face. Pandemics, like hundred-year floods, can reoccur at any time. The fear of COVID has caused other potential individual healthcare crises by the delay of immunizations, particularly in children of preschool age and delay of preventative treatment of sick and elderly patients. This will create long-term health care issues affecting all of us for decades to come.
Community health is a shared public interest and part of the “commons” we share as citizens. Stewardship and concern for community public health is an important legacy for any public official. The next few months will not be easy. But take heart; we know how to do this and can teach others from the best practices we understand about quality service delivery.