Who gets it first? Here’s how Fresno County plans to distribute the COVID-19 vaccine
As Fresno County prepares for COVID-19 vaccines to arrive, the public health department will rely heavily on its partnerships with community based organizations to connect, inform and distribute the vaccine to hard-to-reach communities.
Paramedics and fire agencies, along with major hospitals such as Community Regional Medical Center, Kaiser Permanente, Saint Agnes and Adventist Health will receive the first round of vaccines, according to the plan Fresno health officials submitted to the California Department of Public Health that was obtained by The Sacramento Bee through a public records request. Then other large medical providers including Community Medical Providers, Peachwood Medical Group, United Health Centers and others will vaccinate their employees.
Fresno County is expected to receive 7,800 doses of the two-step vaccine somewhere around Dec. 15 and a second, potentially larger shipment at the end of the month. California Gov. Gavin Newsom tweeted on Friday that some vaccines may arrive to the state as early as the weekend.
Health, hospital and nonprofit leaders have indicated that they’re not so much worried about whether there will be enough vaccines. Rather, they’re concerned about misinformation and building trust so people, including health care workers, opt in.
“We know that there’s a whole spectrum of attitudes right now,” said Dr. Rais Vohra, Fresno County’s interim health officer and an emergency department doctor. “We feel like we’re going to meet the number of people that want to go ahead and get vaccinated, but it’s really just making sure that, you know, that total number … feels comfortable in actually getting the vaccine.”
The state’s template asked county officials to outline how the public health department plans to reach populations “with an eye on equitable distribution.” This is where the county’s partnership with 21 community based organizations will be key.
“We know historically that there has been mistrust in our healthcare system, just in terms of treatment of Black and brown bodies,” said Shantay Davies-Balch, who leads the African-American COVID-19 Coalition for the Fresno COVID-19 Equity Project.
The partnership between community based organizations and the public health department builds trust by putting community health workers in their own communities.
Hopefully, that partnership continues after the pandemic, Davies-Balch said.
Hospitals prioritized for vaccine
Most Fresno hospitals don’t know how many vaccines they will get or when they will arrive. The first 7,800 doses won’t be enough for all hospital workers.
Community Medical Centers alone employs nearly 8,900 people across its hospitals. Saint Agnes Medical Center includes about 2,900 employees and a medical staff of about 800, but some physicians also work at other hospitals and won’t necessarily get the vaccine from Saint Agnes. Kaiser Permanente employs 2,300 employees and physicians in Fresno, Madera, Tulare and Kings counties. Adventist employs about 3,000 people in Fresno and Tulare counties.
At Saint Agnes, health care providers who work directly with suspected or confirmed COVID-19 patients will be first in line for the vaccine.
“It’s so important that we prioritize the vaccine for our caregivers who are on the front lines – particularly those who are caring for our COVID-19 patients,” said Deanette Sisson, the chief nursing officer at Saint Agnes. “We need our caregivers healthy so we, as a health care system, can beat this pandemic and continue meeting the needs of our communities who are counting on us.”
About 145 Saint Agnes staff were quarantined on Friday, and about 90% of those tested positive for COVID-19. Nearly 360 Community Medical employees were isolating due to exposure, and 195 of those tested positive.
While it’s unclear when the vaccines will arrive, Fresno is ready with all the other supplies such as needles, syringes and personal protective equipment, Vohra said.
Community-based organizations help build trust
For vaccine distribution to vulnerable or hard-to-reach populations, Fresno will rely on many of the organizations tapped to help with testing those populations. The 21 organizations focus on immigrants and refugees, the Black community and people with special needs. The lead organizations are Fresno Building Healthy Communities, Fresno Economic Opportunities Commission and Exceptional Parenting Unlimited.
Already, those organizations have trained up and deployed over 100 community health workers who do all types of things — from going door-to-door to encourage people in small rural communities to get tested, to contact tracing, to providing information to COVID-19 patients on how to best isolate.
Now, those community health workers are being trained on vaccine distribution for the second phase, said Tania Pacheco-Werner, a research scientist with the Central Valley Health Policy Institute, one of the nonprofits involved. This was made possible through a six-month extension of the contract with Fresno County, she said.
“The county already is stretched thin on what they have to do, so they’ve seen it as a resource to rely on community based organizations and community health workers,” she said. “This provides a more personal approach to the pandemic, and that’s how you break through.”
The coalitions are focused on watching and learning from the first phase roll out so the organizations know what to expect at the neighborhood level, Pacheco-Werner said.
Davies-Balch, who leads the African-American coalition, said the county has committed to prioritizing those community health workers for vaccination too.
So why does the community based organization approach work?
It comes down to trust.
“We know that when folks have the opportunity to engage with someone that looks like them or comes from their community, that cultural concordant care can be very powerful,” she said.
Plus, the organizations know how to strategize messaging for particular communities, said Leticia Berber, a health educator with the public health department.
“These individuals or staff with CBOs are faces that are known in the community,” she said. “They trust them. They follow their lead.”
Future model for public health
While the first wave of vaccines will be here soon, for most people the option to get vaccinated is months away — and for many, patience is wearing thin, Pacheco-Werner said.
“This pandemic continues to be very real and an immediate threat to our families, friends and livelihoods,” she said.
Davies-Balch said the intent is for the coalitions to continue working with the county public health department even after the pandemic.
“The public health of the future is what we’re building,” she said.
Vohra said these groups were instrumental in community outreach on flu shots, and the coronavirus vaccine work will be an extension of that.
The community health workers deployed in neighborhoods now can be valuable resources for other health disparities, such as diabetes and maternal and infant mortality, Davies-Balch said.
“Historically, we have felt that sometimes our health care systems do things to us instead of with us,” she said. “This structure is really taking a different approach of: Let’s do this together.”
This story was originally published December 12, 2020 at 11:38 AM.