To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Barbie Robinson, 565-7876
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
COVID-19 Response Update - Vaccination Plan
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute the COVID-19 Vaccination Response Plan hereby described, to execute contracts and to obtain necessary resources, services, supplies, equipment, and such other properties to be lacking or needed for the protection of life and property, and to bind the county for the fair value thereof not to exceed the cumulative appropriations already authorized by the Board for COVID-19 Response activities from July 1, 2020 through June 30, 2021.
B) Authorize the Director of Health Services and County Administrator’s Office to work with the Human Resources Department to hire extra-help personnel, temporary agency personnel, independent contractors, and/or other appropriate options to expeditiously hire needed staff to effectively continue the emergency pandemic response, for the Vaccination Unit of the temporary COVID-19 Section in the Public Health Division and associated departments.
C) Receive a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
end
Executive Summary:
This item provides the Board with an outline of the Department of Health Services’ strategies to scale up and expand services to vaccinate a higher number of Sonoma County residents and roll out a rapid and comprehensive COVID-19 vaccine program. DHS requests expansion of a Vaccine Unit comprised of Disaster Service Workers (DSWs), extra-help, temporary help, and/or independent contractors. The COVID-19 Vaccine Unit will leverage existing DHS infrastructure, public, private, and government agency partnerships, and community engagement. The COVID-19 Vaccine Unit will ensure the necessary resources, workforce, and system engagement to support an equitable and timely administration of vaccine by our county medical partners. To carry out these efforts, DHS requires BOS approval to staff, equip, and implement activities for a comprehensive vaccine program. With these resources DHS will continue to build capacity to support the administration of vaccine as it becomes available. Currently, Sonoma County is directly supporting infrastructure that has the capacity to provide up to 2,500 vaccinations per day and will ramp-up its efforts in supporting the infrastructure as supply increases. However, this is highly dependent on COVID-19 vaccine supply availability at the state level, as well as overcoming vaccine hesitancy barriers in the community.
This item also provides the Board with an update of the Department’s COVID-19 response efforts and enhanced COVID-19 strategies.
Discussion:
The Department of Health Services (DHS) remains committed to COVID-19 vaccination efforts that are safe, efficient, equitable, and community-focused. As vaccine supply increases, DHS expects that additional healthcare and community partners will be able to receive, store, and administer vaccines to vaccinate expanding segments of our population. Our ongoing community engagement, implemented in collaboration with Leap Solutions, will work with community partners, focusing on ensuring and increasing robust vaccination availability in neighborhoods with disproportionate COVID-19 positivity.
Background:
Sonoma county DHS is working closely with health care systems, and community partners to develop and implement plans to receive, handle, distribute, and administer COVID-19 vaccine to all Sonoma County residents. DHS is gathering and analyzing the work requirements for a successful vaccination program while also currently executing the plan for all Tiers included in Phase 1a which includes the following groups:
Tier 1:
• Acute care, psychiatric and correctional facility hospitals
• Skilled nursing facilities, assisted living facilities, and similar settings for older or medically vulnerable individuals
• Paramedics, EMTs and others providing emergency medical services
• Dialysis centers
Tier 2:
• Intermediate care facilities for persons who need non-continuous nursing supervision and supportive care
• Home health care and in-home supportive services
• Community health workers, including promotoras
• Public health field staff
• Primary Care clinics, including Federally Qualified Health Centers, Rural Health Centers, correctional facility clinics, and urgent care clinics
Tier 3:
• Specialty clinics
• Laboratory workers
• Dental and other oral health clinics
• Pharmacy staff not working in settings at higher tiers
To date, the Department has executed the plan to the extent that we have received vaccine allocations from the state and is aiming to complete Phase 1a by mid-February 2021. DHS is also engaged with public and private partners to plan an expanded vaccine roll-out including Points of Distribution (PODs) for Phase 1b considering the new state directive to vaccinate all persons 65 years and older. Phase 1b vaccinations are estimated to begin in late January, 2021 and the longevity of this phase will be based on vaccine supply, uptake, and ability to administer vaccine to previous prioritization groups.
Upon completion of Phase 1, Phase 2 will ensue which will include an expanded network of vaccine providers (e.g. clinics, pharmacies, and public health sites) that will service the expansion of vaccine administration. In this phase, everyone else living in Sonoma County 16 years and older will be offered the vaccine.
COVID-19 Vaccine Unit Structure
The COVID-19 Vaccine Mission is organized functionally to support the goal of providing useful and understandable communications to stakeholders and the community, supporting the efforts of medical providers that administer vaccines, and ensuring that stakeholder activities that are aligned with the greater county goals.
The leadership structure of the mission, under the direction of the Director of Health Services, includes oversight by the Health Officer, Deputy Health Officer, the Vaccine Chief, and Vaccine Mission Manager to ensure strong clinical and administrative oversight. Reporting and advising within the leadership structure is the Director of Community and Stakeholder Engagement, the Equity Manager, and medical subject matter experts.
Communications will be led by Judy Coffey, Senior Consultant at Leap Solutions, DHS’s Community and Stakeholder Engagement Contractor, with foundational support from the County’s Communications team. These groups will work closely together to keep the general public and all stakeholders informed, while also supporting internal communications to ensure that all of the partners in this effort are working towards a common goal. The hotline will have staff trained to provide information and direction to callers with vaccine related questions.
In an effort to expand public outreach within the community for vaccinations, the County Administrator’s office will add 3 extra help Communication Specialists through December 31st, 2021. The duties of these positions will develop, plan and implement County-wide public information and relations. Currently, there are 3 extra help Communication Specialists, with a termination date of June 30th, 2021 in the general COVID-19 Unit last approved by the Board on January 5th, 2021. These positions will be extended to December 31st, 2021 for a total combined allocation of 6 extra help Communication Specialists within the County Administrator’s Office through the end of the calendar year.
Vaccine administration efforts are supported through coordination and communication with medical partners such as hospitals, pharmacies and Community Based Clinics. The organizational structure provides resources to collaborate and engage with these partners to ensure successful implementation that is consistent with County goals. We will contract with 3rd party providers, as applicable, to administer vaccines with County logistical support.
The Logistics team will play a critical role, ensuring that vaccines are received, stored and distributed to our medical partners safely and effectively while also providing supplies and equipment needed to successfully implement the mission. The Logistics team will work with medical partners to increase the vaccination distribution as vaccine supply increases. Finance will ensure that expenditures and documentation meet standards for FEMA reimbursement. Planning and data sections will provide necessary data and information to stakeholders and the Board.
For further information on Vaccine Unit positions and functions see Attachment 2 Vaccine Unit Functional Organizational Chart and Attachment 3 Vaccine Unit Roles and Responsibilities.
COVID-19 Vaccine Roll-out Strategies
The Department of Health Services is leveraging existing vaccine delivery infrastructure while strengthening and improving innovative strategies, new public-private partnerships, and robust engagement of public and private sector partners to ensure efficient, effective, and equitable access to COVID-19 vaccines.
The Department of Health Services will approach the work of distributing a safe and effective COVID-19 vaccine to Sonoma County residents in collaboration with health care providers, community leaders, and other partners.
New strategies to be implemented with the creation of the Vaccine Unit include the following:
Strategy 1: Expand number of vaccinators
It is essential to mobilize partners across the county to become vaccinators. To receive and administer COVID-19 vaccine, vaccination provider facilities and organizations must enroll in the California COVID-19 Vaccination Program (CalVax) and California Immunization Registry (CAIR2). DHS has established and continues to establish partnerships with a wide range of vaccine providers to support vaccine administration to the public, such as American Medical Response (AMR), local paramedics, retired volunteer physicians, collaborations with the Sonoma County Medical Association, Redwood Empire Dental Society, Medical Reserve Corps, local in-home nursing agencies and state medical volunteers, as well as Safeway. DHS is expanding the number of vaccination providers by an extensive recruitment effort based on provider capabilities, geographic location, and traditional clientele.
Strategy 2: Conduct stakeholder outreach and engagement
Leap Solutions Group will partner with the County in convening a series of virtual meetings and other engagement opportunities with local stakeholder groups. Leaders from county-wide sectors, companies, organizations, associations, and representative groups are convening to inform and provide community engagement surrounding the implementation of the county-wide vaccination program. Specifically, Team Leap will:
• Support stakeholder engagement to ensure an equitable roll-out of the COVID-19 vaccine
• Provide information and on-going engagement opportunities
• Engage with community leaders and stakeholders to ensure outreach extends to the whole county
• Establish an Outreach Committee composed of stakeholders who represent the county’s diversity, regions and business and nonprofit sectors
• The Outreach Committee will support the implementation of the county-wide outreach and engagement strategies.
Strategy 3: Provide timely, and comprehensive information to the public.
The Communications Office is implementing a six-month communications plan that began with using the SoCoEmergency.org web site, social media, digital and other platforms to provide information on the vaccine to build awareness of the progress of the vaccination campaign and to increase public trust, while encouraging residents to continue social distancing and mask wearing. As the campaign progresses and vaccines become available to sectors of the public, the campaign will morph to provide information on who is eligible for the vaccine and to encourage individuals to get vaccinated while maintaining COVID-19 mitigation measures.
The County will use a multitude of communication platforms to reach the community where they are and in their preferred language. The County will provide English and Spanish information on social media with enhanced community briefings that feature subject matter experts while continuing to use platforms such as print advertising and digital advertising targeted to those key census tracts that have been disproportionately impacted by the virus. Meanwhile, the County will continue to place a high priority on equity in its communications. The County will continue significant efforts to reach the Latinx community with tools such as Spanish-only radio ads, videos and Charlas (chats) with information relevant to the Latinx community, and other information shared through trusted service providers. The County Communications Team also will continue to partner with local community-based organizations to distribute information through tabling and door-to-door campaigns.
Strategy 4: Provide proper vaccine storage, handling, and redistribution.
DHS is working with Federal and State vaccine distributors, regional and local providers to implement vaccine storage and handling practices for COVID-19 vaccines. DHS is adhering to FDA standards and CDC recommendations for vaccine handling, storage, and redistribution to facilities who are not able to store their own vaccine on site. The correct vaccine storage and handling practices are critical to minimize vaccine loss. Vaccine is currently being stored by DHS (for those who are unable to store the vaccine at their own location) and a system has been established for vaccinators to either pick-up vaccine or to have the Vaccine Unit deliver vaccine to sites following all required protocols. Many of the large Healthcare entities including Multi-County Entities are currently having vaccine directly delivered to their sites.
Strategy 5: Collaborate with partners to implement Points of Distribution (PODs) for hard to reach populations.
Local hospitals and healthcare facilities are implementing PODs to vaccinate their Phase 1 populations. Further, DHS is establishing PODS in collaboration with Federally Qualified Health Centers (FQHCs), retail/private sector organizations, EMS, pharmacies, and other partners. DHS will also collaborate with partners to vaccinate those in Phase 1 who are not employees of an institution that can vaccinate. While most individuals in Phase 1b will be encouraged to get vaccinated by their primary care providers, DHS is also in discussions regarding vaccinator agreements with external entities and health systems to vaccinate hard to reach populations. Options are being explored to develop mobile vaccination clinic options.
Strategy 6: Ensure coordination and communications with healthcare community.
DHS is leveraging established communication mechanisms with providers/facilities via the County Health Care Coalition (HCC) and the Medical Health Operations Area Coordinator (MHOAC).
DHS has initiated a multi-agency task force referred to as the COVID-19 Vaccine Distribution Planning Group. The core group consists of multidisciplinary players including: the Sonoma County Department Operation Center (SoCo DOC), Sonoma County Disease Control Surveillance & Response, Public Health Preparedness Unit, and the local Medical Health Operation Area Coordinator (MHOAC). An extension of the core working group is the external stakeholders consisting of healthcare organizations, many of whom are members of the HCC. The external HCC stakeholders include Acute Hospital Partners, Skilled Nursing Facilities (SNFs), Federally Qualified Health Centers and other Healthcare Clinics, and Residential Care Facilities (RCFs).
DHS also has a vaccine allocation distribution planning group with both internal and external partners/stakeholders involved. The following sectors are represented: healthcare providers, Sonoma County Medical Association (SCMA), general acute hospitals, community-based organizations, FQHCs, dental providers, jail medical staff, pharmacies, human services agency, long-term care, county health equity manager, homeless providers, law, fire, EMS, county human resources and the Latinx community. This group is dynamic and can incorporate more or less members depending on the vaccination phase the county is currently in.
Strategy 7: Implement ongoing monitoring and evaluation of vaccine roll-out
The Vaccine Unit will collect, organize, and analyze data to understand provider capabilities, critical populations, vaccine allocation and distribution, and vaccine administration. The Vaccine Unit’s primary objective is to enable the safe, effective, and equitable vaccine administration during all of the allocation phases, focusing on the priority population groups within each Phase. DHS’s vaccination program is currently working with County and provider organizations for vaccination administration through outreach, education, training, and coordination.
Prior Board Actions:
1/5/2021 - COVID Fiscal Update, Community Needs, Eviction, and Sick Leave Policies
12/15/2020 - Department of Health Services COVID-19 Emergency Response
10/20/2020 - Enhanced COVID-19 Response Strategy
9/1/2020 - Coronavirus Relief Fund Community Needs Funding Plan
Fiscal Summary
Expenditures |
FY 20-21 Adopted |
FY 21-22 Projected |
FY 22-23 Projected |
Budgeted Expenses |
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Additional Appropriation Requested |
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Total Expenditures |
0 |
0 |
0 |
Funding Sources |
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General Fund/WA GF |
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State/Federal |
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Fees/Other |
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Use of Fund Balance |
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Contingencies |
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Total Sources |
0 |
0 |
0 |
Narrative Explanation of Fiscal Impacts:
The total estimated cost of the Vaccination Plan for January 1, 2021 through June 30, 2021 is $8,126,088. The department will implement the vaccination plan using current appropriations and work with County Administrator’s Office to determine the level of appropriations needed for FY 20-21 and return to the board as appropriate. Currently funding from the Federal Emergency Management Agency (FEMA) will cover costs at 75%. Local sources providing the matching funding of 25% is undetermined and will be detailed and presented to the Board at a later date. The department will include FY 21-22 costs through the budget process.
Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Description of COVID-19 Vaccination Plan Response Activities and Cost Estimates
Attachment 2 - Vaccine Mission Functional Chart
Attachment 3 - Vaccine Unit Roles and Responsibilities
Related Items “On File” with the Clerk of the Board:
None