Last night I remotely facilitated a session with the senior leadership of a mid-sized city discussing multi-agency coordination, incident management, and other concepts, mostly within the context of the coronavirus pandemic. We spoke at great lengths about the role of local government in this, especially when they do not have their own health department, and what expectations there might be of them in the future. In this discussion I had the realization of a potential scenario that seems to hold a fair amount of probability, and it’s one that is grounded in prior practice.
A bit of a disclaimer up front. My regular readers know that I usually avoid speculation. In the wrong context, speculation can cause undue stress or unnecessary effort. Obviously, that is not my goal. My goal is, as is typical of most of my articles, to promote thought and discussion on preparedness activities which are grounded in reality. As I’ve said to people many times over the past several weeks, it’s not too late to prepare. There are still plenty of things that we need to be preparing for in the midst of our response, including contingency plans for other potential hazards, and obviously continued operational needs. The best emergency managers think ahead. What I’m writing is not a call to action, but rather a call to thought.
When it comes to vaccination (once a vaccine is developed), it’s apparent that everyone will need to be vaccinated. While there are some factors which will force us to deploy vaccines in phases, including the supply of vaccine and the need to provide for fragile and critical populations first, there will eventually come a time when the population at-large will need to be vaccinated. Obviously, our public health system is not equipped to administer inoculations for everyone in every jurisdiction in a timely fashion. As such, there will be considerable reliance on local governments and advanced EMS providers, among others, to make this happen.
First off, addressing the use of advanced EMS providers – this is not without precedent. Advanced EMTs and paramedics have been used for a while now to support public health in mass inoculation needs, which have included H1N1, Hepatitis A outbreaks, and other viruses. I expect that we will see these personnel used again to support the eventual vaccination of the global population against Coronavirus. Because of the sheer volume needed, it is probable that we will see other medical practitioners likewise engaged. When the time comes, state health departments and state EMS agencies will need to develop or update (if they have them already) protocols and just-in-time training for personnel on the proper administration of the vaccine. Agreements in regard to paid third-party EMS service providers will also need to be addressed. Overall, EMS will be a significant and necessary augmentation of our public health system in this regard.
So what’s the role of local government that I expect? Most public health outbreaks we deal with are fairly localized, allowing public health officials to establish and manage vaccination points of distribution where they are needed. In a ‘typical’ outbreak, they can mobilize the resources needed, supported by state health departments and mutual aid from other public health offices. The activities for these points of distribution include the development of protocol and record keeping standards and mechanism, identifying the population, securing suitable facilities, equipping those facilities (tables, chairs, internet, privacy screens, etc.), notifying the public, coordinating with local officials for control of traffic and movement of people, delivery and administration of the vaccine, securing of sharps and biological waste, and clean up; among other things. In the scope of the coronavirus outbreak our public health offices doesn’t have the resources to do all this for every jurisdiction. I suspect that along with providing the serum and supplies to administer it, public health will only be able to establish standards and provide guidance, but I don’t think it’s unreasonable to expect that jurisdictions will be asked to provide significant support in the non-clinical aspects of setting up and managing these points of distribution.
What does this mean for local governments? As I’m not a government official nor do I have an ability to definitively see the future, I certainly would not advise local governments to engage in any detailed efforts now to prepare for this scenario unless they have been advised by a public health entity to do so. That said, it may be wise to pull together some stakeholders and at least outline a framework for how this can be done. I’m confident that at least some of what is identified will be of use in the future of this pandemic. Some jurisdictions may have already developed plans for points of distribution, which will be a good reference, but will likely be found to have inadequacies given current information on planning assumptions, the increased role of local governments I predict, and sheer numbers to be vaccinated.
Who else has considered this future need? I’m interested in hearing from others about their thoughts on these possibilities.
Be smart, stay safe, stay healthy, and make a difference.
© 2020 Timothy Riecker, CEDP
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