Title
Receive an updated response to Board Referral No. 2021.30 which directs the Health Department to partner with the K through 12 school system to increase the rate of vaccination among residents aged 5 to 11 years in communities disproportionately affected by COVID-19.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
Receive an updated response to Board Referral No. 2021.30 which directs the Health Department to partner with the K through 12 school system to increase the rate of vaccination among residents aged 5 to 11 years in communities disproportionately affected by COVID-19.
SUMMARY:
This response provides an update to the Health Department’s Preliminary Analysis Report in response to Board Referral No. 2021.30 (Attachment A), which was provided to the Board on January 11, 2022 (see Attachment B) and the subsequent response provided to the Board on June 21, 2022 (see Attachment C).
Immunization remains one of the most important strategies available to prevent serious illnesses, hospitalizations, and deaths due to COVID-19. COVID-19 vaccine eligibility for children has gradually expanded during the pandemic. Children 16 and 17 years of age have been eligible for COVID-19 vaccination since December 11, 2020; children 12 to 15 years of age have been eligible since May 10, 2021; and children 5 to 11 years of age have been eligible for COVID-19 vaccination since November 2, 2021. Children less than 5 years of age have been eligible for COVID-19 vaccinations since June 18, 2022.
Immunizing the approximately 78,000 children between 5 and 17 years of age living in Monterey County who are eligible for COVID-19 has been a community-wide effort. The Health Department continues to collaborate with a variety of stakeholders including schools, community-based organizations, faith-based organizations, pharmacies, city governments, hospitals, and health care clinics to increase COVID-19 vaccination rates. As of September 29, 2022, the Health Department’s Public Health Bureau has organized and implemented 334 COVID-19 vaccination clinics, administering over 51,000 doses of COVID-19 vaccine. Among all local COVID-19 vaccine service providers, the Public Health Bureau ranks first in immunizing children 5 to 11 years of age and ties for first in immunizing children 12 to 17 years of age. The Clinic Services Bureau has also been an important contributor to the Department’s efforts to vaccinate children. Clinic Services currently vaccinates children 6 months of age and older by offering COVID-19 vaccine at routine pediatric visits and offering vaccine at COVID-19 vaccination clinics. Among all local COVID-19 vaccine service providers, the Clinic Services Bureau ranks second in immunizing children 5 to 11 years of age and ranks second in immunizing children 12 to 17 years of age (see Attachment D)
Schools continue to be important points of distribution sites for vaccinations. To date, of the 334 Public Health immunization clinics noted previously, 61 were hosted at schools (see Attachment E), not including an additional 59 clinics that were conducted at sites directly adjacent to a school campus. Public Health offered a variety of hours of availability at school-based vaccine clinics to make COVID-19 vaccination more accessible to the community. For example, school-based vaccine clinics were held during hours that bridged the end of the school day to accommodate parents that pick their children up from school. Clinic hours were also extended into the evening for parents that work during the day and were held on weekends for parents that could not otherwise attend clinics during the school week.
In addition to vaccine clinic events at schools offered by the Monterey County Health Department, local schools have had access to free pop-up immunization clinics hosted by the California Department of Public Health. Schools can request a pop-up clinic or mobile site by completing an online application at <https://toolkit.covid19.ca.gov/mobile-vaccinations/>. Information on how to apply for these free resources has been shared numerous times during regularly scheduled meetings between Monterey County Office of Education, school leadership, and Health Department representatives, as well as on twice weekly calls the California Department of Public Health hosts for school administrators and their staff.
Health equity remains one of the Health Department’s top priorities. The Public Health Bureau utilizes local morbidity and vaccination data to identify existing health disparities and service gaps. Three hundred twenty (320) of the 334 COVID-19 immunization clinics hosted by the Public Health Bureau to date (96%) have been located at venues within Healthy Places Index Quartile 1 and 2 communities, which represent communities ranked lowest for a variety of predicted health outcomes. As of September 28, 2022, 74% of eligible Monterey County residents living in Quartile 1 and 73% of eligible residents living in Quartile 2 completed their primary vaccination series (compared to the statewide average of 65% and 70% respectively). Vaccination rates among school-age children continue to increase, though at a slower rate than older age groups earlier in the pandemic. Currently, 40% of Monterey County residents 5 to 11 years of age have completed their primary COVID-19 vaccination series, and 73% of residents 12 to 17 years of age have completed their primary vaccination series. These local vaccination rates exceed the California average rate of 37% of residents 5 to 11 years of age and 67% of residents 12 to 17 years of age. The Health Department continues to work with local medical service providers, community-based agencies, and faith-based organizations to increase awareness of the importance of vaccination and to reach additional at-risk communities.
The limited pool of individuals within Monterey County that are available to administer COVID-19 vaccines remains a challenge for the community-wide vaccination effort. Hospitals, medical clinics, skilled nursing facilities, schools and public health departments must compete for the same small pool of qualified staff. Temporary staffing agencies have been unable to meet the demand. Existing Health Department employees have been deployed as Disaster Service Workers for over two and a half years. Burnout and fatigue are often reported among the Department’s vaccine clinic workers. While the Department’s volunteer pool is large, the number of volunteers actually available to support clinics has diminished due to many volunteers returning to work and resuming activities of daily life.
In addition, the Health Department is leading MPX vaccination efforts locally. In order to stretch limited resources, the Public Health Bureau provided $129,000 to the Health Department’s Policy, Evaluation, and Planning Unit (PEP) to subcontract with the Visiting Nurses Association (VNA) and provide additional community-based COVID-19 vaccination clinics with VIDA staff through late Fall 2022. As of September 7, 2022, VNA through this partnership has conducted 7 clinics and administered 70 doses of COVID-19 vaccine.
The Health Department will continue to review existing vaccination strategies and determine if vaccination strategies should be modified. The Department will monitor changes in vaccination policy at the Federal level, including potential privatization of vaccination services. Finally, the Public Health Bureau is hosting dual influenza and COVID-19 vaccination clinics at community-based locations in Monterey County during October and November 2022.
DISCUSSION:
This work supports the Monterey County Health Department 2018-2022 Strategic Plan Goals: 1. Empower the community to improve health; 2. Enhance public health through safety and prevention; and 3. Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services. It also supports four of the ten essential public health services, specifically: 1. Assess and monitor population health status, factors that influence health, and community needs and assets; 2. Investigate, diagnose, and address health problems and hazards affecting the population; 3. Communicate effectively to inform and educate people about health, factors that influence it and how to improve it; and 4. Strengthen, support, and mobilize communities and partnerships to improve health.
OTHER AGENCY INVOLVEMENT:
The Health Department works collaboratively with the California Department of Public Health, local schools, community-based organizations, city governments, medical providers, and other service agencies to promote and administer COVID-19 vaccinations in Monterey County.
FINANCING:
The Health Department’s Public Health Bureau is able to offer COVID-19 vaccination clinics at no charge to the public through funding provided by California Department of Public Health Epidemiology and Laboratory Capacity (ELC) grants and Immunization Assistance Program (IAP) grants.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Check the related Board of Supervisors Strategic Initiatives:
☐Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☐Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability and transparency.
☒Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services; promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
☐Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☐Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Kristy Michie, Assistant Bureau Chief, 755-4503
Approved by:
Date:
Elsa Mendoza Jimenez, Director of Health, 755-4526
ATTACHMENTS:
Attachment A - Board Referral No. 2021.30
Attachment B - Preliminary Response to Referral No. 2021.30 - January 11, 2022
Attachment C - Updated Response to Referral No. 2021.30 - June 21, 2022
Attachment D - Table 1 Proportion of Doses Administered by Vaccine Service Provider and Age Group, as of September 29, 2022
Attachment E - Table 2 School-Based Community COVID-19 Immunization Clinics, as of September 29, 2022