A Shot of Hope

After 16 years of working on immunizations projects in public health, Michele Roberts ’98 (biology) says she is accustomed to hearing from people who don’t want to be vaccinated. But things changed when the first COVID-19 vaccines arrived in Washington state in December 2020. That’s when Roberts started hearing from people who do want to be vaccinated. And there are a lot of them.

“The vaccine is really the pathway out of this pandemic. It’s the most powerful prevention tool we have,” says Roberts, who has led the immunizations office of the Washington State Department of Health (DOH) for the last seven years, and has been acting assistant secretary for DOH’s prevention and community health division since June 2020. 

“The demand is high—and rightfully so—but there’s just not enough vaccine for everyone [to get it at once],” she says.

DOH Chief of Staff Jessica Todorovich ’98 (politics) agrees that lack of supply is the greatest challenge to the agency’s efforts.

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“I think the reason why is that it jeopardizes the best practices around how we can roll out the vaccine,” she says. “Low supply, in and of itself, is what it is, but it creates certain dynamics. If we had more supply, we’d be able to hit a broader range of the targets we set of what’s important to us around vaccine distribution.”

One of those targets is equity in providing the vaccine to traditionally underserved and marginalized communities.

Prioritizing Need

With limited amounts of the vaccine available in the early months of the rollout, the Centers for Disease Control and Prevention (CDC) issued recommendations to federal, state and local governments about who should be vaccinated first—based on three goals: decreasing death and serious disease, preserving the functioning of society, and reducing the additional burden the pandemic is having on people already facing disparities. Other groups, including the National Academy of Medicine and the Advisory Committee on Immunization Practices, released their own guidelines. 

Roberts’ team considered information from all three bodies to create the framework for Washington’s vaccinations efforts. It was not an easy task, she says. 

“What judgments and values do you use to decide who [gets the vaccine first]?” says Roberts. “Restaurant workers or farm workers? People who are pregnant, or have disabilities or older people who have the highest risk of death? These are the types of decisions we’re trying to make every day.”

As supply caught up to demand in each eligibility tier, the vaccine was made available to the next tier, until April 15—right as this issue was going to print—when Washington Governor Jay Inslee deemed anyone over the age of 16 years was eligible to be vaccinated. The goal is to have enough of the state’s population vaccinated to meet the minimum requirements for herd immunity by the middle of summer. 

“We’ve never done anything like that in our lifetime,” Roberts says. “We do amazing things each year with getting kids immunized or getting flu shots out there, but it’s never been 70% of the adult population within six or seven months.”

Building Trust

An adequate supply of the vaccine is only one part of the equation, though, says Maria Courogen ’85 (French), director of systems transformation at the DOH.

“Having the vaccine does not mean you automatically have the path to vaccination—that takes staffing, and it takes resources from the states and the counties to be able to do that,” she says. “And while a lot of money was poured into the development of the vaccine, we’re still waiting to get adequate resources into the states and counties for them to be able to actually deliver them. Unless you can get shots into arms, they’re not going to do what you need them to do.”

In the early days of the pandemic, Courogen, who has a background in infectious disease, worked with her team to identify and offer the things residents needed in order to be able to quarantine and/or isolate. 

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“As we were putting together that body of work, we thought it was important to hire a workforce of folks who were already familiar to and trusted by the community we needed to serve,” Courogen says. 

The pilot site for this care coordination effort, which would soon spread out across the state, was in Yakima. The county had a high rate of COVID-19 infections early on and has a large population of agricultural workers, including many from the Latinx community who may be wary of interacting with government agencies. Courogen’s team used community-based organizations and health centers to get past these barriers to share information and let the community know they needn’t be afraid to accept government services. 

“Once the word of mouth from people who received health care or services got out to the community, it built trust—not only for the purposes of our quarantine and isolation services work, but it makes people less afraid to go to a testing site or if they get a call from the health department about contact tracing.”

Roberts says the inroads Courogen’s team made with care coordination and empowering communities to lead local efforts have also been important to the organizing the vaccination.

“It’s our job to make sure we’re giving people equal access to vaccines and to figure out their questions and concerns,” Roberts says. “One of the major things we’ve done is funding the communities to do this work. Rather than just asking for feedback or input, we’re asking ‘Can you create messages, materials and outreach for your communities if we give you the resources to do it?’”

She adds that another role community organizations have taken on is helping people make appointments for the vaccine through the state’s online tool. The DOH is also setting aside 30% of appointments at mass vaccination sites for phone-based scheduling. “We know that some populations don’t have access to technology in the same way others do.”

Looking Ahead

Although the coronavirus vaccine rollout offers progress and much-needed hope, there still is a lot of work ahead to meet the numbers needed for herd immunity. 

There are many factors that could complicate the effort. Researchers don’t have definitive answers regarding how long immunity lasts after receiving the vaccine, or after recovering from sickness from the actual virus. 

Roberts is also concerned that as more people start getting vaccinated, others could feel the virus isn’t as much of an immediate threat anymore and lower their guard around safety precautions or even decide not to get vaccinated themselves.

But overall, she’s cautiously optimistic: “Rather than feeling like taking one step forward and two steps back, now it feels like we’re taking two steps forward and one step back.”