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Vaccine Distribution and Public Trust: Maximus Public Health Offers the First Promising Practices

One year into the COVID-19 pandemic, the fight to contain the novel coronavirus faces new challenges as the virus mutates. The Brazilian, U.K. and South African strains of SARS CoV-2 appear to be more virulent and deadly. While current vaccines are reportedly effective against these new strains, epidemiologists worry they may not be effective against future mutations. All of this raises the stakes for accelerating vaccine distribution. The sooner we can slow transmission, reduce new case numbers, and build herd immunity, the sooner we can curb the process by which dangerous strains of the virus evolve and spread. To that end, tens of millions of doses have been distributed nationwide, and states are each preparing to extend distribution operations to include broader segments of the public

The public is starving for authoritative information on vaccines

While roughly half of American adults self-report as very willing or somewhat willing to receive the COVID-19 vaccine, the largest group of Americans self-report that they will "wait and see" how the first few months of the roll-out go before deciding on getting themselves vaccinated. Vaccine epidemiologists worry that poorly implemented state and local distribution efforts will reflect poorly on the credibility of the vaccine itself — resulting in a negative feedback loop of decreasing vaccine uptake coverage throughout the rest of 2021. Epidemiologists have consistently identified this pattern and recorded its harmful impacts during previous pandemics and their vaccination campaigns.

A successful vaccination program roll-out builds public confidence in the safety and urgency in getting their household vaccinated. At the end of the day — effective communications about the distribution progress will be the key to building trust and momentum that will drive levels of vaccine uptake necessary to establish herd immunity.

Vaccination programs will only succeed if a wary public trusts the entire process

Make no mistake — what the scientific community achieved in partnership with government in fast-tracking a safe and effective vaccine is a historic accomplishment. These vaccines offer an unprecedented means of getting people and the economy back on track to “normalcy.” BUT — vaccines will only ever be effective if embraced by the public in large numbers. As we’ve seen in recent weeks of vaccination efforts, trust may prove harder to manufacture than the “miracle vaccines” themselves.

The logistical complexity required for the accelerated vaccination of the entire population places immense strain on public health programs, resources, and personnel. As vaccinations expand beyond the initial population of frontline healthcare workers and people with high-risk conditions, expect public demand for information and assistance to skyrocket. Charged with managing complex operations and supply chains, the additional stress of fielding thousands of inquiries will only make this task harder on agency personnel and partners going forward. The coming months will put the nation's carefully crafted vaccine plans to the test.

“There is no time for pilots. A public-private partnership offers the best opportunity to deploy epidemiologist-trained, human-centered call centers quickly and cost-effectively. Choose a private-sector partner with solid credentials in public health communications, privacy concerns, scientific knowledge, and technical expertise. Without this specific technical experience, contractors will struggle to get health messages disseminated broadly and connect people with vaccines at scale. They will likely struggle to deploy and redeploy trained contact tracing and vaccine FAQ agents — staffing, both up and down — in line with local demand surges.”

Amber Bickford Cox, MPH, Ph.D., Director Public Health Epidemiology, Maximus Public Health

Recommendations and promising practices: launching effective vaccination contact centers that build trust in the program

In many ways, the real test of the government's ability to communicate and build trust in the vaccine program will come as distribution expands beyond Phase 1 and efforts to engage the broader population begin. As part of our work assisting state and local governments with their vaccine distribution, contact tracing, and contact center operations, my colleagues and I at Maximus Public Health collected these early lessons learned for launching, expanding, and scaling operations through 2021.

The appetite for information will not be satisfied through online or one-way communication channels alone

In some states with COVID-19 contact center operations, we have observed that significant numbers of people are willing to remain on hold for three or even four hours rather than disconnect to read web content or wait for a return call. No matter how carefully states and local governments write up their policies and FAQs, many people will call and seek out human representatives to ask questions and seek reassurance. They want their questions answered by a human being — and the human element and interpersonal connection are an indispensable part of the process for many people. But making them wait 4 hours to talk to a live person risks eroding their faith in the vaccine and the vaccination campaign.

 

The citizen journey matters more than ever

States that put serious effort into making information dissemination to the public easy, transparent, and responsive will have more successful vaccine distribution efforts. Clear-cut, uncomplicated customer service experiences promote trust in local government — and in the vaccination campaign itself. While some individuals read and follow detailed information on COVID-19 from sources like CDC and NIH, most people only want clear answers to their specific questions and concerns as they come up. They will observe and judge how convenient or difficult it is to get clear, timely information from authorities about their concerns and vaccine availability.

 

All public health is local — collaborate with partners to expand the reach of public health experts

Enabling a two-way dialogue with local professionals will build and maintain trust. This will require arming providers with comprehensive resources and a framework to get people answers to whatever questions and concerns they bring with them — and a means of escalating cases to public health experts. Launch a centralized service center as the source of accurate, consistent, and current information and a collaboration point for facilitating communications between the public, providers, and other stakeholders. By providing excellent customer service and straightforward, responsive channels for getting information, government can reduce fear, hesitation, and frustration as the pandemic wears on through 2021.

 

Be persistent and communicative on prioritization and equity efforts

Most states and cities have put a lot of thought into ensuring vulnerable populations are not overlooked or left out of pandemic relief and vaccine distribution. They will need to persist in efforts to ensure that medically marginalized and vulnerable people are provided priority access to vaccines through health systems — by communicating their methodology and decisions about prioritization. Critically, states must resist the temptation to loosen or abandon guidelines that promote equity in favor of driving metrics. Some modifications and recalibrations will be inevitable — but vulnerable populations must remain a priority, and changes to timelines must be communicated clearly, consistently, and transparently.

 

Process: program integrity, fraud, waste, mismanagement

Scarcity of any highly-sought resource — from concert tickets to vaccines — can lead to fraud, profiteering, and abuse. To avoid these adverse developments, consideration should be given to shoring up program integrity protections in vaccine distribution operations, just as are in place for pandemic economic relief programming. The public is watching, so agencies should anticipate and prevent foreseeable shortcuts, fraud, mismanagement, and human fallibility. In particular, "vaccine shopping" across providers, pharmacies, and geographies; efforts to circumnavigate the rules; and pay-for-access schemes will have a detrimental impact on the public's trust. Improved processes and technologies for accountability and pre-registration are worthwhile investments to mitigate potential reputational damage if disadvantaged, and minority groups perceive that bad actors and better-connected people have unfair access to vaccines.

 

When the appointments run out, continue answering the phones

We've seen the consequences of appointment scarcity play out in several localities. The process of scheduling should not be divorced from the public's interest in seeking information from authorities. When people call to schedule vaccinations, the phone lines must be manned — even when the schedule is fully booked. Nothing hurts the credibility of a program more than getting feedback from the community that “No one ever answers the phone when I call.”

 

The hard work starts now:

The coming months will continue to put the nation's carefully crafted vaccination plans to the test. COVID-19 vaccines and the record-breaking scientific accomplishments that created them offer a path out of the pandemic and return to “normal” — but only if the vaccines cross the finish line and people are vaccinated in large numbers. To accomplish this mission-critical objective, we must work together to bolster the public's trust in the vaccines and the governments that provide them.