Mobilizing the Community to Implement Mass Coronavirus Disease-2019 Vaccination Clinics
The Power of Free and Charitable Clinics
Kristi Mattzela,
MSW, LSW a email address:
@CentreCVIM , Cheryl Jo White,
RN a email address:
@CentreCVIM and Lori A. Francis,
PhD b ,
∗ aCentre Volunteers in Medicine, State College, 2520 Green Tech Drive, Suite D, State College, PA 16803, USA bDepartment of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA 16802, USA ∗ Corresponding author.
email address:
lfrancis@psu.edu A free and charitable clinic successfully designed and implemented mass COVID-19 vaccination clinics in a semirural area in Central Pennsylvania. A total of 172 clinics were offered, approximately 500 volunteers were mobilized, and approximately 45,000 vaccine doses were administered. Partnering with local schools, universities, and recreation centers to offer mass vaccination clinics made it possible to expand the clinic’s reach beyond its own patients. Findings provide evidence for the capacity of small community clinics to respond to major public health emergencies, such as a pandemic.
Keywords
COVID-19 vaccine; Free and charitable clinics; Mass vaccination; Rural health care
Key points
- • A small, community clinic provided more than 44,000 coronavirus disease-2019vaccine doses in a semirural community.
- • Mass vaccination clinics can be implemented by small health care systems using a volunteer model.
- • Given their volunteer model, free and charitable clinics are well poised to implement mass vaccination clinics.
- • Community clinics, as a trusted source of health care, have the power to address vaccine hesitancy in the community.
Introduction
Coronavirus disease-2019 (COVID-19) vaccines have been shown to be efficacious in significantly reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, severe illness, hospitalization, and mortality, particularly among individuals who receive at least two doses.
1 The vaccines were developed rapidly, in less than 12 months,
2 despite most vaccines taking up to 10 years or more to be developed. This accelerated vaccine development pace presented several challenges for health care systems and local public health agencies, including difficulties acquiring the vaccine, difficulties securing adequate space and equipment to store vaccine doses, difficulties mobilizing health care systems to vaccinate individuals in large volumes, and vaccine hesitancy given uncertainty about the short- and long-term effects of the vaccine.
3–
5Rural areas are faced with unique challenges due to geographic isolation and greater levels of vaccine hesitancy.
6–
8 A national US study of adults found that rural respondents were more likely to report feeling that the COVID-19 vaccine was unsafe.
9 Using the use of mass vaccination hubs within communities has been shown to increase vaccination reach.
10 Furthermore, community clinics can play an important role in vaccination efforts within communities, given that (1) they often rely on a volunteer model of care, which is crucial for mass vaccination efforts, and (2) they may be serving individuals at higher risk for vaccine hesitancy. The purpose of this article is to describe the design and implementation of large-scale, mass vaccination clinics implemented by a small community clinic in a semirural area in Pennsylvania.
Methods
Clinic History
Centre Volunteers in Medicine (CVIM) is a free and charitable community clinic that provides medical care, dental care, case management, behavioral health services, and medication assistance to those without health insurance and whose household income is at or less than 250% of the federal poverty level. CVIM serves those living or working in Centre County, PA. In addition to a small paid staff, the clinic is mainly staffed by physicians, nurses, dentists, pharmacists, social workers, and other licensed clinicians who volunteer their time to provide care to patients. In addition, referrals are provided to specialists and social service agencies as necessary. In the fiscal year 2018 to 19, CVIM served a total of 483 medical and 632 dental patients, with a total of 1427 and 2355 medical and dental visits, respectively.
The first Volunteers in Medicine Clinic opened in Hilton Head, South Carolina, in 1991. Since then, many additional clinics have begun serving the uninsured and underinsured nationwide. The clinics function on volunteers who provide a caring and compassionate medical home for those who do not qualify for medical assistance and/or are working without health care benefits. Efforts to establish a Volunteers in Medicine Clinic in Centre County, PA, began in February 2001 when a group of local citizens met to address health care needs in the Centre Region. CVIM was incorporated as a nonprofit organization on June 12, 2001. In February 2003, CVIM opened its doors to patients seeking medical care. Based on data provided in a 2019 Community Health Needs Assessment report
11 from a local health care system, 11 townships served by CVIM are considered medically-underserved areas, and two major towns served by CVIM are considered Health care Professional Shortage Areas.
Coronavirus Disease-2019 Vaccine Clinic Timeline
Owing to the rapid COVID-19 vaccine development timeline, efforts to mobilize for mass public vaccination had to occur at an accelerated speed. CVIM applied to be a vaccine recipient in the State of Pennsylvania in November 2020. Vaccine storage requirements and preparation procedures were researched, and staff began writing standard operating procedures and policies, in addition to completing several trainings. A total of 3 CVIM staff were trained to manage vaccine doses. In addition, a freezer was purchased for vaccine storage. CVIM’s approval to become a vaccine recipient was granted in December 2020, and vaccine orders began to be placed the same month.
The COVID-19 vaccine became available to the public on December 11, 2020, but only to special populations, including first responders, health care workers, essential workers, older adults (≥65 years), and adults with specific underlying medical conditions, such as cancer, diabetes, and obesity. By April 2021, the vaccine was available to all US adults (≥18 years), although the vaccine shortage limited the number of doses that could successfully be administered within a 7-day period. CVIM’s first shipment of 100 Moderna vaccine doses arrived on January 13, 2021, and efforts were focused on vaccinating clinic volunteers ≥65 years.
In January 2021, CVIM, the local hospital, pharmacies, and a small apothecary were the only entities that were vaccine recipients. Given staffing and scheduling restraints, we estimated that it would take nearly 2 years to vaccinate the county. Based on data from the US Census Bureau (www.census.gov/quickfacts/centrecountypennsylvania), the Centre County, PA population size was estimated to be 158,172 in April 2020, and some entities could only schedule a maximum of 10 vaccinations/d. Given how smoothly the initial, in-house volunteer vaccine clinics operated, CVIM recognized their capacity to address the vaccine demand and needs of the larger community, and they began to mobilize to offer mass vaccination clinics. CVIM began administering the Moderna vaccine in January 2021, the Pfizer vaccine in February 2021 and the Johnson & Johnson single-dose vaccines in April 2021; all vaccines were offered after April 2021.
“Super Saturday” Mass Vaccination Clinic Planning and Mobilization
Word that CVIM was a vaccine recipient began to spread rapidly throughout the county, and residents began to contact CVIM for vaccine appointments before additional vaccine doses were available. A waiting list was created and grew exponentially (>10,000 individuals). This provided unequivocal evidence that the demand for the vaccine was great. CVIM saw an opportunity to address this demand, and given its volunteer model, they determined that they would be able to mobilize volunteers on a large scale to meet the demand. In addition, given the burden that the local hospital and other health care entities were experiencing as a result of the pandemic, including health care professional shortages, and staff who were overstretched and experiencing burnout, CVIM was committed to lessening the burden on community providers who had supported them in the past. Most importantly, CVIM was committed to playing an active role in public health efforts to end COVID-19. CVIM had the bandwidth and energy available for this important purpose. As such, efforts to develop and implement mass COVID-19 vaccination clinics began in January 2021. Plans were made to offer the mass vaccination clinics on Saturdays, and to name them “Super Saturday Clinics.”
Space and room capacity. Since 2008, CVIM has been housed in a building with 6217 square feet of clinic space, including a waiting/check-in area that can seat up to 10 patients (five during COVID to allow for social distancing), with an adjoining bathroom, six examination rooms, three case management rooms, and four dental operatories. Given that CVIM was continuing to see medical, dental, and...
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