Community-based COVID-19 Vaccination Points of Dispensing (POD) Sites: Adapting to Changing Needs

The Los Angeles County Department of Public Health (LACDPH) serves 86 out of 88 cities and all unincorporated areas. The County spans approximately 4,000 square miles and has the largest population of any county in the United States with nearly 10 million residents. It is also one of the most ethnically and socioeconomically diverse counties in the nation.

During the course of the COVID-19 pandemic, LACDPH Points-of-Dispensing (POD) sites transformed from large drive-through mass vaccination sites that primarily provided COVID-19 vaccinations, to seven community PODs. These sites are focused on how to encourage vaccine uptake via increasing accessibility and establishing trust within the communities the sites serve. Vaccine hesitancy and misinformation, poor public adherence to non-pharmaceutic interventions, and general pandemic fatigue made vaccinations an even more critical tool as the Fall/Winter 2022 possibility of a tri-demic” (COVID-19, influenza, and respiratory syncytial virus) threatened to overwhelm the health care infrastructures.

The overall goal of the PODs is to provide COVID-19 vaccines rapidly and safely, while ensuring Los Angeles County residents have equitable access to the vaccine. The goal in transforming these larger mega PODs to community PODs was to become a trusted community resource in specific underserved communities and create an accessible one-stop shop” for nearby residents to receive community health services. The objectives include ensuring accessibility to COVID-19 vaccinations while supplementing additional public health services that respond to the needs of the local community and serving as a trusted source to combat misinformation.

Activities implemented for this practice included:

- Strategic site selection using a health equity lens

- Utilization of real time data and trends to incorporate additional services beyond COVID-19 vaccinations that best catered to the community's needs

- Community outreach to provide education and increase LACDPH's visibility in the community

- Deployment of Vax-on-the-Go” (VOTG) outreach teams that offered vaccines on-the-spot near local businesses and faith-based organizations within five miles of POD locations  

Major Process Milestones and Results:

- Community outreach efforts to spread awareness about LACDPH presence in the community and provide health education. Result: Over 28,000 local community venues visited (June 2021 to date).

- Availability of flu and mpox vaccines at PODs. Result: Over 17,000 flu vaccine doses and almost 40,000 JYNNEOS  vaccine doses administered.

- VOTG outreach teams established to provide on-the spot vaccinations. Result: Over 3,500 COVID-19 doses and over 1,300 flu doses administered on-the-go" (February 2022 to date).

- Incorporation Test to Treat” program. Result: Almost 6,000 rapid COVID-19 antigen tests administered and almost 500 residents referred for therapeutics (April 2022 to date).

- Produce pick-up program established. Result: Over 7,200 households served (June 2022 to date).

With the available resources, LACDPH was able to ensure accessibility to COVID-19 vaccinations despite fluctuating vaccine demand by continuing to remain in the community with consistent days and hours of operation, including offering evening hours and weekends coupled with walk-in availability. VOTG was designed as a hub and spoke” model - with the PODs serving as the community hub and outreach efforts as the spoke. VOTG teams offered vaccines on-the-spot to capture hard to reach and vaccine hesitant populations. Supplemental services were incorporated including flu and mpox vaccinations, COVID-19 test kit distributions, rapid COVID-19 onsite testing and therapeutics referrals, a produce pick-up program, and additional psychosocial resources such as on-site mental health workshops and other enrollment services.

Factors that led to the success of this practice include the high level of community engagement through LACDPH's strong community partnerships and commitment to immerse within the local community via extensive outreach. Community outreach teams were deployed for targeted outreach and dissemination of health education materials. Supportive partners, such as the LA County Department of Parks and Recreation and local cities, provided facility space free of charge. LACDPH utilized staff subsidized from the State of California Medical Health Operational Area Coordination (MHOAC) Program to supplement DPH staff. These collaborations minimized the logistical hardships that would have occurred while attempting to expediently expand or contract the POD footprint based on rapidly changing community demands.  

LACDPH's consistent presence for over 18 months helped strengthen community trust, especially through the changing phases of the pandemic, from various COVID-19 surges to the emergence of mpox. The continued community visibility also signified the ongoing nature of the pandemic. LACDPH leveraged the existing infrastructure of the PODs to respond swiftly to other unprecedented needs, such as providing mass mpox vaccinations or linking residents directly to COVID-19 therapeutics resources. Building community trust takes time and this approach was respectful and empowering towards the communities that LACDPH hoped to reach.

The locations of the community PODs were strategically chosen through a health equity lens to ensure that the most vulnerable communities in Los Angeles County would easily have access to services. Utilizing the California Healthy Places Index (HPI) indicators, specific cities and communities were identified as harder-to-reach and had historically more challenging barriers to health access. There was also an additional focus on prioritizing trusted locations such as community centers, parks, and recreation sites, as they were conveniently accessible to the public.

Program website: http://publichealth.lacounty.gov/media/Coronavirus/vaccine/sites.htm

LACDPH's target population was unvaccinated individuals, communities with low vaccination rates, and populations disproportionately impacted by COVID-19 in Los Angeles County. In January 2021, LACDPH established large mega PODs to urgently meet the need of mass vaccinating eligible individuals, as quickly as possible, based on federal supply availabilities. Five large drive-through sites, which had the capacity to vaccinate 4,000 people per site per day, were established across various parts of the County. As vaccines became more available through other channels, LACDPH significantly downsized the POD footprint to efficiently manage the decreased vaccination demand and provide better access to communities hardest hit by the pandemic. Having the preexisting infrastructure of the PODs provided the opportunity to layer on services and rapidly respond to communities' evolving needs. The five large drive-through mega PODs were subsequently demobilized and new community PODs were opened in underserved and vulnerable communities, based on geographical gaps of access to the vaccine. Four of the seven community PODs offer expanded services through internal and external partnerships and collaborations.

The COVID-19 pandemic has disproportionately affected historically marginalized groups – when looking at race/ethnicity, socioeconomic background, and geography. From facing inaccessibility challenges such as location, transportation, and limited networks of providers, getting tested and vaccinated has not always been easy for community members. In some regions of Los Angeles County, the pandemic continues to exacerbate the already existing health and social inequities. Utilizing the California Healthy Places Index (HPI) indicators and the CDC's Social Vulnerability Index, specific cities and communities were targeted for prioritization in designating POD locations. For example, one of the sites is located at Ted Watkins Memorial Park, which is in South Los Angeles. Based on its zip code data (90002), HPI places its percentile as 2.5, meaning this zip code has healthier community conditions than 2.5% of other California zip codes. The lower the percentile meant the more vulnerable the community [https://map.healthyplacesindex.org/?redirect=false].

As the public's needs changed during the pandemic, LACDPH quickly shifted priorities at the community PODs. As most major metropolitan areas downsized or closed their mass vaccination sites due to waning demand, LACDPH-run sites continued to remain open. LACDPH has been able to continually respond and mass vaccinate during the different phases of the pandemic. There was a concerted effort to transform the traditional model of PODs by expanding services that kept them relevant in the community as a trusted partner.

One of the major focuses for the PODs has been accessibility. PODs were strategically placed where there was greatest need. Services and outreach efforts were continuously tailored as more real time data was received from the community (such as focusing on specific populations – elderly, those with low booster uptake, expanded age eligibility, etc.). PODs are operated five days a week including weekends, evening hours, and select holidays. These hours and days of operation are convenient to the populations LACDPH aim to serve. The PODs have appointments and walk-ins available to allow for easy access to services. All seven community PODs provide vaccines, distribute at home test kits, conduct targeted outreach and VOTG. To address emerging needs, access to additional vaccines (i.e., mpox and flu) were made available at the PODs. Services were expanded at four sites, where Test to Treat programs, fresh produce pick-up/giveaways, and mental health services were implemented. LACDPH was able to leverage their co-location with LA County Department of Recreation and Parks by hosting community events and providing additional services to further strengthen ties with the community. Continuous efforts were made to encourage those more reluctant, unwilling, or lacking in resources to get vaccinated. As services contracted and expanded, resources and capacity were always monitored.

Since June 2021, LACDPH's efforts to outreach at nearby harder-to-reach communities has provided the public more opportunities to engage in community dialogue, dispel vaccination myths, and increase awareness and education.  Providing COVID-19 and flu vaccinations on-the-spot” at nearby offsite locations increased vaccine accessibility. Staff canvassed the areas surrounding the PODs, using data provided by demographic heat maps to target specific neighborhoods. Outreach teams were deployed to surrounding communities to distribute flyers and health education materials offered in multiple languages. The goal of these outreaches was to increase community awareness and confidence in COVID-19 vaccinations. The in-person outreaches provided opportunities for community members to ask questions and receive accurate information about the COVID-19 vaccines from a reliable source. These efforts are an example of LACDPH's commitment and dedication to address vaccine equity and work directly with community partners to ensure a safe and inclusive recovery from the pandemic.

When anti-viral medicines were first approved and released at the end of 2021, the data trends were monitored in the County. Since there was low uptake in COVID-19 therapeutics, the PODs were designated as Test to Treat” sites that allowed referrals to therapeutics. As of April 2022, on-site rapid COVID-19 antigen testing has been provided to the community. If a resident tested positive, they were given a test-to-treat flyer or referred to the LACDPH telehealth. If they tested negative, they were provided with COVID-19 education. This additional offering increased awareness about therapeutics and was a way to directly link residents to this new service.

In response to the emerging mpox pandemic, the JYNNEOS vaccine was integrated into the offerings of existing services. At its height, four of the PODs were providing over 5,000 doses on a weekly basis. Once federal supplies increased, LACDPH acted swiftly and put together a delivery system to coincide with the COVID-19 vaccines. Since the beginning of the mpox pandemic in July 2022, almost 40,000 doses of JYNNEOS vaccine have been administered at the PODs. LACDPH utilized the CA Department of Public Health (CDPH) MHOAC staff to expand personnel capacity. MHOAC staff were placed at four of the PODs to specifically administer mpox vaccinations. Additionally, flu vaccines were routinely offered during the flu season as another vaccine that community members could receive. The flu vaccine continues to be a necessity, as communities are currently facing a triple threat from COVID-19, influenza, and RSV.

The PODs expanded their services to also address social determinants of health. Existing partnerships and agreements were utilized at the County to expand services and meet on-going needs. Food insecurity is a prevalent issue in the County and has only increased as a ripple effect of the COVID-19 pandemic. To address this issue, LACDPH leveraged an existing partnership through the department's Nutrition Program and were able to provide fresh produce at three of the seven POD locations on a bi-weekly or monthly basis, serving over 7,000 households. During the nationwide infant formula shortage, LACDPH partnered with the Maternal, Child and Adolescent Health (MCAH) program and utilized resources within LACDPH to provide formula to residents most in need. Families were also able to get connected to the MCAH program to access additional services.  

In emergency preparedness practice, the POD framework has shown to be a proven effective strategy to distribute essential interventions (e.g., vaccines, masks, water, etc.) expediently to a mass population. Multi-level interventions were implemented at four of the seven community PODs to evolve beyond the traditional model by providing expanded services and adapting to the on-going needs of the community. The ability to provide supplemental services (produce pick-up, testing, other vaccinations) increases public awareness and interest, which draws potentially unvaccinated individuals to LACDPH sites, offering more opportunities to reach target populations. Furthermore, evidence has shown that by using a combination of community-based interventions to increase vaccination rates in targeted populations [it may] increase community demand, enhance access to vaccination services, or reduce missed opportunities by vaccination providers” [https://www.thecommunityguide.org/findings/vaccination-programs-community-based-interventions-implemented-combination.html].  The on-going training and education provided to staff at the PODs resulted in timely updates and increased staff capacity to respond to the communities' changing needs.

The overall goals of the PODs are to provide COVID-19 vaccinations quickly and safely to reduce transmission, morbidity, mortality of COVID-19 disease; help minimize disruption to society and economy, including maintaining health care capacity; and ensure equity in access to vaccine to the entire population of Los Angeles County. The goal in the transformation to the community PODs is to become a trusted resource in specific underserved communities and create a safe one-stop shop” for nearby residents to receive community health services. LACDPH's objectives include ensuring accessibility to COVID-19 vaccinations, layering on additional public health services to respond to the needs of the local community, and serving as a trusted source to combat misinformation.

As vaccine supply began to flourish with multiple providers, plans were underway to convert larger mega PODs into smaller community PODs. Utilizing a health equity lens to examine the existing data coupled with willing facility partners, new sites were chosen that matched LACDPH's commitment in addressing systemic inequities as laid bare by the pandemic. LACDPH staff and partners ensured that there were no breaks in service when the demobilization occurred for the larger mega PODs while concurrently moving into the new community sites. With no gaps in service, the community sites opened without incident at new locations the next operational day.

To publicize LACDPH's presence in the community and increase vaccine uptake, small outreach teams were sent out by each POD to canvas neighborhoods while providing flyers and education. These teams were usually led by an experienced LACDPH Public Health Nurse (PHN) who listened to concerns from residents, answered any questions that may have caused vaccine hesitancy, and shared resources. The LACDPH Epidemiology (Epi) team also provided heat maps to strategically target outreach in neighborhoods near the PODs with the lowest vaccination rates. Further adaption of the outreach teams included a small team of clinical and nonclinical staff with the ability to provide vaccinations at local venue storefronts. With permission from the venue and supplies from the POD, staff registered and vaccinated willing residents on the spot. Examples of participating venues included faith-based organizations, apartment complexes, grocery stores, malls, and restaurants.

The incorporation of dispensing additional vaccines at the PODs relied on creativity and flexibility with the existing space, layout, and staffing. Due to different formulation and vaccine type, at its height, staff dispensed up to 9 types of vaccines concurrently - 6 Pfizer types due to various ages and formulation, Novavax, flu, and mpox. To minimize vaccination errors, a color-coding labelling system was utilized and, when space and staffing allowed, distinct tables with different staff focused on a specific formulation. LACDPH's Nursing Administration created training videos and provided in-person guidance to ensure staff was informed and felt comfortable managing a collection of various vaccine types. Supplying a multitude of vaccines ranging in age and type continued the goal of enhancing accessibility, while providing more value to the community by offering other vaccines in addition to those for COVID-19.

Providing free at-home COVID-19 test kits encouraged residents to be safer within their community. By removing the costs barrier, residents were more likely to test prior to gathering or when they feel ill, which helped to decrease community transmission. PODs received test kits from LACDPH warehouse and staff freely handed them out to residents. In April 2022, integration of the Test to Treat” program at selected POD sites for COVID-19 therapeutics referrals decreased barriers in accessing a medication that can help reduce the severity and length of COVID-19 symptoms. Staff oversaw a self-administered rapid COVID-19 antigen test and provided guidance as needed. If the test was positive, staff either provided them a Test to Treat informational flyer or connected them with the LACDPH Call Center that linked them to the LACDPH Telehealth services. From there, LACDPH Telehealth services performed intake and connected them to a provider to receive a COVID-19 anti-viral prescription if they qualified for therapeutics. In June 2022, to further streamline the process and remove barriers for residents, staff started to assist with the intake process at the PODs so residents can be connected to a provider in a more expedient manner. This intervention ultimately increased therapeutics uptake and access, with residents receiving guidance on how to navigate the system and having confidence that the medications received would be free of charge.

Partnering with other County departments, LACDPH sought to address some of the social determinants of health needs of the community exacerbated by the pandemic. For example, the LA County Department of Mental Health routinely deployed outreach workers to select PODs to conduct mental health workshops and provided referrals to services. The LA County Department of Social Services also deployed eligibility workers to certain POD sites to assist and educate residents about various social services programs. The DPH Nutrition Program coordinated the produce pick-up program at select PODs to address food insecurity in the community. At the PODs, these partners were featured in a prominent location with clear signage, so it was easy for residents to see the resources available.  

Timeframe for Practice:

June 2021: Conversion of the mega PODs to community PODs; Community canvasing and outreach began

October 2021: Started providing flu vaccines

December 2021: Started distributing at-home rapid COVID-19 antigen test kits

February 2022: Started "Vax-on-the-Go (VOTG)"

April 2022: Launched Testing and Therapeutics referral (Test to Treat); Launched community resource tables in collaboration with partners

June 2022: Started produce pick-up program

July 2022: Started providing mpox vaccine

LACDPH led the way in the establishment of the initial large drive-through mega PODs and its iteration as the smaller community PODs. LACDPH staff played key roles in leading, managing and filling many of the roles needed for this operation. Initial POD planning required collaboration among a wide range of public and private sector partners, including immunization and public health emergency preparedness programs and emergency management agencies. Countless LACDPH departments and staff participated in executing the PODs. LACDPH also engaged across the entire County system (i.e., Internal Services Department, Fire Department, Department of Mental Health, Department Parks and Recreation, Department of Social Services, etc.) as well as California Department of Public Health to provide additional resources to ensure the program was well-rounded in serving the needs of the community. The collaboration between the specific cities and county departments has proven to be fruitful. Besides LA County Department of Parks and Recreation providing their facilities free of charge, the PODs were regularly publicized and incorporated into any special programming events hosted by the facility owners. Examples include Parks after Dark, the Harvest Festival, and city-led holiday events. These partnerships allows LACDPH to continue to push vaccination efforts and increase awareness of LACDPH's stable presence in the community.

The strategic POD location selection helped with ensuring equitable, meaningful, and representative collaboration with target populations. With the community outreach teams, LACDPH had the opportunity to network and connect with mainstays in the communities such as libraries, schools, senior centers, and faith-based organizations. Further engagement with residents was done to provide education and remind them that even if they are currently hesitant to receive the vaccination, there is an available place situated in the nearby community where they can receive reliable vaccine information and access vaccines when they are ready.  LACDPH PHNs continue to assist with warm hand-offs to other County departments for residents requiring additional community resources. Local businesses supported LACDPH efforts by allowing staff to be stationed in visible areas to provide on-the-spot vaccinations as part of the VOTG outreach. This presented an opportunity to meet people where they are” and administer vaccinations immediately.

Funding for the community PODs is supported by a mix of federal, state, and local county dollars. Total funding to support the program from July 2021 to June 2022 was approximately $26.7 million dollars with about 63% associated with contracted clinical, logistical, and security personnel, 19% for county personnel, 12% for contracted ambulance services, and 6% for supplies/material costs. As LACDPH continues to look for ways to operate more efficiently, the budgeted/projected costs for the program from July 2022 to June 2023 is expected to be approximately $20.9 million dollars with about 72% associated with contracted clinical, logistical, and security personnel, 12% for county personnel, 12% for supplies/material costs, and 4% for ambulance services. Ambulance services will be phased out in January 2023. In addition, it is important to note that the above funding/budget does not include facility costs since partnering county departments, cities, and organizations provided physical locations for the PODs free of charge thus eliminating the need to incur real estate costs.

County and contracted personnel expenses continue to account for over 70% of the total program costs.  The high percentage of personnel cost reflects the labor-intensive nature of the POD operation and the high salary cost to employ clinical staff including physicians, nurse practitioners, registered nurses, and licensed vocational nurses. Support staff with expertise in management, information technology, logistics, finance, and human resources, as well as registration and security personnel were needed onsite and offsite to assist with the POD operations.

Multiple data collection methods were utilized to evaluate the practice. The data science team created an online survey that POD staff completed at the end of each operational day to report daily numbers of interest. Vaccinations were entered in real-time into MyTurn, the COVID-19 Vaccine management and documentation platform developed by the State of California. MyTurn communicates directly with the California Immunization Registry (CAIR) and with MyCAVax, the COVID-19 vaccine allocation system also developed by the State. MyTurn platform can provide historical and current vaccination data and generate multiple POD data reports. For continuous quality improvement, data was utilized to inform and strengthen internal and external practices. After getting vaccinated, residents were encouraged to take a survey and rate their satisfaction with the services they received.  POD teams also used internal tracking systems to monitor supplies, staffing, and safety needs.

Outcome Measures:

Since the transition to community PODs in June 2021:

- 179,393 COVID-19 vaccines have been administered (data through 12/9/22)

- 3,589 of total covid vaccines have been administered through Vax-on-the-Go (VOTG)

- 39,707 mpox vaccines have been administered (data through 12/8/22)

- 17,770 flu vaccines have been administered (data through 12/8/22)

- 1,335 of total flu vaccines have been administered through Vax-on-the-Go (VOTG) (data through 12/4/22)

- 96,710 COVID-19 at-home test kits have been distributed  (data through 12/4/22)

- 5,740 COVID-19 tests have been administered at three full-service sites (data through 12/4/22)

- 489 residents have been referred to therapeutics at three full-service sites (data through 12/4/22)

- 28,286 venues were visited through community outreach (data through12/4/22)

- 7,270 households were served through the produce pick-up program (data through 11/30/22)

Process Measures:

- The population that received vaccinations is tracked through registration data via MyTurn. Data such as demographics and type of vaccine dose/s was available through this platform.

- Residents were directed to take an online Customer Satisfaction Survey to share their feedback about the services offered and received. Data was collected on the number of surveys submitted on a monthly and quarterly basis and reported out to the Leadership Team. Residents rated their overall satisfaction and their service wait time. Residents were also encouraged to provide qualitative feedback. These results were reported monthly to the POD Incident Commander and Operations team leads to identify changes or improvements that could be implemented. Results were also used to identify what was working well and provided the opportunity to recognize individual staff members who were mentioned in the survey for their exemplary service.

- Interdepartmental partnerships were established to develop heat maps, which identified populations most in need of vaccination and helped strategically guide community outreach efforts. Data was collected on the venue type and location visited by the outreach team.

- There was on-going recruitment of clinical and non-clinical staff. The number of staff was tracked in the end-of-day online survey. A staffing and nursing administration team monitored these changes and responded to meet the varied personnel demands.

- Completion of staff education and training was tracked. As new vaccines were authorized, it was important to ensure staff were up-to-date and trained on the new vaccine products. Staff were also trained on internal processes and POD operations.

- Within the POD team, there were daily safety reports after each operational day that helped inform safety protocols. Changes were made as needed.

- There were on-going leadership meetings with all POD team leads (operations, staffing, logistics, etc.) that helped to inform everyday work in meeting objectives and adapting where needed. Discussions during these meetings identified existing resources, partnerships, contracts, and agreements to expand services.

Data Analysis: In addition to a daily report provided by the data science team, data was also compiled into a Situational Report that went out twice a week, providing key data covering multiple operational days. The continuous reports ensured the delivery of timely updates used to inform everyday operations to identify trends and make changes and adjustments as needed. For example, when the department looked at the vaccine breakdown by ages recently, trends of vaccination among those most in need and at risk were identified. This led to targeted outreach to the specific populations of 65+ and the newest eligibility age group of 6 months to 4 years. LACDPH continues to meet the objectives of ensuring accessibility to COVID-19 vaccinations, layering on additional public health services to respond to the needs of the local community, and serving as a trusted source to combat misinformation.

A county attempting to replicate this practice should plan for increased financial investment in personnel, utilize contracted vendors, and partner with public and private organizations to leverage existing spaces and staffing.  Utilizing contract staff and relying on vendors and partners enabled LACDPH to quickly downsize the POD operations as the demand decreased without the burden of managing assets that were no longer needed. Contracting temporary personnel and partnering with other avenues of employment also allowed LACDPH to quickly set up staffing needs at the PODs. For example, LACDPH utilized staff resources made available from the State of California MHOAC Program and hired contracted clinical and non-clinical registry staff to help support the PODs. The nature of fixed term employment allowed certain flexibilities as LACDPH staff roles changed to meet the evolving needs. LACDPH was able to shift priorities to address health inequities and respond to the communities' needs.  

One factor that increased buy-in from key stakeholders was having strong support from LACDPH leadership and building upon existing relationships. LACDPH's staunch internal advocates valued the work at the PODs, and this has been a key driver in being able to continue to extend supplemental services. It was important to foster the relationships with community partners, vendors, and other local departments that were also contributing to the operations. Regular updates were provided to key stakeholders with data to show the impact within the communities and reinforce the need for continued services. Due to high staff turnover rate of contracted workers, staffing the PODs is at times challenging.  A lesson learned includes having different personnel sources to ensure that adequate staffing is available. Utilization of the MHOAC Program enabled the ability to fill vacancies as needed. Internal LACDPH staff was also recruited to backfill certain positions by sending out a monthly survey to provide an opportunity to those interested in working at the PODs during the week or on weekends.

Existing partnerships and agreements made expanding services an achievable goal. The LACDPH partnership with LA County Department of Parks and Recreation and local cities provided a huge cost reduction in operations due to waived facility charges. Local health departments interested in adopting this practice should look at their options to utilize similar partnerships, whether it is through their county, through community partners, or through another outlet to access a location that will meet their program needs.

The LACDPH Communications Team developed outreach materials, online toolkits and resources, and advertisements for POD services in various languages to reach the ethnically diverse communities of Los Angeles County. The VOTG outreach strategy allowed LACDPH to connect with residents by having a regular presence in the community and by addressing concerns and common misconceptions about the vaccine. Participation in community events and extended POD hours to make POD services more accessible helped with community engagement. Integration of communities' feedback through voluntary satisfaction surveys, informed future improvements and adjustments on an on-going basis. The accessible services helped community members return and recommend the services to others.

The POD model is a foundational tool that can be leveraged and adapted for future public health emergencies. Other local health departments can build upon existing resources to transform PODs into trusted community hubs that address the needs of residents more broadly. Updating operations manuals, best practices, and process guides to rapidly deploy and implement PODs should be an on-going common practice. It is crucial to be strategic about identifying and establishing POD services to engender the trust and strengthen relationships with community members and partners.