Public Health Surge Vaccinator Program

Montgomery Township Health Department (MTHD), which also serves the boroughs of Hopewell, Pennington, and Rocky Hill, is a local health department in central New Jersey. We serve a population of nearly 27, 500 residents within Somerset and Mercer Counties. The demographic breakdown of our population is: 55.6% White, 38.5% Asian, 2.9% Black or African American, and 0.5% American Indian and Alaska Native. Our health department staff consists of 1 Health Officer, 1 Public Health Nurse, 1 Health Educator, 2 COVID-19 grant funded positions (outreach coordinator and generalist), 2 Registered Environmental Health Specialists, and 1 Animal Control Officer.

OVERVIEW

During the initial roll out of the COVID-19 vaccine and our continued efforts to vaccinate the populations we serve, the vaccinator capacity within our local health department staff and at the within the County Medical Reserve Corp was nowhere near enough to meet the demands of our community. As a result, MTHD has worked to expand its hyperlocal community team of surge vaccinators that includes physicians, nurses, pharmacists, dentists, and nursing students. The goal of this practice was to increase clinical surge capacity to address public health needs in our community. Our objectives were to increase membership in our surge vaccinator program;  increase the number of vaccination clinics offered within our community; increase the number of vaccinated individuals.

Activities implemented:

o   Developing a process to streamline recruiting

o   Offering paid positions at a reasonable rate

o   Targeted outreach to:

§  Elected and appointed officials

§  Professional associations

§  Community groups

o   Promoting this program at our vaccination clinics

With these activities, we have been able to increase our surge vaccinator membership to 24 members, which is a 118% increase from our pre-COVID-19 pandemic membership. This increased vaccinator capacity has allowed us to increase the number of vaccination clinics hosted by the health department throughout the year. It has also allowed us to bring pop-up vaccination clinics to high-needs areas in our community (e.g., long term care facilities, older adult housing, homebound residents, low-income housing, food pantry recipients, faith based organizations, restaurant workers, landscapers, schools). Since 2021, our health department has held on average 12 vaccination clinics a year. This increased vaccination capacity would not have been possible without the support of our hyperlocal team of surge vaccinators.

A specific factor that led to the success of this practice was recruiting surge vaccinators locally at our vaccination clinics as our community has a large number of healthcare providers and personnel. For those that expressed interested in becoming members of our program after attending one of our vaccination clinics, having an efficient intake process helped boost our membership numbers.

Overall, this model practice has allowed our health department to boost vaccinator capacity by identifying the issue at hand, get out into the community to provide a needed public health service.

The small number of healthcare personnel on staff at local health departments can make hosting regular vaccination clinics challenging without additional vaccinator support. Our model practice describes a program to boost surge vaccinator capacity at the hyperlocal level to meet the needs of our community. MTHD serves a population of about 27,500. With our Surge Vaccinator Program, we have administered 9,366 vaccines since 2020.

MTHD previously launched a successful W9 Surge Nursing initiative during H1N1 pandemic that focused on recruiting school nurses to respond during a public health emergency (i.e. Schools being the first place to close in an emergency frees nursing resources for a response). A similar approach was used during our COVID-19 response, with a focus on increasing surge vaccinator capacity to meet the demand for vaccinations in our community. To address health inequities in vaccine access, our health department conducted targeted outreach to underserved populations (e.g., landscapers, food workers, food pantry recipients, low-income housing renters, homebound residents). Our Surge Vaccinator Program increased our health department's capacity to bring the COVID-19 vaccine to these underserved populations, reducing barriers to vaccination.

The MTHD Surge Vaccinator Program is a creative use of the Mobilizing for Action through Planning and Partnerships (MAPP). A boots on the ground” approach was used for capacity building and strategic planning by utilizing the key underlying principles and six phases of MAPP processes. By planning and building a team of vaccinators that MTHD could mobilize during a time of need, MTHD not only positioned itself to manage the latest public health emergency and but also enabled us to be better prepared for future needs. This model practice allows local health departments to bring needed public health services to the community at a time when county resources (e.g., Medical Reserve Corp.) may not be as readily available. 

LHD & COMMUNITY COLLABORATION

The goal of our word of Vaccinator Program was to develop a hyperlocal grassroots group of vaccinators to increase and maintain capacity during a time of critical need.  MTHD has one full time public health nurse and vaccinator support from the county Medical Reserve Corps isn't always readily available. Our objectives were to increase membership in our Surge Vaccinator Program and increase the number of vaccination clinics offered within our community. To meet these objectives, MTHD took the following steps:

-        Developed a process to streamline recruiting and onboarding

o   Flyers were created and posted on the Township's website.

o   Messaging about the Surge Vaccinator Program was shared with elected and appointed officials, professional associations, community groups, and at vaccination clinics.

o   Application process and vaccinator just-in-time trainings were developed.

-        Offered paid positions at a reasonable rate.

-        Secured funding from grants to support this program.

MTHD's Surge Vaccinator Program has been an ongoing practice that has been revitalized during the COVID-19 pandemic. 

o Fostering collaboration started out with regular and timely communications. The Department's almost daily crisis communications calls morphed into weekly communications call with elected officials, board of health, township leadership, communications officer, law enforcement, office of emergency management and more. Information and requests by the Health Dept. on these calls played a major role in expanding solicitations for vaccinators as Montgomery Township has one of the highest per capita health care providers per square mile.

o Engaging a diverse Board of Health that is representative of the community, it serves, to refer qualified candidates to the vaccinator program that represent Montgomery Township.

o Utilizing a bilingual vulnerable populations outreach coordinator to assist the surge vaccinators in communicating with Spanish speaking recipients.

The goal of this practice was to increase clinical surge capacity to address public health needs in our community. Our objectives were to increase membership in our surge vaccinator program and increase the number of vaccination clinics offered within our community. Funding from the 2021-2022 Vaccine Supplemental Funding and Strengthening Local Public Health Grants administered by the New Jersey Department of Health were used to fund this program. The Department budgeted $25,480 for surge vaccinators with total expenditures rounding out at $19,114, plus $3,000 in In-Kind hours of Board of Health members who volunteered their time.

EVALUATION

Our Surge Vaccinator Program has met our goals and objectives. This program has successfully increased our clinical surge capacity to vaccinate the community during the COVID-19 pandemic. To evaluate our program, we used the total number of vaccination clinics held, number of vaccination clinics targeting underserved populations, and total number of vaccinations administered.

-        Objective: Increase membership in our surge vaccinator program:

o   We increased membership to 24 active surge vaccinators, an increase of 118% from our pre-COVID-19 pandemic numbers.

-        Objective: Increase the number of vaccination clinics offered within our community.

o   With these efforts, MTHD was able to regularly hold vaccination clinics and still continues to hold COVID-19 clinics 1-2 a month. Currently, MTHD has one full time public health nurse and creating surge vaccination program has allowed us to expand public health nursing capacity. Not only has the surge vaccination program been effective in for COVID-19, but it has also helped build the capacity of our flu vaccination outreach. In previous years, influenza clinics were only held 1-2 times per year. Through our surge vaccination surge program, that number has increased to 12 in 2020, 14 in 2021 and 15 in 2022.

-        Objective: Increase the number of vaccinated individuals

o   Data source: Total number of vaccines administered

§  Total vaccines administered since 2020: 9,366

§  2020: 477 (all influenza vaccine)

§  2021: 6,474 (6,116 COVID-19 vaccine, 358 influenza vaccine)

§  2022: 2,415 (2,001 COVID-19 vaccine, 414 influenza vaccine)

SUSTAINABILITY

The MTHD Surge Vaccinator Program is a sustainable resource that relies on local partners who can be more readily available to respond during public health emergencies. This model practice harnesses interest from local community members and allows the health department to expand services beyond what our health department staff would be able to do by itself. Many of the surge vaccinators within our program have been members for over a year and continue to provide support vaccinating our community. Having a pool of active surge vaccinators is financially sustainable, is more cost effective than using staffing agencies, and engages community members to bring public health services to their community.