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Commentary

COVID-19 Vaccination: Forging a Path Through the Pandemic

The COVID-19 pandemic has presented a unique set of challenges to the medical community and amplified preexisting issues in this new context. VHA’s response to the pandemic provides foundational experience on which to build future public health efforts and offers an opportunity to examine lingering questions as we work toward both slowing the pandemic and finding new norms of service and care. VHA’s success in COVID-19 vaccination is a result of comprehensive efforts of leadership and staff at every level, as depicted in the figure below.

An Effective Communications Network

The efficiency of VHA’s COVID-19 vaccination efforts relied in large part upon its communication channels. External and internal communications between all levels of leadership and staff focused on transparency, with daily national VHA leadership briefings regarding vaccine administration. VHA held mandatory vaccine administration tabletop exercises across all sites to ensure that information on vaccines, including anticipated challenges, was accessible, and to maximize strategic planning and collaboration. VHA leveraged its strengths as the largest integrated health care system in the nation via collaboration and frequent contact between vaccine coordinators across VHA and regular national presentations to broad audiences including operations, clinical leadership, and staff. These meetings and presentations promoted information sharing and dialogue. 

Resource Development

VHA developed a vast catalogue of resources to effectively educate staff, Veterans, and other stakeholders about COVID-19 vaccination. These tools and documents were tailored to ensure accessibility and comprehensiveness and utilized both electronic and physical media. Notable resources include VA-specific facility guides for vaccine coordinators, toolkits tailored to African American, Latino, Asian, Pacific Islander, and American Indian Alaska Native populations, professionally designed template materials for internal and external distribution and weekly updates on federal partners such as the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). Materials were stored and distributed digitally via a national COVID-19 Vaccine SharePoint database and supplemented by a Microsoft Teams venue for vaccine coordinators to engage with peers and share information.

Dynamic Quality Improvement

The scope of the COVID-19 vaccination effort required VHA to create new systems of information gathering and sharing. This included externally-facing resources, such as an online tool to track Veteran interest in vaccination, and operational resources, including an outreach tool for facilities to identify Veterans in accordance with risk stratification principles. VHA developed informatics solutions both to accurately capture and track data and to efficiently transmit information to the CDC. The vaccine planning team worked with the Office of Patient Safety to anticipate potential issues in vaccine administration, develop appropriate mitigation strategies, and promote open communication with the field to address and highlight challenges as they arose. VHA leveraged informatics to track its progress and to facilitate ongoing quality improvement while building its vaccination efforts across VA. VHA also shared its vaccination progress through external and internal channels to help inform leaders and stakeholders at all levels.

Focus on Maximizing Access

The concept of maximizing access served as an underlying principle that drove VHA’s vaccine planning. VHA developed transportation guidance to maximize the reach of available vaccines within strict cold-chain storage and handling requirements. Sites across VHA displayed both creativity and flexibility in reaching Veterans in remote and rural areas. Local leaders determined best approaches, with strategies including drive through vaccination clinics, use of Mobile Vet Centers, and even a fixed-wing plane to deliver vaccine to some rural sites. Vaccine coordinators also shared best practices with peers across VA. Beyond simply expanding geographic reach, VHA chose to also expand eligibility. VHA granted vaccine eligibility to Veteran Family Caregivers under the Program of Comprehensive Assistance for Family Caregivers to help Veterans maintain their health and standard of living during the COVID-19 pandemic. On March 24, 2021, the SAVE LIVES Act expanded legal authority for VHA to offer vaccine to additional Veterans, their spouses, and caregivers, and VA quickly moved to broaden vaccination further.

Focus on Health Equity

The COVID-19 pandemic amplified preexisting inequities in health care, with some racial and ethnic minority groups experiencing a disproportionate burden of morbidity and mortality, and with surveys revealing lower levels of vaccine acceptance among rural and minority populations. VHA focused on accounting for and correcting potential inequities within its scope of influence. Outreach, communications, and risk stratification considered needs of populations historically underserved in health care and most at risk from COVID-19 infection. Along with established relationships and trust between Veterans and VA, this approach contributed to the lack of racial and ethnic disparities in COVID-19 vaccination rates within VA. Throughout COVID-19 vaccination, VA tracked vaccination progress among key populations and addressed evolving barriers to vaccination quickly. For example, VA noted higher refusal rates and lower vaccination rates among rural Veterans and is currently working to address potential contributors such as ease of access, particularly as recent authorization of vaccines with more favorable transportation options allows more flexible distribution.

Looking Forward

As we continue forward with COVID-19 vaccination, we face additional challenges beyond physical access to vaccine. The next step in stemming the tide of the COVID-19 pandemic via vaccination is more complex than supply and demand. Having provided access to vaccine, we now must continue to help Veterans reach the decision to be vaccinated.

Even before COVID-19, many of us in VHA worked to address barriers to vaccine acceptance, which have become an increasingly important public health threat over the past several years. This mission has become more critical as the COVID-19 vaccine is an intervention with rapid returns in saving lives of Veterans, colleagues, and neighbors as well as in changing the way we live our daily lives. Newer virus variants with ability to spread COVID-19 more efficiently not only raise the threshold for community (herd) immunity but also place us in a race between speed of vaccination and speed of spread of variant virus.

Scientists continue to work to anticipate and defend against the virus as it changes, and the remarkable advances of the past year allow us a path through the COVID-19 pandemic to our new normal. VA is working hard to build on the trust that we have developed with the Veterans we serve, and to maximize transparency and sharing of information, so that Veterans have the information they need to understand how COVID-19 vaccine can protect them, their families, and their communities. We are grateful for the tireless work of our teams across VA in bringing vaccine to our Veterans and staff, answering questions and hearing concerns. We are also grateful to those Veterans, staff, and civilians who have come forward to be vaccinated. Their choice to receive the vaccine will help us fight our way through the COVID-19 pandemic together.