This week’s discussion is about COVID-19 vaccine allocation and distribution at the local level. Sam Jarvis from Johnson County (Iowa) Public Health talks about the distribution plan and the process used to arrive at it along with how it fits in with overall emergency preparedness.

Megan Pospisil:

Hello, everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Megan Pospisil, and I’m joined today by Alex Murra and Emma Meador. If this is your first time with us, welcome. We are a student-run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and out of the field of public health.

Megan Pospisil:

Today, we’ll be chatting with Sam Jarvis, who is the community health division manager for Johnson County Public Health. In this role, Sam coordinates with different healthcare providers, hospitals, and emergency service agencies to prepare for the unexpected. He earned his MS in public health at Western Illinois University, and today he’s here with us to discuss the current distribution plans for the COVID-19 vaccines in Johnson County, Iowa. Welcome to the show, Sam.

Sam Jarvis:

Hey, thanks for having me.

Alex Murra:

To start us off, could you tell us about how you ended up in public health and what your role is at Johnson County Public Health?

Sam Jarvis:

Yeah, absolutely. Long story short, it was by complete accident. I originally, an undergrad, was thinking pre-med, had a really amazing opportunity to be an EMT for a short while, and to realize that I did not want to touch patients anymore. And so public health was [inaudible 00:01:20] and so it made a lot of sense. Initially, in grad school in health ed, communication kind of coursework, but then was able to really jump into the field of emergency management and really enjoyed that.

Sam Jarvis:

So one of my first jobs in public health was emergency preparedness. It’s really paid off because it’s an emerging field. It’s really necessary because we continue to see disasters, disease outbreaks and other things happen, it seems like more frequently, which is kind of unfortunate. But business is booming, I guess you could say.

Sam Jarvis:

How I came to Johnson County Public Health, my spouse is a resident at the University of Iowa Hospital and Clinics. So actually today is match day. And so I know a lot of med students are celebrating today. They found out where they’re going. And so this time three years ago, my spouse and I were celebrating that and found out that we’re coming to the University of Iowa. Really exciting and really happy and feel very fortunate to have been able to be hired by Johnson County Public Health.

Sam Jarvis:

When I first started here, I was their emergency preparedness planner. And so I was able to meet a lot of our partners that we’re working with right now for COVID vaccine disease investigations, but also vaccine planning. So right time, right place or maybe wrong time, wrong place. However you want to look at it, but I try to be optimistic about it.

Emma Meador:

And going off your role with emergency preparedness and response, what has it been like working in public health, especially overseeing the community health division in the past year?

Sam Jarvis:

It’s been phenomenal, despite the fact that it’s pandemic. I think the silver lining is the fact that Johnson County, our community here, has a lot of amazing partners and a lot of persons who are willing to help out and collaborate. And so despite pandemic sized problems, we create pandemic sized solutions. And so really having been able to meet so many partners, even individuals throughout the entire pandemic, a lot of the partners are agencies that we work with normally throughout other programs, whether it’s with our health educators or disease investigators or folks in our clinical services division, or even environmental health. It’s just a lot of meeting folks and working together. So it’s been really wonderful to have that support because we know that’s not the case in other communities. We often hear stories of other counties in Iowa and across the nation, other states and things. And we know others don’t get as much support as we do here in Johnson County.

Megan Pospisil:

Yeah, definitely. That’s super awesome that you have a very different kind of population than other places without large hospitals, but yeah. Okay. So how do public health or emergency planners decide who gets the vaccine first?

Sam Jarvis:

Oh, that’s a great question. So that’s the toughest question overall, right? Especially when vaccine is so scarce, but we’re pretty fortunate. And certainly there’s the ACIP, or the Advisory Committee of Immunization Practices, that did a lot of heavy lifting along with a lot of other bioethicists. And they really looked at what would be the most benefit and most fair, most equitable way. And they’ve really created a framework. There’s actually a 230 page document that one can read through and it really walks through their thought process. I attempted to do so I got fairly far through it, but then shortly after, the CDC produced a MMWR that was five pages. And that’s just a lot more appealing right now, given the fact that things move quickly and time is of the essence.

Sam Jarvis:

So that really set a great framework for states to go off of and really look at a framework that could be, we’ll say, standardized across the nation. Most states like Iowa stood up a infectious disease advisory council. And so ours in the state of Iowa then took those recommendations and applied them to the state. And so that really helped us answer the toughest question of who gets vaccinated first. For the most part, they’re substantially similar to other states. We saw healthcare workers and long-term care staff or residents get vaccinated first. And that makes sense. Our health care system we saw throughout here and other places surges in cases, lots of patients directly COVID related. Those who are in the ICU, certainly ventilators and things like that we saw on the news, not just here but nationwide. I’ve certainly saw a lot of morbidity and mortality in long-term care facilities specifically because there are skilled nursing facilities where folks are a bit more fragile, but they also have a lot of underlying conditions because of their age and other things.

Sam Jarvis:

So after that, we began to see some deviation that other states were doing, some went through and they had critical infrastructure and they listed out specific occupations. Others did not go as far. So really, we took those and implemented that here in Johnson County as best we could. There were those recommendations and really the shortage order, which is signed into law where we follow those through as best as possible.

Alex Murra:

That’s really interesting to hear about how we can take these national plans and then trying to adapt them to our state or even our County level. So we’re wondering if there’s any special demographic characteristics of Johnson County that you guys had to account for when trying to figure out the distribution plans? Example is that we have a pretty high healthcare population with UIHC being here. So what made it unique in that way?

Sam Jarvis:

That’s a great example. So initially one really, when we think of just phase 1A. We brought a huge healthcare population, I think the second largest to Polk, which makes sense because they’re the largest County. But we have a fairly population dense healthcare workforce here because of places like UIHC, the VA and Mercy, but there’s so many other health care providers here too. And as you can imagine, there’s a lot of other private practices and things. And so as we were looking at that and really trying to stay true to as strictly as possible to healthcare workers, we knew that we had, we’ll say for lack of a better term, a larger denominator than other counties.

Sam Jarvis:

And one of the other things that was really unique about Johnson County was the fact that you can look at license of healthcare workers and that’s typically related to their place of residence. So how many folks live in other counties around Johnson County, but they work here? And so if you looked at that solely, you would see larger healthcare populations in different counties than Johnson County. And so that was a discrepancy that staff here noted pretty quickly and we even touched base with other health departments and they noted that as well. So we certainly sent those concerns or other kinds of things that we were seeing to the state. And they noted that and recognized that there’s sort of a commuter effect. So that was one thing that we saw early on.

Sam Jarvis:

The other portion is certainly looking at different counties here in Johnson County and older adults, and just recognizing a larger population. We have more folks in those categories, whether it’s by age or anything else. So we continue to kind of see different, unique things as time goes on as well, too.

Emma Meador:

So going off of that, what kind of data, if any, is Johnson collecting regarding this new vaccine?

Sam Jarvis:

In terms of the vaccine and its effects, we’re not really looking at that, but certainly we’re keeping track of more of the logistics of us allocating and things like that. We certainly rely on our state and federal partners to really help us wade through the waters of how effective it is. Certainly I think many have seen the news with the CDC noting that if you’ve been fully vaccinated, so two weeks post either your second dose or a single dose, if it’s a Johnson & Johnson, what you’re able to do. And many folks are pretty excited about that, because that means getting a little bit closer with friends and family and not having to wear a mask.

Sam Jarvis:

But really what we’re looking at, we’re more on the back end of things. So a lot of the logistics and allocation, it’s a numbers game. It’s a lot of communicating with partners and trying to sub-prioritize persons in those tiered occupations. And so we’re having a lot of conversations with employers to really line up the exact amount of doses for the persons that we’ve really deemed eligible by the shortage order and then certainly at high risks. So we’re pretty fortunate that we’ve actually really not given a vaccination ourselves onsite, but we really coordinated a lot of our partners. So that’s been a huge benefit as well, too.

Megan Pospisil:

Cool. Thanks for sharing that with us. So our next question is, what are some unforeseen challenges that Johnson County has run into with the rollout of the COVID-19 vaccine?

Sam Jarvis:

Some of the unforeseen things are really just how quickly and rapidly information changes. Again, we’ve seen variety of the eligibility changes pretty quickly. Those are things that even the slightest bit of change really does affect our thinking. And a good example is before we approach phase 1B initially on, it was 75 and older. And so we had rough estimates of how many folks that might be.

Sam Jarvis:

And so really when we think of our distribution plan, we were trying to think of ways that we can make sites more accessible and a lot easier for those who are 75 and older, but then the change with adding 65 and older, really from what we know, doubled the demand across the state, but it did not increase the supply at all. So as you can imagine, that posed a lot of different issues. And really we had to think of different ways to be able to meet that set population without wanting to have long lines. This was also really early on in February. So we were dealing with inclement weather so we don’t want folks waiting outside. It’s primarily older adults with icy weather and things like that. So really even the slightest thing, it can really change a lot of our thinking.

Sam Jarvis:

In terms of other unforeseen things, really it relates back to supply. Again, it doesn’t sound as exciting, but when we talk about the logistics of it, really that’s a key piece that we focus on. So Pfizer comes into, they call them flats of originally, it was 975, then due to some really clever pharmacists, they recognized if you use certain needles, they’re lower volume in the needle until you’re able to get a sixth dose. And so now it’s technically 1,170. Then Moderna comes in boxes of 100. And so we’re really trying to do our best to line it up and not break those up because the other part of this really complex logistical kind of puzzle is we have to also remember where we allocated doses for those second doses.

Sam Jarvis:

And so that’s one of the benefits the state health department has helped us with, is ensuring that anyone who gets vaccinated with their first dose, as long as we kind of follow our recipe of where we’ve been, we can ensure folks that they’re getting their second doses, which is pretty important. That’s how the study was completed. That’s how we can really provide the most benefit out of vaccinations.

Alex Murra:

Going off of this recurring theme of the complexities of the logistics of rollout of the vaccine and even the constant changing information, I think a lot of Iowans and even just people around the country are struggling to figure out how do they even schedule a vaccine appointment. So is there some type of centralized vaccine appointment scheduling tool that individuals can access? And what are some ways that Johnson County is trying to make sure that this information is disseminated in a meaningful and accessible format?

Sam Jarvis:

Yeah, that’s a great question. Originally when we started this out, we wanted to avoid having one centralized list. We saw a lot of complaints from other states and I think the hindsight is 20/20. If you had a list, people didn’t like it. If you don’t have a list, people don’t like that either. So you always kind of hear those comparisons, but the reason why we chose not to have one centralized signup list is because, one, we’d be handling a lot of information. And two, keeping that list up to date would have been very burdensome.

Sam Jarvis:

And so what we’ve asked our partners to do, kind of thinking of how we allocate in our distribution plan, we’ve asked our hospital partners to help us with individuals and really focus on those who are older. And we’ve asked them to really proactively call folks instead of just solely relying on online signatures. And so they really stepped up and they’ve asked, they pulled staff from their regular job duties to do that for us. So we’re really grateful to UIHC and Mercy for doing that. I mean, they could have said, “No” and said, “We don’t have time. People can just get it how they can.” But they stepped up and they’re doing that.

Sam Jarvis:

Other ways that whether we know at least right now thinking back with our older adult population, when we’re planning kind of other offsite clinics or different clinics for across the County, we’ve had volunteers step up. And they say, “We’ll help call folks. We work with these populations that don’t have internet access or would have difficulty navigating an online scheduler.” They’ve called them and they’ve assisted them to sign up and make sure that they can get an appointment before we announced the clinic publicly. So really it’s a strategy to kind of front load that schedule to get those folks in first. So we’ve seen a lot of benefit to that.

Sam Jarvis:

And then we’ve got a lot of other irons in the fire right now, working with how we can address home bound folks, certainly others who are non-English-speaking, those who are working during the day. They don’t have time to take off work or they aren’t afforded the ability to take sick time because it’s not offered to them to get an appointment during the day. So it’s always a battle and issue with access, but now it’s been so much quickly so much more because supply. We’re really trying to fit in as many folks as possible every week we get an allocation.

Emma Meador:

So a question I have been hearing a lot of students ask is, “When can I get the vaccine?” or, “When you think I’ll be able to get the vaccine?” What can you tell us about how the vaccine rollout might look for us UI students?

Sam Jarvis:

Yeah. So if you would have asked that a month ago or even at the beginning, I would have said maybe in the summer, because even for ourselves, we thought we might not get vaccinated, thinking that those 65 and older would take quite a while, especially knowing that the supply could be very limited. But from what we’re told, the state had noted that if supply increases dramatically and they’re projecting by April 5th, every Iowan would be eligible. And so it really it’s based off of age, 16 years and older for Pfizer, 18 years and older for Moderna and Johnson & Johnson. So it can be sooner than what many people think about.

Megan Pospisil:

Yeah. I thought that was really interesting too. This is kind of leading into our next question, how vaccine availability has occurred. But have you observed more hesitancy from the general public in opting to receive this vaccine? And do you think that’s why more people have become eligible so soon?

Sam Jarvis:

That’s a good question. So we believe that that might be the case with opening up eligibility. Initially on obviously December, January, demand was so high. We only heard from people who wanted to get vaccine because there was hardly any vaccine coming in. And so I think as progress and time goes on, we’ll take care of those folks, right? The high demand, the early adopters, people who got vaccinated now, they’ll be vaccinated. They’ll be, we’ll say for lack of better term, out of the way. And then we’ll start to really see the portion of the population that says, “Well, I’m not really sure, or maybe I’ll wait.” or, “I’m not getting it.” And so then, we can really start to address that.

Sam Jarvis:

And so this first part of the vaccine campaign is getting the folks who want it. The next part will be trying to get folks who don’t want it to get vaccinated. So we’re starting to hear a bit more about hesitancy and some concerns. Doing your best to try and address those misinformation and just kind of flat out wrong information. It’s not a microchip or things like that. So I think as time goes on, we’ll have another kind of a pandemic sized problem to address and that’ll be hesitancy, because really the goal is to get everyone vaccinated. We know that there’s a handful of folks that will definitely not do it at all. And there’s some that if they had a little bit more information, we can get them there. That’ll be our next kind of battle.

Megan Pospisil:

Yeah. I feel like that’s always part of the public health battle is educating people and making sure that you’re not just increasing disparity by educating only people that you can reach or just, yeah. It’s definitely an ongoing public health challenge, but okay. Our last question for you is, what is one thing you thought you knew, but were later wrong about? And it doesn’t have to be with regards to COVID-19.

Sam Jarvis:

I was going to say, in regards to COVID-19, so many things. Really just, again, hindsight. Things happen and change so quickly, really just to pivot and be pretty nimble. But I think the one that probably sticks out the most, and this was pretty much everyone in public health, it was masks. For the longest time, there was just a lot of confusion about you don’t need to wear a mask or don’t wear a medical mask because save that for hospital surgeons. And then April comes along and then it’s like, “Nope, nope. Everyone needs to wear a mask all the time and everything.” And so really that was a huge lesson learned, especially how to communicate that change too. It changed so quickly. And there are certainly a lot of researchers and other folks and countries that were doing that already. And they’re probably looking over here and thinking, “Why are you not doing the thing that you need to do right now?” And so that’s probably the one that sticks out the most.

Megan Pospisil:

Cool, okay. Well, I think that that’s all we have for you. Alex and Emma, do you have anything to add?

Emma Meador:

Just thank you so much for taking the time to speak with us and answer these questions. I think everything that Johnson County Public Health and just the field of public health in general is doing is just amazing. And your work does not go unappreciated. So just thank you so much.

Sam Jarvis:

Yeah, I appreciate it. And appreciate you guys reaching out to us. Again, it’s wonderful to be on team public health, during a pandemic. Really, we’re grateful for our partnerships. We’re grateful to be able to have the opportunity to serve, but I think for the most part, it’s just been in terms of a profession to be noticed, seen, even scrutinized. People know more about public health than they ever have before. So it’s been exciting to be a part of all of this.

Megan Pospisil:

For sure. All right. Well, thanks again for taking the time to come and talk with us. We really appreciate it.

Megan Pospisil:

That’s it for our episode this week. Again, thank you to Sam Jarvis. This episode was hosted and written by Megan Pospisil, Alex Murra and Emma Meador, edited and produced by Alexis Clark. You can find out more about the Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Music and SoundCloud. If you enjoyed this episode, please share it with your colleagues. Our team can be reached at cph-graduateambassador@uiowa.edu. From the Front Row is sponsored by the University of Iowa College of Public Health. Thanks, and keep healthy.