Since Dec. 14, when the first doses of COVID-19 vaccine were distributed to frontline health care workers, the call to “get shots in arms” has been dutifully answered by Texas hospitals. On March 29, vaccine eligibility was expanded to all Texans age 16 and older, signaling the proverbial gauntlet against the pandemic and circulating COIVD-19 variants.
“Our goal is to get shots in arms quickly. Vaccine hubs enabled us to get large numbers of Texans vaccinated in a short amount of time” said Lara Anton, press officer at the Texas Department of State Health Services (DSHS).
Photo courtesy of UMC El Paso.
BANNER: COVID-19 vaccine recipients at the El Paso County Coliseum, hosted by UMC El Paso. Photo courtesy of UMC El Paso.
With the expanded vaccine eligibility, Texas hospitals and other vaccine providers had their next challenge in a year marked with unique public health challenges.
Mass Vaccine Hubs
In early January, when vaccine eligibility expanded to those in the 1B population, which consisted of people 65 and older and those with comorbidities, the need for large hubs to vaccinate many people as expeditiously as possible became apparent.
Texas hospitals were faced with a plethora of patients anxious to get the vaccine.
On Jan. 5, The Texas Hospital Association issued the following statement along with guidance on how to access the vaccine. “Vaccine availability still is in limited supply for the general public. Texas hospitals are eager to vaccinate as many people as possible as soon as possible. In addition to launching an unprecedented vaccination effort, hospitals are grappling with daily record-breaking COVID-19 hospitalizations and are fighting to save the lives of the sickest, most vulnerable Texans.”
On Jan. 10, the DSHS published its first list of 28 vaccine hub providers that were tasked with large community vaccination in their respective counties. This initial list contained 28 hub providers. At the time of this writing, the number of vaccine hubs in Texas has grown to 73 – 36 of which are maintained by hospitals and health systems. Other critical points of access include public health departments, fire departments, sheriff offices and pharmacies. Texas military teams have also been relied upon to help vaccinate areas of rural Texas.
During a recent interview with The Texas Tribune, Imelda Garcia, MPH, associate commissioner of laboratory and infectious disease services at DSHS and chair of the state’s COVID-19 Expert Vaccine Allocation Panel (EVAP) discussed the critical role vaccine hubs played during the early stages of the vaccine rollout.
“Our hubs have done exceptionally well. I think it was week five or six [of vaccine allocation] when we kicked that off. At the time, we had very little vaccine and we knew we needed to vaccinate large numbers of people quickly in order to help fight the virus, and they were very successful in doing that.”
At the time of this writing, Texas has administered 17.3 million doses of vaccine; 10.7 million Texans have received at least one dose of vaccine and 7.2 million Texans are fully vaccinated against COVID-19.
Staff from Memorial Hermann administering vaccine at a drive-thru vaccine clinic at NRG Park. Photo courtesy of Memorial Hermann.
Becoming a Hub
The appeal of becoming a mass vaccine hub is receiving a reoccurring allocation of COVID-19 vaccine, however, the reward doesn’t come without responsibility. Vaccine hubs must find the space and staff to host members of the community seeking vaccine and must also be willing to accept people from other communities.
Once a vaccine provider becomes a designated hub for their county, they must contend with the appreciable logistical challenges with vaccinating people at a mass scale. Memorial Hermann Health System became a vaccine hub for Harris County on Jan. 16 and administers approximately 3,300 vaccines per day. During large, drive-thru vaccination events, like the ones they host at NRG park, they can administer between 6,000-7,000 vaccines per day.
“The real challenge is to figure out how to operationalize vaccinating that many people because it doesn’t fit well into the regular workflow of patient care, says James McCarthy, M.D., executive vice president and chief physician executive at Memorial Hermann.
“We had to stand up a completely different infrastructure in areas that can bring in large volumes of people and process them very quickly. The first challenge was figuring out where we could do this, then it was figuring out how we could free up staff to staff these clinics. Then the third part was developing an automated system to register people quickly who may have never been our patient before, then have the data fields that would report back to the state for the state’s required reporting.”
St. Luke’s Health was included in the first list of vaccine hubs announced, and while they were excited for the opportunity to be a hub, getting it up and running amid a COVID-19 surge was a challenge.
“We were thrilled when we learned that we were going to be a vaccine hub,” recalls Liz Youngblood, FACHE, senior vice president and chief operating officer of the Texas division of St. Luke’s Health. “Then you really go into planning mode and think about how much extra staff and PPE you’ll need, and, at that time, COVID-19 hospitalizations were surging after the holidays. We were still able to get our vaccine hub operational one week ahead of schedule, which speaks to the amazing team we have.”
Some hospitals unknowingly spent the past year preparing for the challenges of being a vaccine hub. In March 2020, Parkland Health & Hospital System hosted one of the largest COVID-19 testing sites available to the public at the Ellis Davis Field House in Dallas County. Now, it has evolved into one of six vaccine hubs serving Dallas residents. During flu season, when public health officials feared a “twindemic” of influenza and COVID-19, the hospital system sprung to action by offering free flu shots in October to patients who were getting a COVID-19 test at Ellis Davis.
A drive-thru testing site operated by Parkland Health & Hospital System. Photo courtesy of Parkland Health & Hospital System.
Improving Health Equity Through Vaccine Distribution
As the state planned for the vaccine rollout, the effort to mitigate racial health disparities through vaccine education and vaccine accessibility became a focal point for hospitals and public health officials.
A November study conducted by the Pew Research Center showed that only 42% of Black Americans said they planned to get vaccinated, compared to 61% of white respondents. The projection painted a bleak outlook for communities that have already been disproportionately affected by COVID-19. Data from the Centers for Disease Control & Prevention showed that non-Hispanic Black people and Hispanic or Latino people were hospitalized at a rate 4.7 times higher than non-Hispanic white people.
In his chair speech during THA’s 2021 Annual Conference & Expo, Marc Boom, M.D., THA board chair and president and CEO of Houston Methodist made a point to address the imminent threat of further health disparities with the vaccine rollout.
“Even now with a COVID-19 vaccine available, the mistrust in medicine is deeply rooted in some minority groups and communities of color, further fueling skepticism about this new vaccine,” he said. “As we make progress in eradicating COVID-19, we must give special attention and consideration to these communities. We must listen to their concerns. We must be open to understanding the very real hesitancy people may feel about the vaccine. And we must be ready and willing to answer their questions and assuage their fears.”
Leaders like Dr. Boom at Houston Methodist recognized that many potential barriers to accessing the COVID-19 vaccine, such as language, lack of transportation or access to internet were going to make vaccine unattainable for those at highest risk of COVID-19 complications.
Pharmacy students and faculty at the Texas Southern vaccine hub. Photo courtesy of St. Luke’s Health.
The hospital system partnered with many organizations, such as historically Black fraternities and sororities, the Houston Food Bank and religious groups to help identify vaccine-eligible individuals who might otherwise be overlooked.
Other hospitals in the Houston area made a concerted effort to vaccinate marginalized communities that might otherwise have difficulty accessing the vaccine.
“Vulnerable communities are certainly an area we’ve made an effort to target,” says Dr. McCarthy. “Memorial Hermann utilized internal data to identify zip codes in Houston with the highest prevalence of COVID-19 infection and used targeted social media campaigns to help people in these socioeconomically disadvantaged areas register for a vaccine appointment.”
Memorial Hermann is also utilizing its three neighborhood health clinics to vaccinate nearby residents and their family members. Each of the three health clinics are located in disadvantaged parts of the city and typically provide low-cost care to uninsured patients in the community.
One of the vaccination hubs operated by Baylor St. Luke’s Health is located on the Texas Southern University campus in Houston. The university is one of the nation’s largest historically Black universities and has an upstanding reputation for serving its community – further legitimizing the COVID-19 vaccine to those who need it most. Since the Texas Southern site opened, 18,594 doses of the vaccine have been administered to 11,973 people that qualify under state criteria. More than 52% of those recipients are Black and approximately 26% are over the age of 65.
Vaccine providers gather during a vaccine clinic at St. Luke’s Woodlands Hospital. Photo courtesy of St. Luke’s Health.
Administering Hope and Relief
Everyone has a vaccine story. For many, the COVID-19 pandemic was the first public health crisis experienced first-hand. Unlike other viruses and illnesses, we witnessed the toll COVID-19 took on our state, country and world – making the experience of finally getting the vaccine a memorable one.
“I’ve been practicing medicine in Texas for 20 years, and this is the only time I’ve been thanked every time I stick someone with a needle,” Dr. McCarthy jokes.
In a recent social media post, Missy Herndon, whose son Will Herndon received the vaccine during a drive-thru clinic at St. Luke’s Woodlands Hospital in Montgomery County captioned her image saying, “Hello human kindness. I cannot think of a better slogan and more symbolic of our experience today thanks to St. Luke’s Health and Montgomery County Public Health. Our Will received his first vaccine and we are so grateful. Thank you to the entire crew who makes the monumental effort of vaccinating nearly 4,000 people a day on-site look like a breeze.”
Will Herndon receives a COVID-19 vaccine during a drive-thru event hosted at St Lukes Woodland Hospital. Photo courtesy of The Will Herndon Research Fund.
“Texas owes a debt of gratitude to all of our Texas hospitals and vaccine providers that dutifully cared for Texans amid the COVID-19 pandemic, says Ted Shaw, THA president and CEO. “And they further contributed to ending the pandemic by vaccinating as many Texans as possible. The best way Texans can recognize and thank our state’s health care providers is by getting vaccinated.”
The experience has been memorable for patients and providers alike. For vaccine recipients, getting the shot symbolizes protection. For vaccine providers, giving the shot to thousands of patients every day is a tangibly gratifying experience for those who’ve dedicated their careers to caring for others.
“Watching the hope and relief of our patients coming through these lines to be vaccinated has been incredibly rewarding,” says Dr. McCarthy. “And the folks we have that are volunteering to work all these vaccine sites tell us this is some of the most gratifying work they’ve ever done in health care because of how happy and grateful everyone is.”