Authors: Elizabeth Dunn, MPH, CPH & Maria Paula Ibarcena Woll
The University of South Florida Community Emergency Response Team (CERT) program has been fortunate to support the Hillsborough County COVID-19 Vaccination Points of Dispensing (POD)areas. PODs are community locations in which the state and local agencies dispense Medical Countermeasures (MCM), such as the COVID-19 vaccine, used to effectively prevent and mitigate adverse health effects of a public health emergency (Center for Disease Control and Prevention [CDC], 2020).
“In a time of need, the COVID vaccination sites allowed the community members such as USF CERT to rally and give a helping hand to the frontline workers who had been putting in efforts since the beginning to fight the pandemic.” - Maura Gongora.
Reviewing existing plans and updating them accordingly to meet the needs of the COVID-19 pandemic was done across the Hillsborough County Public Health Preparedness team at the Florida Department of Health in collaboration with the Hillsborough County Office of Emergency Management. Once the planning and logistics were taken into consideration, those plans then needed to be tested. USF CERT was invited to help test both the process of the POD and help test the online scheduling tool prior to the first vaccines becoming available to the public.
Influenza Vaccination POD at King High School
In early December 2020, the Hillsborough County Office of Emergency Management, in partnership with the Florida Department of Health, organized an Influenza (commonly referred to as “The Flu”) Vaccination POD at King High School. CERT members were invited to run through how the POD would operate and practice each step of the process. “The flu vaccine POD was useful for us to have a practical hands-on exercise and further perspective on what was to be expected operational-wise for the COVID-19 vaccination PODs,” shares Maria Paula Woll, our USF CERT Health & Medical Director.
Images: In December 2020, CERT volunteers collaborate with FDOH and Hillsborough County Office of Emergency Management at the King High School Influenza Vaccination POD to walk through a similar process that the COVID-19 Vaccination will be administered starting early 2021.
CERT members were able to shadow a Florida Department of Health or Office of Emergency Management employee to learn each step of the process and be able to ask questions. This allowed them to look at ways to strengthen the existing procedures and determine what roles would be most ideal for CERT members along with determining the type of training needed.
Pre-POD Activation Scheduling Test Run
Before the online registration system opening up, CERT members assisted the county in a test run in an attempt to overwhelm the system and fix any glitches that may come up in the registration process. Since some of our CERT members are also fluent in Spanish, we could test both the English and Spanish system options. Our USF CERT Health and Medical Director, Maria Paula Woll is Peruvian and shared her experience and thoughts about the Pre-POD Activation Test Run, "I made two calls, one in English and the other Spanish, which happens to be my first language. It seemed very important to me to try and have a bilingual system even more with the largely Hispanic and Latino population in Florida."
COVID-19 Vaccination PODs Site Locations & Design
In January 2021, CERT members were asked to support four COVID-19 vaccination PODs to help work through the challenges and help in areas of need. “CERT was able to bring rapid, local response to POD sites with volunteers who had an understanding of public health protocols and with the dedication towards helping the community,” states CERT member Quemi “Mimi” Cao.
CERT volunteers dedicated approximately 206 hours of service to the vaccination PODs. Over the course of three weeks, 18 CERT members signed up to work at the COVID-19 Vaccination PODs across four locations. These selected site locations included the University Area Mall on East Fowler Ave, Ed Radice Sports Complex near Citrus Park, Strawberry Festival Fair Grounds in Plant City, and Vance Vogel Sports Complex in South County near Gibsonton. Mimi goes on to share how “volunteering for the PODs offered a lot of insight on how vaccination programs work during a pandemic. As someone who's focusing on a career in epidemiology, it's good to have this kind of experience to bring to the table when considering options and understanding vulnerabilities.”
Point of Dispensing (POD) design and the site plans are different from one location to another with distinct functional stations, but all are planned so that the public can safely move through the POD to receive their vaccine. The initial logistics and process for vaccine dispensation changed over time. Because each site was structurally different in its layout and surrounding communities, it required emergency managers and health personnel to adapt and improve each process to increase efficiency based on the area the POD was operating. One consistent among all POD’s was the CDC protocols regarding vaccination and social distancing and having individuals remaining inside a vehicle while in line through the whole process.
For example, University Mall served as a vertical POD. They utilized the on-site parking garage to filter cars into the vaccine’s initial screening and administration area. When vehicles entered the parking garage, they were sent to the third floor and then funneled down to the second level, where the health team was in position at 12 stations to vaccinate those with an appointment. Once they received the vaccine, the personnel would then direct them out of the parking garage. On the other hand, the Ed Radice Sports Complex POD was set up on ground-level as an open POD where patients are directed on-site through a series of lines toward four stations. This was a much smaller operation in comparison to the University Mall.
Image: COVID-19 Vaccination POD at Ed Radice Sports Complex in Hillsborough County.
COVID-19 Vaccination POD Operations
When deploying to a POD, it is essential to respect the privacy and maintain the confidentiality of every person being served. Upon arrival, CERT members are provided personal protective equipment (PPE). The PPE included hand sanitizer, masks, and a volunteer vest. General CDC guidelines and safety protocols are in place across all of the PODs.
Once geared up, CERT members receive on-site training relevant to what they will be assisting with, such as working alongside healthcare workers or helping law enforcement. After getting placed at a station, CERT members were able to support in various roles, including traffic control and direction, temperature screening, data processing, examining paperwork, and assisting nurses. Maura Gongora, CERT member and USF graduate student shared, “to come alongside healthcare workers and peers to fill in the gap was a truly rewarding experience, especially because we all shared a common goal: To promote public health in our community.”
Image: CERT volunteer directing traffic at a Hillsborough County COVID-19 vaccination site.
Points of Dispensing Process for those with Appointments
CERT members were able to learn the process for mass distribution of vaccines at the PODs through hands-on application. Maria Paula Ibarcena-Woll, USF CERT’s Health & Medical Director, shares how “setting up the POD is vital for ensuring there is an efficient process for conducting prior health assessments for patients and optimal workflow.” Confirming the patient’s identity and the appointment for the day and time to receive the vaccine was essential, especially as vaccines first became available. They would then have their temperatures checked and asked questions about pre-existing conditions. If cleared, they would continue to the next POD station. If there was speculation that the individual had contracted or had been exposed to COVID-19 prior to receiving their vaccine, they were asked to reschedule their appointment for a later day.
“Responding to one of the most important public health efforts of the century went beyond getting people vaccinated. Being at the service of the community implies building trust and competence in operations, which will shape the community's experience, leading to an impact on the long term outcomes of the intervention and providing key insights in the ongoing evaluation for the continuous response. “ - Maria Paula Ibarcena-Woll.
Once the patient has been cleared from the medical assessment area, they go through a secondary screening process where they are asked to complete their vaccination forms or to provide their forms that were completed before their arrival. After a few weeks, it was determined that this process led to longer wait times and increased traffic in the surrounding areas due to improper completion of forms or the time it took to complete the paper forms. POD staff then shifted to a system that streamlined the process by allowing individuals to complete their paperwork on-site using an iPad. Once complete, staff would check these forms for existing allergies and any relevant medical condition that could provoke any health complication. This is designed to ensure it is safe for the individual to receive the vaccine.
Image: Health and Medical Director, Maria Paula Ibarcena Woll, posing at a COVID-19 vaccination POD during her volunteer shift with USF CERT.
The next step in the process is for the patient to receive the vaccine from a certified clinician authorized to administer vaccines. Once the individual has been vaccinated, they move on to the public health education area,receiving information about the vaccine and their vaccination card. They then set up a secondary appointment to schedule their second dose of either the Pfizer-bioNtech or Moderna Vaccine, which requires them to return respectively in 21 and 28 days. Patients are then monitored for adverse side effects for either 15 or 30 minutes before leaving the POD. The time varies depending on if the patient has any relevant allergies. After that process, the patient is good to go and expected to return to their already scheduled second appointment at the same POD unless administered the Johnson & Johnson vaccine since this requires one dose.
Image: Vaccines ready to be administered by clinicians at the University Area POD.
CERT members shared their experiences and worked with planners to share some of the challenges they identified in the process. This allowed them to provide continuous feedback designed to help identify strategies to streamline the process or enhance efficiency especially pertaining to traffic flows, communication, volunteer assignments, and training, existing gaps that may exist, or addressing complaints that the staffing might have about the process.
Community Partners and Staffing
The Hillsborough County Office of Emergency Management (OEM) has taken the lead in developing the plans and setting up the Hillsborough County PODs designed to vaccinate 1,000 people per day. A handful of mobile units were deployed for various missions in Hillsborough County. This operation requires a large volume of health and emergency management professionals who were mobilized to reach not only the large communities of the county but also to be able to provide immunizations in smaller and more isolated areas. Three teams focused on carrying out mobile vaccination events that could inoculate 600 people, and in turn, other smaller teams were assigned to missions in confined communities. Additionally,to the Open POD locations. The county hired a contractor to help support their small team to help manage the PODs alongside Hillsborough County. The Florida Department of Health and local law enforcement also assisted in ensuring all operations run smoothly.
In addition, the OEM reached out to the CERTs across Hillsborough County to engage members and help provide additional assistance at the vaccination sites. Jay Rajyaguru, Hillsborough County COVID-19 Vaccination Task Force Lead, shares how the Palm River POD response was a great mission for the USF CERT. Jay shared how “it truly was a gap in an underserved area where USF CERT was called on and responded in real-time to support the State vaccine unit and provide critical translation services to the people there. Without USF CERT, that mission would not have been anywhere near as successful as it was.”
Veronica Soler-Torres, USF CERT Co-Deputy Director, assisted the front-line workers at the Palm River mobile POD to help translate in this majority Spanish-speaking community where many could not read or write. She shared how “there were a lot of people nervous and frustrated about not being able to speak to someone about their concerns before I arrived. I had to act as a mediator. As we discussed what made them nervous, I was able to translate these concerns to the nurses and get them answers." Soler-Torres goes on to share, "this was a proud moment for me to serve as a voice for both the community members and for public health. Being able to provide aid to help vaccinate our underserved populations.”
Image: USF CERT Co-Deputy Director, Veronica Soler-Torres, assists with Spanish translation at a mobile POD in Hillsborough County.
USF CERT Director, Elizabeth Dunn, states, “this has proven to be a valuable service to our community as we were able to address a need; however, this was also a remarkable opportunity for our CERT members. An opportunity for them to practice working as a team and provide support when the need arose.” Ms. Soler-Torres adds that “during the pandemic, we all have to do our part to ensure each other’s safety, and I am honored I was able to help in such a crucial way.”
State and Federal-supported Points of Dispensing
Soon after its activation in January 2021, the University Area Mall transitioned to a State-run vaccination site, relieving some pressure from local government officials. The Florida National Guard has been a supporting agency for that site location since it transitioned to the state. Unfortunately, the demand and number of vehicles in the area led to major traffic issues on Fowler Avenue and in the surrounding areas of the University Mall. After a few weeks, the state decided to move the vaccination site to Raymond James Stadium, where the COVID-19 testing was previously operating while moving the testing location to the mall. Since the start of 2021 and the release of the vaccine, the number of people getting tested has dropped substantially.
The state has been able to provide support with a mobile unit that goes into different neighborhoods with the aim of vaccinating 250 people per day. Each day this mobile site is moved to a new location-based on areas with low vaccination rates and high social vulnerability.
Then, in March 2021, Tampa was selected as a location for a federally supported distribution site where a Community Vaccination Center (CVC) led by the Federal Emergency Management Agency (FEMA) would be able to vaccinate about 2,000 - 3,000 people per day. This site location opened up at the Tampa Greyhound Track in Sulphur Springs. This site accepts walk-ups if you can't schedule an appointment ahead of time which is instrumental in providing an option for those without internet access or a vehicle. The Community Vaccination Centers Playbook provides guidance for these federally supported sites, including interagency coordination, resource support, facility setup, and other requirements (Federal Emergency Management Agency [FEMA], 2021).
Allocation of vaccines poses both logistical and social equity challenges to include having a limited workforce to assist at each of the PODs. Leveraging existing partnerships at academic institutions and through local CERT programs provides opportunities to engage members while supporting local government. Progressive evaluation of operations gave way to continuous improvement. Areas of improvement consist of the enhancement of logistics and the availability of a qualified workforce. One lesson learned is that the magnitude of efforts in response to public health emergencies relies on strategic partnerships. CERT programs were an asset designed to assist when needed to ensure the success of operations throughout Hillsborough County. CERT members were on stand-by each week for the PODs and answered the call to action when needed. The resilience found in conjoined emergency operations is due to having qualified volunteers—with a majority of Our CERT members currently studying at the University of South Florida, College of Public Health—which only strengthened the response with the strain of a limited workforce.
Center for Disease Control & Prevention. (2020). Fact Sheet: Medical Countermeasures
(MCM) and Points of Dispensing (POD) Basics. Center for Preparedness and
Response, State and Local Readiness.Retrieved from https://www.cdc.gov