Hello everyone, I’m sorry for the false starts, but we are ready to get going. And thank you for joining today’s webinar, Lessons Learned from COVID-19 and Other Emergencies.
I am Kathryn Martucci, director of policy and programs at the Alliance for Health Policy. And for those of you who are not familiar with the Alliance, we are a non partisan resource for the policy community, dedicated to advancing knowledge and understanding of how policy issues. And we gratefully acknowledge the Commonwealth Funds for supporting today’s webinar.
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So now I am pleased to introduce our moderator for today’s briefing, Mr. Reginald D Williams, the second is Vice President of International Health Policy and Practice Innovations.
In this role, he is responsible for fostering International dialog, Exchange and education that enables US policymakers and healthcare leaders to learn from cross national experiences. Grantees also experience, excuse me, responsible for the Commonwealth Fund’s International Benchmarking Activities, International Research Policy Analysis, and the educational exchanges and Conduct with Key International partners, so we’re very excited to have him today to lead this conversation, and I will turn it over to Rajiv.
Well, thank you for that warm introduction.
Covid 19 this is officially the deadliest outbreak in recent American History, surpassing the estimated fatalities from the 19 eighties influenza pandemic.
This system means that roughly one in five hundred Americans have died from criminal virus, this winter, may very well bring a new search.
Last week, world leaders gathered the United Nations General Assembly, President Biden held a summit, call on global leaders to make a new worldwide commit to bring an end to the pandemic, and to cite future pandemics.
Last week, the Commonwealth Fund also released a new report that shows how proactive investment in public health and healthcare delivery can help develop the resiliency needed to meet the challenges, posed not only by disease pandemics, but my other emergencies like hurricanes flooding wildfire.
Today, we have a brief opportunity to pause and reflect and grapple with topics like staffing, are healthcare facilities, general access to care, decision making and triage, data infrastructure, and communications for pandemic preparedness, response and dealing with other emergencies.
We’re excited to have panelists with us today to explore these and other important topics from both the international and domestic perspective.
And each one of the individuals here has had an opportunity to really engage with people that have been working on the front lines of the pandemic, inside and outside the US to bring for perspective that we all can learn from, from a policy and research standpoint.
So, now, I’d like to introduce today’s panelists.
Here with me today to further explore the lessons learned from Covid-19 are 3 experts.
The first we have is Dylan Scott.
Dylan is a senior correspondent at Vox. This report reporting primarily focuses on health care and other domestic policy issues.
And Dylan has been a great partner to the Commonwealth Fund, doing work that really looks internationally at the experience of delivering care and reporting back to people on what it’s like to be in other countries.
Prior to Joining Vox, he worked as Washington correspondent for Stat News and it was a reporter at the national drink.
Next, I’m pleased to introduce Caroline Pearson, who’s going to join us today.
Caroline, the Senior Vice President at NORC at the University of Chicago, where she leads the Healthcare strategy group and provides research data analysis and policy support to a wide range of organizations.
And I can also say, Caroline is a former colleague, and a good friend.
And, finally, we have doctor Rebecca Weintraub.
Is a Director of Better Evidence and … delivery and Assistant Professor in the Department of Global Health and Social Medicine at the Harvard.
She’s also an Associate physician in the Division of Health Equity Hospital.
And she said, practicing interests.
She’s also been a great partner who’s been focused on really understanding the experience of working in the hospital and primary care, and delivering vaccines to people in Detroit.
So we’re going to launch today’s discussion, by first hearing from Bill. It will provide a high level overview of how other nations have responded.
Dylan, I’d like to invite you now to speak.
Please turn your mic and camera, OK.
Apology. Hi everybody. Thanks for taking. Thanks for taking the time to be here. Thank you for having me. Read, you alluded to. About a year ago, my colleagues and I started looking at pandemic responses around the world. And we wanted to, you know, we were after the same Objective panel, which was trying to figure out what were some of the lessons that we can learn from other countries that have excelled in particular part of the response, COPPA 19.
So rather than try to capture the totality of any given country, experience with cobain, we decide to focus on specific parts of their response. and how they expelled and how those strategies actually held up over time as the pandemic dragged on.
For example, we looked at South Korea, and their program for testing, and tracing, and isolating potential Coburn contact, that they were able to set up. very quickly. In the first few weeks of the pandemic, we looked at Vietnam and how they use border closure to try to manage the crisis.
We also looked at the United Kingdom, which in general, obviously is not really been a covert success story, but their recovery trial program run through the UK. National Health Service has been very effective and identifying existing drug that could be useful in trying to treat people with my team. And so beyond the particular story, I had two big takeaways from our reporting.
one was that the ability to act quickly and decisively was paramount to crushing that first wave of Kobe and the countries that were better.
Addition to do that, were countries that had had recent traumatic experiences with infectious disease and had built up the capabilities to combat the next outbreak, though, South Korea, for example, had struggled with MERS in 20 15. And they introduced a whole slew of public health performed after that that gave the government more authority, and more resources, that up the kind of testing, tracing and isolating program, that they were able to quickly implement … arrived.
Likewise, Senegal with another country that we wrote about, particularly with an eye toward their health capacity. Had recently struggled with Ebola and so the first thing that they did want covered arrived in their country was implement some of the protocols that they bill, you know, laying around from the … a few years ago. That was one. Second, you know what was obvious as an reporting period over the course of several months during the pandemic with constantly changing, you know, Germany at first. It looked like a success story when we started reporting on it. They have that evidence based communication campaign that had built support for wearing map and other social distancing measure. But over the course of the pandemic you know the solidarity that that communication campaign had built up, started defaulter from the country’s internal politics, which also obviously reached a climax here in the last week. Started to get in the way, that Germany became a cautionary tale of our country.
Control the virus when the solidarity and support for some of the public health intervention way, and we thought the molar story in Senegal and South Korea as well. And, on the flip side of that, the United States, we would always wanted to do a story about economic relief and the economic, you know, the ability to manage the economic crisis, that accompany code. But then we found that over the course of the 6 to 9 months that, we worked on the project. It turned out the US was actually the country, arguably, the strongest economic response, not something that we necessarily expected going into it or that AV even been true. We started reporting out the project and that was another way.
The story of the pandemic, we’re constantly evolving underneath our feet. And I think, you know, the other thing that I’ve been reflecting on Anton …, that this has continued to be true.
You know, our project published in the late spring, just at the time of vaccination drive, was really becoming the dominant storyline. And so, some of the countries that we profile that had had really more early intervention with Cove and have them struggle with their data. Their back new campaign, South Korea, for example, Gold Trail, the US, and the percentage of the population that is vaccinated, and they are current being, currently being case level that. Wow.
You know, much lower than what we’re seeing here in the US. Are higher and be the country level experienced before.
And likewise, I wrote a story in December about Australia and there program for managing and loosening or are strengthening locked down depending on case level, you know, at that time. They seem like a success story for how those kinds of social distancing measure could be implemented with the kind of clear pathway towards Getting To zero coven. And something that we’ve found.
That, you know, I think Australia has discovered in the month and I wrote that story, the limitation of those strategies, and they’re struggling now, you can get a percentage of their population back. And so, you know, that, that has applied to the US. As well, you know, the UFW started out as a leader, in the back being dry worldwide and has said, lips to become much more mediocre and how we stack up to other country.
And, you know, I did a story recently on Portugal which has surpassed the United States and its vaccination campaign and actually ranked the top among European countries.
And something I found that was interesting, and talking to a point, to an expert about why their country had proven successful, there were two things that stood out to him.
one was the kind of cultural factor, Fortunately that some of you may know that under a military dictatorship, until the 19 seventies, and was only with that, more recent, the rotation that vaccines are widely available.
And most people got them in Southern, There was a different kind of appreciation among the Portuguese, for what bacteria can do, maybe compared to a country with a longer period of a more liberalized capacity, like the United States, And the other part of it, with that, know, Portugal had a very centralized program for administering and distributing it back in. That had probably been helpful as well. And that kind of twofold, takeaway is really where I left here, you know, sitting here in September 2021, thinking about how we learn from what’s happened over the last 18 months. You know, on the one hand there are intrinsic thing, you know, cultural and social factors that will be really hard to change and that will always have an influence on how we are able to respond to something like the pandemic. But on the other hand, there are programmatic thing, policy changes that could potentially be made that would be better prepared. Something like this happens, I think the examples of South Korean Senegal speak to that ability to learn from the lessons of the past.
And so my question now which, you know the other panelists and maybe even the audience might be better equipped to answer is whether we will actually learn how you know how much have we really learned from the from the pandemic and our failures? And how much better prepared will we be next time? That’s what I’m going to be watching going forward.
Well, thank you for that helpful context.
And now I would like to invite Caroline to speak a little bit about the work she’s been doing.
Caroline, you’re on.
I thank you so much.
So I wanted to talk a little bit about some of the research that we have done and published recently, with support from the Commonwealth Fund, again, similar to Dell, and really looking at some of the lessons learned that we can find from international health delivery systems. Now, our research was really specifically focus on delivery systems and the provision of health care, and how those, that health system operates. We were not focused on the public health response, including things like mask mandates, and lockdowns, given how much emphasis and attention that got from other other coverage. But I think it’s similar to Dylan. one of the things that really struck me in our research is just how important those public health measures were in terms of enabling providers, hospitals, and the rest of the healthcare system to actually operate effectively during the pandemic.
Clearly, countries that responded quickly and were able to flatten that curve and at slow their case rate took a lot of pressure off of the delivery system. And so that was very helpful especially early on.
In the pandemics we talked with with people in the United States who were on the ground trying to manage delivery system response. And we identified sort of five key areas of focus.
The first was staffing, you know, in the United States, we struggled mightily with maintaining adequate staffing during kogod 19 surges. Folks were worried about when we did our research stress and burnout among staff.
And we have certainly heard that I come to be a huge issue as the pandemic has worn on.
We were focused on access to care. And so, you know, how does the Delivery system pivot in order to continue to provide ongoing regular care, in addition to Delivering coven 19?
Care and treatment as needed?
Our third big topic was decision making.
And, you know, one of the things that we really saw as a challenge in the United States was, because of our pretty federalist nature, we had sort of limited leadership at the federal level, But a lot of decisions were really left to state governments. We saw a huge growth in the rural GOV’s during the pandemic, as well as sort of city mayors, and, frankly, health system leadership themselves.
And, you know, one of the challenges was a lack of clarity around who was making, which decisions at which points in time.
We also were very focused on data. Relative to other countries.
We saw the U S struggle with data systems to not just report on kovac case rates, but really monitor supply and system capacity, whether that be staff capacity, ventilator capacity, oxygen, as we’ve seen it be a challenge in many regions, things like that. And so that the US could actually manage naturally what the need was and deliver supply to those areas of crisis.
And then the fifth area that we focused on was communication and sort of how communication occurred both between the government and the public, with regard to come at 19 and between policymakers and the delivery system itself.
And as we began to do our interviews, we really saw sort of three critical components of the delivery system response come to the forefront.
So this really echoes I think a lot of what Dylan said at first and foremost is preparation And, you know, thinking about what sorts of upfront investments in training and planning and data systems enabled countries to respond quickly.
We also heard a lot of emphasis on countries like South Korea, Singapore, where you had recent viral epidemics. They were better prepared, right? Not only did they have preparedness plans, they had patient triaged plans.
They conducted simulations. But they were really able to recognize what was happening and the seriousness of what was happening and what the necessary response was, I think, more quickly than the US and many other countries around the world.
The second big area that we focused on was the response. And obviously, this is where lots of attention has been paid. And, again, you know, one of the issues here was timing. How quickly could delivery systems address a changing? And very dynamic situation information was changing. The threat was changing. And so we really focused in a lot on what we called sort of adaptive management approaches.
So, how did different countries help clarify and speed decision making in an uncertain environment?
And a lot of that really came to clarifying roles and responsibilities between states and local decision makers, and the federal government that involved data systems.
We saw many countries, Australia being a good example that had more centralized datasheets systems and dashboards that enabled consistent information for both local and federal audiences.
Then, you know, mitigating staff shortages. So for instance, in Germany we saw very quickly that they hold research staff out of their research institutes. Switch in Germany are somewhat separate from some of the direct delivery systems and pull pull those those clinical staff back into a clinical setting research and doing that quickly in a way that we didn’t see quite. So much nimbleness here in the US.
And then our third big piece of analysis was really about sustainability.
And this, of course, has become clear as we enter 18 months of pandemic. and I still am said, many countries that were doing well at the beginning have really struggled and that is really about that ability to sustain a strong response over a long period of time.
And a couple of highlights and we can talk more about this as we go.
But again, staff burnout, you know, in the United States, a lot of what we’ve relied on is longer hours, you know.
We’re staffing ratios and just really stretching existing staff further, which has created just tremendous wear and tear on those health care workers as this pandemic continues. And so, in other countries, we not only saw them increase staff capacity by pulling clinical and non clinical staff from other industries.
But we also saw a lot more focus on mental health support. And, you know, we saw a psychological first aid program that was created in Singapore really trying to identify folks who are struggling, and get them the support they needed, because we need them to stay healthy and be able to continue to work.
Um, and so we can go through additional examples. I think I’ll pause there, but lots of alignment with what Dylan mentioned and look forward to talking more about how we can take these lessons learned and continue to improve in the future.
Thank you, Caroline, for those opening remarks.
And now I’m going to turn it over to Rebecca for her citizens.
Thank you. Thank you so much.
Just a much reinforces, um, and I have to say if someone playing this dual role of the physician and vaccinator and a researcher, we see the burnout. And I’m just so pleased that this many people want to be in conversation, so really eager for Q&A today.
Also, just wanted to thank the Commonwealth Fund and ready your ongoing excellent questions to have us think through what are the implications, not only for 19 vaccination, for example, but what does the deception to routine vaccination, and how do we think of these lessons regarding future pandemics?
So, this is then, I’m going to share a bit of data. That’s been an incredible collaboration between my colleagues at Boston Children’s Hospital. With support from Google Health, regarding some of the data sources, if anyone wants to go into the weeds of any of this, I’m eager to connect afterwards.
And I’m going to try and focus on in order to prioritize speed, equity, and scale, why our central, our first order work is about geographic access. And geographic access actually promotes convenience.
And when we seen the vaccine, for example, become convenient, seeing those who are waiting and seeing come to get vaccinated, for example, come to begin the conversation.
And when they see my primary care providers being able to engage in 19 vaccination rollout, you see that added layer of trust and connection.
That’s been a powerful lever for increasing equity for all.
Next slide, please.
And just if you need additional reasons, why, to talk to your communities about why vaccines are effective, Just to remember that you have the data now, that that’s it individuals who become infected, clear the infection more quickly.
The breakthrough infections for those who are vaccinated are not only uncommon, but they tend to be milder and shorter.
And third, that’s it, individuals are decreased risk for long haul.
So, I’m gonna walk you through kind of a few things we’ve observed without the vaccination. Here’s a review where we saw on the plans that jurisdictions submitted that 39% of the state’s actually had vaccine distribution lens, that reference health equity committee.
Only 16% referenced minority group representatives.
And about 51% during the time of the submission, we’re collaborative community based organizations. And we know these plans have evolved over time. It’s kind of an initial review. Next slide, please.
Our team looked at the CDC play that’s in the first submission, both in December, January, and then later in the spring. And what we saw was kind of this interesting pattern. First, this 2 by 2 shows you the jurisdictions that are using a disadvantage index. This is one of the first time we’ve used, for example, a social vulnerability index or an additional type of vulnerability index to think about, how should I allocate a scarce resource? So those that have changed on the top bar there.
And then the question was, are you vulnerable jurisdiction or vulnerability index jurisdiction? And are you using various? Which I can explain later on and quite an interesting pattern that’s evolved over time. And the quest for all kind of be longitudinally. Should we be in the center work further recommending the use of vulnerability index is when we had the scarce resource.
Next slide, please.
So what we’ve also seen, and I know many of you on this call, have been following this as well, is that it’s not only this, unfortunately, the planning for equity, but the planning for speed and the effect of the sluggish summer of vaccination. Unfortunately, on death rates across the United States, and this has been heterogeneous.
So this is a wonderful analysis done this month by colleagues where they looked at it all states, at the fastest rate, which was Vermont, they had actually had fewer deaths than what actually happened.
And so acknowledging is that speed, obviously to the first dose then folks we’re seeing the second is that really prevents at this point in the pandemic. Next slide please. And ongoing barrier that we’ve all been discussing, I think many of you thought of this for your own research and policy implications, is how we’ve ended up with such a decentralized data infrastructure. And, as I mentioned before, type various, relatively new piece of software in the midst of the pandemic. And this is, in a sense, the complex mapping, where you’re seeing at the federal side, as each jurisdiction, the 64 jurisdictions, are inputting into a data lake.
And, unfortunately, many of these data sets are incomplete, making it quite difficult for states to understand and monitor the effects of their interventions, and then longitudinally, for us to evaluate the Cuban 18 Vaccine, so, work ahead to improve these flows.
Next slide, please.
So, I just want to spend a few minutes kind of thinking through, and I’ll share, a public tool, for those of you interested in why we think geographic access is essential element to convenience, and, that allows us to sense Bridge to our trusted providers, for example, primary care physicians, family medicine, that’s and pediatricians. And I think, as we’ve all seen this wave from low to high supply, from high demands live, because he’s seeing a change and distribution of the sites that are open, and will be continuing to see more changes, and we’ve been tracking this today.
So, to help you track it, interested me map this out week by week, vaccine planner dot org. This is a collaboration between Boston Children’s, I add the labs.
That’s what’s in Google, not the vaccine deserts in your area. So we’re continuously seeing, unfortunately, geographic access is not well distributed across the country. We display the county’s five, for example, that social vulnerability index that I talked about earlier. We shaved the counties by the number of people who intend to be vaccinated that aren’t, then, as the user and the planner, you can define a vaccine desert by mode of transportation.
Are you trying to ensure folks can get to that scene by driving, walking, or public transportation?
Then, you can display the potential sites within the desert switch sites. Do you want to promote that the provider to begin vaccinating individuals are set up a mobile? Or think about vaccine education? And those are the red dots are seeing on the slide, and you can hover over them, and Google Maps will highlight their location and kind of information.
You can also download the contact information for potential sites.
Next slide, please.
And, we’re continuously make iterations on the planet, are eager for your input, what we should do. And that’s, here’s an example of what we felt to prepare for. The Pfizer vaccine may be a third dose, for example. And, obviously, we’re all waiting for the Emergency Use Authorization for 5 to 11 year olds, which will likely be Pfizer first.
So, you see on the left is the State of Alabama, when we’re looking at all of the vaccine, so, during the Johnson and Johnson and Pfizer, but when we look at the sites that have, fi’s are only unfortunately the tan color, the slide is more significant. So, there’s more deserts.
Unfortunately, in Alabama, if you’re trying to access advisor dose and there are more providers that are not vaccinating width ties are today, So this allows Alabama to think about who to outreach, to, educate, and where both the mobile down or additional supply to be distributed.
Next slide, please.
So, I just also want to make a comment that you know. We’ve talked evolving, guidance, evolving, science, and one of the things that’s been striking, interfacing with primary care providers and colleagues all across the country is this information gap regarding the storage guidelines. And, to remember back in May of 2021 that the FDA authorize the vaccine for Pfizer could actually be refrigerated for up to a month.
And that information, we have not seen get dispersed and pushed out to as many providers as we’d like to see so that we see, in a sense, some providers think, gosh, I can’t manage the Pfizer … vaccine. Because I don’t have the fine, for example, storage requirements.
And we actually really want to counter that message that most providers can manage, because it can be stored in the refrigerator for this amount of time and here, the Madonna and Johnson and Johnson, as many of you know storage environments.
And I mentioned because we’re hearing innocence, fear, and concern regarding wastage of the Pfizer vaccine. For example. I don’t want to be able to store it, for example.
And well, yes, there are reports of wastage is really minimal wasted in comparison to our routine vaccination campaigns for flu Or what the WHO has reported regarding other routine vaccination campaigns. So, we’re eager to help providers understand and those who are interested in engaging with the Pfizer Biotech vaccine, how they can manage it within their outpatient settings.
Next slide, please.
So, just, I think both John and Caroline mentioned this that, unfortunately, here’s kind of a visual of what Dylan mentioned, that the US in two days well had the lowest vaccination level of all prosperous democracies.
And we have to remind ourselves we had the legacy supply.
We actually had the most significant headstart turned into nations that are ahead of us.
And why this has happened, maybe a decentralized system, the flow of information, the lack of preparation of our public health workforce, but much to discern and discuss for the second part of the hour.
Next slide, please.
I just wanted to kind of acknowledge at this point well, we think about the flow from high supply, the supply of high supply in the US. Obviously, know most countries are still facing vaccines.
Scarcity mean a vaccine banning certain countries and we’ve since the acts of vaccine naturalism that had gotten to today, if you look at Canada, Australia, for example, the United States, you know, we have procured more justice than per capita. And, still imagine this is not a new pattern.
We saw this with the H 1 N 1, that they’ll be significant work to, not only move the dose is properly procure for low and middle-income countries the weeks ahead.
Last slide, please, and just kinda wanted to end in many ways that, even once we sort through the supply sufficient supply for every nation, we think there’s just significant work to help upgrade the systems. The flow of information during the supply chain, for example, preparing for this phase one of low supply demand and supply demand.
And there’s much to be discerned from the heterogeneous nature of the US. Rollout.
back to your attic.
Wonderful. Well, thank you so much, Rebecca, for providing that insight into the provider experience.
Now, I’d like to invite all panelists to turn on their video cameras and unmute, and we’re going to start the Q&A portion of our dialog here today.
And so, as a reminder to the audience, you can submit your questions through the interface at any time, and thank you very much for all of you that have submitted questions thus far. But just to kick us off, I have one question that I would love everybody’s take on.
What role did misinformation and skepticism and distrust of science play in different countries?
And are there lessons to combating this misinformation or are addressing resistance to vaccines or other issues, like climate change, that that could potentially be important to take forward?
Mean, you all have that opportunity to think about how do you communicate complicated information, and this environment, this, love your, your perspectives on that.
I can start. I’ll start.
Oh. All right, Carolyn.
I think, um, you know, I think that we did not see many other countries that we talked to had much less challenge with misinformation and skepticism.
That seemed like very sort of uniquely U S problems in our research, and, know, one of the challenges that we know this was just the heterogeneity of the communication. So, I was so struck.
I mean, we spoke to a Senior Health official in Australia, and he said to us, you know, My office is the single point of, of information for the country.
We are using lots of voices to move that information forward, but we provide the messages, the data, the information out to sort of all stakeholders, including the physicians.
And he held regular webinars with any clinician, wanted to join, to answer their questions. And they just stayed on the line until every question was answered. And so they’ve invested so much in creating really compelling messages that were very distant.
And I think our sort of lack of consistent messaging created the opportunity for a lot of information that sprung up ultimately.
Yeah, I am. I am a pessimist on this question. Unfortunately.
You know, I think I mentioned the example of Portugal and, you know, But they have had it missing their population to get vaccinated and some of that is, you know, I highlight that and you know their history with the military dictatorship and their relative really recent economic liberalization because, you know, there are just be intrinsic factors in a given country or society that have a lot of influence on how people react.
You know, public health messaging. And, you know, I think we very evident, you know, we wrote about Germany as evidence of the campaign.
Being able to communicate effectively with people to be able to prevent that kind of empirical case for some of these interventions and, and finding with the audience in the population.
But at the same time, you know, I’ve been working on the Dory. Actually, ironically enough, for the last group of people, a lot of psychologists about, you know, why we do have the vaccine hesitancy here in the United States that Caroline Munson seem somewhat uniquely American. And a lot of this, I think, it goes back to problem putting up with long before the pandemic. Like we all know in the survey data on people, crop, tuition, Bulgaria, figures of authority. And we know that the countries become very politically polarized.
And that has a lot to do with which information you give credence versus which ones you printed out of hand.
And so I think if we’re going to be able to no more effectively communicate public health people, we need to do more to kind of rebuild people. Some of the mainstream courses of information.
Because I think before and how we kind of, Apple about root cause, the more specific interventions or messages that need to be rolled out during an emergency are going to continue to fall on deaf ears that we are from the local population.
The thing that I found interesting kind of time period, that we consistently kind of survey people and ask them, Who do you trust?
And I’m the primary care physician, or a person, someone who wants to speak to around their everyday care is someone who always ranks high. So Rebecca speak a little bit from your perspective and staff lounge.
Guess the first down fundamentally agree, the politicization of this moment actually decouple your experience as a patient asking an individual question is the vaccine right for me? What are the risks of my behavior? So many patients weren’t able to access their outpatient providers and the commonwealth funded a very important study kind of seeing that depth. And then the resumption, but it’s hard to get an appointment, telehealth is doing a subset of this work that we need to alleviate. But we also, now, many Americans in particular, don’t have a primary care provider.
The ability to reach out to an individual to start this conversation, is this array vaccine for me. What does this mean for? My family is a series of conversations needs to happen and we haven’t thought through not only seeing where that should happen, but I’d say the reimbursement as it’s happening. And so on. So many of the interstitial spaces.
So I just found it in the next insights that I work and people can eager for the conversation.
They don’t want to read a post. They want to interact with an individual. They want to interact with the healthcare provider.
Question full answers and then the person that I’ve interface when I have a full conversation with, engages and chooses to get vaccinated.
And so I think it’s a remnant of the isolation of a pandemic dress.
What’s happened to the workforce under employment? Those things sick at home, remote schooling, You name that. Cascade stressor, that space. And so once again, need to go back to why we need strong, robust outreach. Folks have longitudinal trust in providers.
Would anybody else like them?
I think I think there are important points about the experience and having that opportunity to engage and work with.
Health care workers.
And see, each of you have discussed the trauma that healthcare workers have stays as far as the pandemic, whether it be burnout from constantly being on the job, mental health supports or services, and senior research that shows that there are many health care workers that have issues like transportation and food insecurity that are impacting their ability to do work.
And then on top of all of that, there is there is a turmoil now with some of the vaccine mandates that have been placed on healthcare workers.
And so, I would just wonder, kind of, from your, your various perspectives, are there any best practices to engaging the healthcare workforce and supporting them, seeing from your experience, your work?
Please just start some obvious friends, So, David … is a faculty member who looks at nursing homes and staffing, and nursing homes.
Now, when we looked at the nursing home mandate, our first pause, is this needed to be health care, workforce mandate, not exclusively nursing home?
So, the reason why is that many folks are working within many different settings. As we have, unfortunately, it had 24 hour coverage and many of these people working on a night shift being underpaid, not receiving benefits, for example.
And, so, first, the mandate should have been out of the gate for all of the workforce.
And, we should have publicly, it displayed for the public, the percentage of the workforce that’s vaccinated before you’re walking into the clinic or hospital where you’re being served.
Pay and benefits in many ways. You know, we have a significant amount of part-time night workers in the United States.
And that is not appropriate. At this point, you need to think through what are the pay and benefits to protect the workforce doing this work?
We also have an issue with visiting nurse visiting nurses Many. So, Marcel providers, they’re running around so, business.
Once again, there’s tremendous risk personally for getting roundhouse in their own economic status.
Again, fluctuations during the pandemic so, are all obvious. He says that When I talk to my friends in NHS and others, they are embedded in a very different system, and the planning was quite different. The ease of getting that first, this was significantly.
I think we rolled out the vaccine in many ways within health systems, hospital based first, and there is a lag between our inpatient providers, understandably, at different risks of exposure, that there’s a lag before outpatient providers who are, without TTE, are able to receive.
Yeah. As Rebecca was talking about the nursing home tapping, immediately popped to mind some of the research I’ve read, just in the last month about the current law. Yeah, the amount of turnover, that a lot of capability, the, basically, like, 100% turnover rate, every year. And so I think, you know, in most people’s mind, including mine, until a person there, it seems like there’s some dissonance between the healthcare workforce, you know, being reluctant, to get vaccinated or not feeling some of that institutional support that you were describing Reggie. But when you remember, recall, that like some of these places are seeing their staff completely turnover a year over year, you realize that, you know, these workers don’t have a lot of attachment to either that’s specific institution or even the entire line of work in part.
Maybe they feel they can’t afford to, given how or the pay and benefits can often be public with another. I think we’ll probably end up repeating our time here. But this is another case where you know the over the structural problems that have just been revealed by the pandemic. And so, we want to work for both, you know, more willing to buy into some of the public health intervention, but also feel more supported. We know pay and benefits and those kind of things can be linked back to what their job. No general mental health day.
So, I think there’s another quite where we, if we want to be, you know, better able to react and have a more kind of nimble and healthy lap in the middle of an emergency, we need to do more.
We’ll provide them with that.
I would just add, I mean, I think, you know, the mental health piece is really hard.
This is a traumatic experience, to have lived through and worked for 18 months.
And I didn’t see any countries where I said, wow, they did an amazing job. Right? I mean, but, but I think there was a level of attention and care for healthcare workers that we didn’t fully see in the United States since the first. It’s really financed. And you know, we largely fee for service Environment Shutdown elective. And non elective. Right, non coding procedures. And we saw hospital systems around the country sort of immediately shift into, sort of stopped our financial loss protection mode, including cutting pay to their healthcare workers, including stop and contributing to retirement savings. And so, you know, the sort of starting point in the US was actually a really financial hit on.
On a lot of health care workers, by contrast, we saw many countries internationally. You know, paying physicians are not demanding electric procedures to just sort of sit tight and we’ll sort of hazard pay and then we saw other programs to really try to help protect families including health care workers to keep them separate from saint Louis and not risk exposure. Better child care benefits, even sort of individual benefits as group childcare was closed during the pandemic. So, you know. It’s not an easy answer, but I think we did not nearly enough, not seen enough, so important point.
Talk a little bit about kind of lessons and where we could potentially go from here.
When you think of the successful examples of resiliency in health systems here in the US or internationally throughout the pandemic. Could you talk about what you, what you see in those environments and what policies you believe we’re supporting those successes?
I would say two things.
Number one, data, yeah, no, data alone was not enough, but the sort of terrible data infrastructure that we started with, I think, really hampered response across. So many examples, whether that be supply shortages, staffing shortages, vaccine rollout, you know, you name it.
Um, and, you know, there’s, there’s been sort of endless recent literature that’s come out sort of highlighting just how many hospitals weren’t able to submit data electronically, couldn’t participate in some of the data systems that got stood up. So, that feels like an obvious must do for the US that would enable a lot better response in the future. And, then, the second would, would come back to that decision making structure.
It is not that we need national, Federal government decision making.
But we need to clarify sort of who we want to be making which decisions, and how we’re communicating that because that may need to change throughout the pandemic.
And we just simply don’t have any structure for thinking about, you know, what’s the hospital administrators role versus the mayors And how are they communicating with the White House. So, I think those are, Lewis would be my tune.
Caroline Point, um, you know, I worked on a story in the last month or so, as you have to help hospitals are starting to reach capacity, and having the courage to emergency standards of care.
And, you know, I think those episodes and throughout the pandemic, in countless examples of how the US lacked a true healthcare system, even, the ability to kind of stand up a co-ordinated system. In a moment of crisis, like Caroline was referring to with some of the data and potentially making limitation, and do some reporting on what happened in other countries. And, you know, what I found was, not at other countries, are not stretched or are nearly pushed to their capacity, but there was no decision making structure in place. You know, in Canada or in the United Kingdom, there was either like a local or national government authority that with managing the flow of patients, you know, they’re up in Ontario like the local government decided. All right. We need to move 100 patients from here to here because we’re starting to see a covert.
Kobi Surge and we’re worried about running out of bed or running out of that where, you know, here in the United States adopt to individual doctor or the individual hospital executive to try to navigate those difficult situations and make those kinds of decisions. So, there’s certainly a debate, I think, to be had about what kinds of systems are decision making processes might look like, you know, whether we want to even have them anonymous the time.
But I think that inability to have any kind of democratic bond, the crisis or an emergency like there has really been laid bare. And there are obvious examples of other countries of how you might be able to avoid the situation.
Rebecca. So, you want to get in there?
I absolutely agree. Carolina. There’s, you know, Now, what do we do and, what are the lessons that we’ve already made happen?
Clearly, telemedicine works or subset of care delivery, having multi-state licensing across the United States, fixing the data lake infrastructure. At the slide I showed, Caroline Point. You know, we need to be able to have a robust set of data flows or states for this planning purposes. And we said, you know, State after state leader who had been beleaguered. And I want to, just for the shout out there that it’s not only the frontline providers, public health officials leading through this pandemic communicate. And then we now do not have 40% of that technical group in those roles anymore.
We have a lack of that expertise, at the forefront, to be communicating at this phase of the pandemic.
But these are things we can fix. And, obviously, we’ve seen countries and we kind of see that an error of line with those data systems were built, but it’s also the leadership capacity.
That’s should be should have professional development should be seen as X experts in this realm. And I think this has become so much more complicated in the midst of the political … of the pandemic.
Well, I think one thing that you all mentioned is that the US Under zaps and public health as well as the other kind of related social supports. The compliment and many other countries that we have observed, more places that do well have provided those types of supports.
So, do, you know, I guess the first questioner around this point is, do you think of the 19?
It is an opportunity catalyst for change, that could potentially open the door for, for new policies and practices to better support public health and the related social services for people.
Ah, and if not, what do you see on the horizon?
So, anybody want to kick us off?
Pleased to start with a yes, part of it, and you can go to that. I fell apart!
one of the striking polling data that we’ve been finding is that employers, across the United States have become a trusted provider of information, mission, and on-site services.
And I’m working with several large employers to date, the rollout of the vaccine.
Mandate has become another bridge to think about workplace wellness, workplace well-being, what does it mean to return to better, safer, more inclusive workplace?
And, I suspect we’ll be seeing more of that and more investment that actually plays choosing to be in a workplace that thinks about wellness.
Thinks about flexibility as possible, thinks about your identity as a family member, as a worker within a company, at all rates.
And, you know, in many ways, we think about the vaccine mandate. It has not been a step We have seen more people initiate or received their second guess the vaccine company and actually seen employees move to companies that have a significant population of their staff be batch. And people want to be around and at work with vaccinated colleagues.
So, I suspect that trend line will continue, and you’re seeing a tremendous amount of virtual care being offered directly by an employer, for example, to help you navigate, provide telemedicine, maybe for behavioral health, family planning, for example, as necessary. So I think that will be the best avenue.
OK, Yeah, I’m glad you mentioned that, Rebecca, because, you know, I certainly worry about a lack of public investment and attention. So it may be that we need to be more creative and imaginative about what some of the vector for this kind of change can be. And, you know, certainly could be a big role for private industry, because obviously, they have a lot invested and not, you know, having the kind of, economic disruption that we’ve seen over the last 18 months.
But on the public side, I, you know, I still have my head conversations I had last spring with public health.
Both bad, you know. Yeah, there’ll be a momentary interrupt or renewed investment in public health but, you know. As soon as I start to get tied again, that’ll, that’ll rapidly evaporate. And you know, I don’t know the, new, you know, how long coping with laughter, how disruptive that would be, and maybe that starts to change the calculus a little bit. But, you know, we’ve already seen, outside experts and even the Biden White House, talking about like one number to invest in pandemic preparedness going forward. And Congress Has at least initially come in with a much lower number and so you know I Am Concerned that they’re not going to be the kind of you know formal public reflection. There are some people out there who are kind of putting together Coated Planning Commission Model with the involvement.
Some of the folks who worked on the 9 11 commission, and they’re kind of getting that, you know, they’re doing a lot of the preparatory work. You know, and they have even describe, like, if Congress were to optimize this kind of commission, We would be, you know, we would have done a lot of the groundwork to, to make that possible. And but that’s where some of my optimism comes from. You know, I know there’s a lot of smart people who care about those who are trying to really get the conversation started. And some of this change affected, but, you know, just because of the nature of our political system. And, you know, our inability to hold that our attention on a single problem for a long amount of time. And just the general struggle for over resources. You know that that is where my glass half empty pessimism comes from. So, you know, I can see it going both ways, but I think it will pick a lot of work and dedication on the part of people who care about that.
The kind of force the powers that be and policymakers, and the people who hold the purse string to be accountable on that and to continue to folk their, focus their attention on it.
I think we I’m also a bit of a skeptic on, you know, the ability for politicians to DC. To stay focused on one issue in the long term. And I think also our challenge and sustaining that public response speaks to assert that fatigue. And the desire to move on.
I think that what we need to do is really get the conversation to public health more broadly. So, you know, the thing that keeps coming at us at the moment is natural disasters, right, whether that’s hurricanes and fires, and God is sort of at the moment, a continued threat every time we have a named storm.
And, you know, and a lot of the sort of data, the ability to deliver, emergency response, the ability to deliver supplies, the ability to relocate folks, necessary.
Those are similar needs across natural disasters response, and so I think thinking about that infrastructure development for public health more broadly, and not just code specific, will really help us sort of, hopefully ride the coattails of unfortunately whatever the latest disaster it’s going to be.
I end on the side of optimism because of all the different crises that we face and the trauma that they’ve experienced, whether it’d be friends, the climate emergency, because in 19 and the pandemic itself, social, mental health, and other kind of side effects of the pandemic.
I think there’s a real cry in the call for change.
There’s an opportunity to engage around.
Well, we’re coming up on time here, so I want to thank all of you for your insights on this important topic.
And thank you for sharing your ideas and thoughts. And audience, thank you for all the wonderful questions. We tried to amalgamate them and present them in a way that would allow us to have some great discussion so thank you all for engaging with us.
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You want to hear more here, this recording, again, this webinar will be made available on that Alliance website, Dylan, Caroline. Rebecca, thank you all for joining us.
Thank you. Ready for moderating.