Calling the shots
A look at the healthcare workers and community leaders driving COVID-19 vaccination effortsMelissa Liu, Managing Print & Design Editor, Rachel Everett, Staff Writer, & Cameron Chappell, Staff Writer
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Graphic by Melissa Liu, Managing Print & Design Editor
With vaccine eligibility expanding to include everyone aged 16 and older on March 25, things are finally looking up for the millions of Georgians eagerly awaiting the pandemic’s end. Georgia’s vaccination efforts have come a long way since it first implemented Phase 1A of its vaccine rollout plan on Dec. 14, 2020, thanks to the dedication of healthcare workers and community leaders. Brooke Yang, a nurse practitioner, has been vaccinating patients against COVID-19 since January. Yang herself received the first dose of the Moderna vaccine on Dec. 24 and the second dose on Jan. 19.
“[After] the second shot, I personally experienced a really bad sore arm. It was very painful, and I couldn't lift that arm,” she said. “I had chills and fever for two days, so I took Tylenol every four hours and rotated it with ibuprofen.”
Although the medical personnel at the clinic Yang works at, Buford-Norcross Primary Care, have all been vaccinated, they still take the same precautions as before in the unlikely event that they can still contract COVID-19 and infect others. Since it first began, the clinic has vaccinated over 1,000 patients, and it now receives shipments of vaccine doses regularly.
“[In] each shipment, we received hundreds of vaccines,” Yang said. “[Shipments] can be weekly, but sometimes, it gets delayed because there's a lot of things involved in the shipment like weather can affect that too.”
For the clinic to receive vaccine doses as one of Georgia’s 330 vaccination sites, one of the physicians, Dr. Patrick Huynh, had to become certified by the state. Huynh underwent mandatory online training regarding vaccine storage, injection, and appointment scheduling guidelines. In accordance with these guidelines, the clinic schedules certain patients who wish to get vaccinated.
“We try our best, and we prioritize whoever has more medical conditions. [If] they're over 65, we put them on the priority list,” Yang said. “This week we loosened up the criteria. The people who are actually younger than 65 start to get [the] vaccination now.”
In addition to looking at who is eligible to receive the vaccine according to the phases of Georgia’s vaccine rollout plan, Buford-Norcross Primary Care also recommends that some patients who previously contracted COVID-19 not get vaccinated. The clinic is currently conducting extensive tests for quantitative titer, a numerical value that indicates someone’s degree of immunity to an infectious disease based on antibody count; the higher the quantitative titer, the more protected someone is against a disease. In this case, Yang and her colleagues are researching the quantitative titer for COVID-19.
“We're drawing the antibody testing after the first shot and then after the second shots,” she said. “So what our research found out is that the people who receive second shot get the quantitative titer higher than 250. [For] people who have not received the vaccine, but actually got naturally infected, their titer can vary from 25, 180, to 250 or higher.”
Yang conducts antibody testing on previously-infected patients who wish to get vaccinated. If their quantitative titer comes back as higher than 250, she tells them they do not need to receive the vaccine because they are already heavily protected from COVID-19.
She notes that not everyone who can receive the vaccine wants to. For instance, she knows several colleagues in the medical field who are waiting until researchers publish more results relating to the long-term effects of the vaccine. Despite this, Yang finds that demand for the vaccine is still extremely high.
“The biggest challenge is that we do not have enough vaccines,” she said. “Our clinic has a signup system, and over 10,000 people signed up for the vaccination, but we do not have enough.”
In light of the vaccine shortage, the clinic has dedicated two employees to handling shipment and scheduling, and the medical personnel also use vaccines as efficiently as possible to maximize the number of people they can vaccinate.
“After we defrost [the vaccines], we have to count the number [of patients] who are able to come. We'll defrost just a few each time because it can be good for six hours at room [temperature],” Yang said. “Usually, we use the vaccines very effectively, so we don't have leftovers.”
Brooke Yang, a nurse practioner at Buford-Norcross Primary Care, receives the vaccine herself.
Photo courtesy of Brooke Yang, Special
Like Buford-Norcross Primary Care, Emory Healthcare and University take many measures to prevent vaccines from going to waste. Dr. Amir St. Clair, the associate vice president and director of COVID-19 response and recovery at Emory, runs vaccination according to how many doses Georgia allocates to Emory.
“Emory plans based on what the state provides us, and that changes every single week. We're building planning and models to help support vaccination as soon as we get vaccines in,” he said. “Every time the state moves to a new eligibility group, we adapt our planning to make sure that we can provide vaccines to eligible groups.”
St. Clair works to ensure Emory does not overschedule appointments so that it always has the ability to provide those who have already received the first dose of the vaccine with a second dose. He emphasizes the importance of communicating with people to remind them of their appointments. If someone does miss their appointment, which, according to St. Clair, is rare due to the high demand for the vaccine, Emory does its best to make sure someone else receives their dose.
“It's not always possible that you can use every single dose because there are all these complicated factors, and people might cancel an appointment at the last second,” St. Clair said. “But If someone can’t make it, and we have enough time to plan, we can slot somebody else into that appointment time.”
Emory has delivered almost 100,000 doses of the vaccine to date. However, like many private healthcare institutions, it is only vaccinating its own healthcare workers, faculty, staff, students, and patients due to limited vaccine availability. St. Clair looks forward to the day Emory will be able to vaccinate those outside the enterprise in the future but acknowledges that it is too early to tell when it will have this capability.
“Our hope is that we can provide vaccines to as many people as possible. That's ultimately the goal,” he said. “So if there is enough vaccine available, and there are processes by which we can vaccinate other members, then there will be a discussion as to does Emory have the availability to provide vaccines to anyone outside the enterprise.”
Emory currently administers Moderna, Pfizer, and Johnson & Johnson’s vaccines. While those who make vaccine appointments do not get to choose which vaccine they want, St. Clair encourages people to focus on getting vaccinated as soon as possible, noting that all three vaccines have demonstrated their effectiveness against severe COVID-19 symptoms.
“We don't want people to feel concerned that they have to pick one [vaccine] or the other. It's not about the vaccine, which one you get, It's about getting it,” he said. “And that ultimately is the best thing you can do because they all help prevent death, serious illness and hospitalization, and that is the end goal.”
To promote vaccination to those who are more hesitant, Emory has dedicated a new section on their website, called “Emory Forward,” to provide data and other information regarding vaccination. Emory University also established a community relations team to create and drive partnerships between the university and the city of Atlanta and the state of Georgia.
“Through those partnerships, we're helping to educate the larger community,” St. Clair said. “So we have some of our public health experts, faculty, and staff members who are talking to these groups. We're trying to do everything we can not only for our campus community but for the wider community to understand why it's so important.”
Like St. Clair, Yang emphasizes the importance of getting vaccinated in order to achieve herd immunity to COVID-19. According to Yang, herd immunity will occur when enough of the population, roughly 85%, becomes immune to COVID-19 through either vaccination or natural infection. This protects people who are not immune by reducing the likelihood of contracting the disease from those around them. Dr. Michelle Au, the state senator for Georgia’s 48th district and an anesthesiologist at Emory Saint Joseph’s Hospital, has also been doing her part to promote vaccination. Instead of telling patients and constituents what they should be doing, Au prefers to lead by example and demonstrate the importance of getting vaccinated through her own actions.
Au, the state senator for Georgia’s 48th district and an anesthesiologist at Emory Saint Joseph’s Hospital, does her part in administering the vaccine.
Photo courtesy of Michelle Au, Special
“People call it vaccine hesitancy or vaccine deliberation. A lot of people on my team and I personally have worked in the vaccine clinics, giving the vaccine. I think that helps people to see that not only do I personally believe we should be vaccinated, but I myself am also vaccinated and I help give vaccines to patients,” she said. “To work it from all angles shows people that it is a trustworthy endeavor and important.”
After she received the first and second doses of the Pfizer vaccine, Au also posted videos on social media documenting her experience and explaining what someone can expect after getting vaccinated. She listens to her constituents’ concerns and does her best to address them to encourage vaccination.
“What I try to do is to be as open as possible [and] really learn what the issues that prevent people from getting a vaccine [are],” she said. “Like, ‘What is it that that makes you anxious about it?’ What is the unknown element that makes you hesitate from immediately signing up to get a vaccine?’”
According to Au, the biggest concerns people have revolve around the speed with which the COVID-19 vaccines were developed. Because most vaccines take 10 to 15 years to develop, while the Moderna and Pfizer vaccines were all developed in under a year, she has heard many, including healthcare workers, call the COVID-19 vaccines experimental and not thoroughly tested. Au reminds those who are worried about getting vaccinated that, like their predecessors, these vaccines had to go through three phases of clinical trials, during which over 30,000 volunteers received the vaccine without severe side effects before they were approved by the FDA and made available to the public. She notes that vaccine development for COVID-19 was expedited due to the number of researchers working on it, not disregarded precautions, equating the process to completing chores.
“Just because [vaccine development] was quick doesn't mean it wasn't safe,” Au said. “It's like if you're cleaning a really big house. If you're just one person, it's going to take you all day to clean that house. [If you] get 10 of your friends to come, it's going to take you maybe like an hour. It doesn't mean the house is less clean because it's faster. It’s just more people were working on it.”
Au was impressed by the increased collaboration among researchers and international information-sharing regarding COVID-19’s genetic code that made rapid vaccine development possible.
“It really shows what science can do when a lot of people are working together,” she said. “It shows you the power of collective action and teamwork and scientific technology.”
Au’s advocacy of vaccination extends to mass vaccination sites, locations that can handle a high volume of patients and get them vaccinated quickly.
“At the Gwinnett mass vaccination site, once the supply loosens up, they can handle about 3000 patients a day, which is very impressive,” Au said. “That's the way we're going to be able to get more people vaccinated.”
As caregivers for his 75-year old grandmother, Northview junior Aman Dhamapurkar and his family members received the first dose of the Pfizer vaccine on March 6 at the Gwinnett mass vaccination site, a former Sears in the Gwinnett Place Mall. Dhamapurkar recalls the efficiency of the vaccination process there.
“They had a line outside, and every 15 minutes, there was a new group [of people] going in. The first thing they do is take your temperature just in case, and then you go in, you talk to someone, they get your insurance card, your ID, and they confirm that you can get the vaccine,” he said. “From there, you go with a person who is giving the vaccine, and they ask you questions like if you had any symptoms or if you had COVID before, and they give you the vaccine. Then they put you on observation for 15 minutes before you can leave.”
On March 17, Georgia opened five new mass vaccination sites in Bartow, Chatham, Muscogee, Ware, and Washington counties. Although Au has never started one of these sites herself, she suspects the process involves finding a suitable location, securing funding for medical supplies, and, most importantly, hiring both clinical and nonclinical workers to run the site.
“You need a large staff to staff a mass vaccination site, not just the people injecting the vaccine, but people who are registering patients people, walking them back and forth to the vaccination station, people who observe them afterward for 15 or 30 minutes to make sure everything is okay, and people to run supplies, there's a lot of need for people,” she said.
However, there is a nationwide shortage of workers to help vaccinate people, and as both Yang and St. Clair can attest to, many healthcare facilities have turned to retired nurses, students training to be medical personnel, as well as nonclinical volunteers, to support vaccination efforts.
“At Emory, they are recruiting a large number of people who are trying to help with the vaccinations. They're even asking retired people,” Yang said. “They try to mobilize all different people, including nursing students or medical students.”
To accelerate vaccination, Au and the other members of Georgia’s state senate also voted to approve Senate Bill 46, which permanently authorizes emergency medical technicians and cardiac technicians to give vaccines during public health emergencies, on Feb. 18. Au acknowledges that, as a member of the state legislature, her role in the vaccine distribution is limited, though, since she does not have the power to make the executive decisions regarding vaccine allocation. Instead, local administrators like Dr. Lynn Paxton, the district health director of the Fulton County Board of Health (FCBOH), are in charge of the many processes involved in vaccine rollout. Paxton works with a vast array of government officials and healthcare workers every day to combat vaccine hesitancy through community outreach and find the most effective ways to provide more priority patients with the vaccine.
“This is not a one-person operation. [The Federal Emergency Management Agency] has been working with us since the very start of the epidemic, and they have lots of experience with logistics and moving things out,” Paxton said. “And we work with volunteers in terms of getting enough people to be able to vaccinate. We have volunteer firefighters and paramedics come in. It is literally a cast of thousands in the state that's needed to roll out vaccine distribution.”
Every week, she sends the Georgia Department of Public Health (DPH) a request for vaccines based on how many vaccines the Fulton Health District, one out of 18 health districts in the state, needs. Fulton workers take custody of the weekly vaccine shipments upon arrival and store them in the freezer until they are delivered to vaccination sites.
Dr. Paxton receives one of the first vaccinations in Fulton County.
Photo by Emilie Ikeda, Fox 5
“There are 18 health districts in Georgia, so [the DPH was] allocating based on a proportional basis based on population,” she said. “They send us a tracking number, and we know when it's going to arrive, and then from there, we distribute the vaccines on a daily basis to our different vaccination sites for that day.”
However, Paxton notes that health districts are not the only ones controlling vaccine allocation, as many vaccination sites in Georgia, such as universities, hospitals, and pharmacies operate independently of the local health departments, receiving shipments directly from the DPH. She hopes more private health institutions like these will become vaccination sites in the future to increase the accessibility of vaccines.
Although Paxton and her colleagues have streamlined vaccine distribution and hired more workers to manage call centers since vaccination first began in December, she acknowledges that the road getting here was long and difficult due to a lack of support and funding from the federal government, as well as vaccine shortages
“It was left up to the local county health departments and the states to develop an appointment system to handle that. Our vaccine systems were built to handle what we normally do, which is back-to-school vaccines for school kids, so maybe several 100 in a day. We were not equipped to handle 10,000 people in an hour trying to access the system to schedule an appointment,” Paxton said.
Now that the FCBOH has set up three mass vaccination sites at the Mercedes-Benz Stadium, North Point Parkway, and the Aviation Cultural Center to vaccinate thousands of people daily, the biggest challenge it faces is vaccine hesitancy. With the extreme rise in demand for Pfizer and Moderna’s vaccines also comes skepticism towards their use of mRNA technology. Paxton encourages those who have been vaccinated to encourage vaccination among their friends and family members, believing this is the most effective way to convince those who are hesitant of the vaccines’ safety. She runs webinars and media campaigns to reassure concerned citizens, paying special attention to underserved populations like people of color, the poor, and the elderly.
“I'm really proud to say that we are the best-performing accounting health district in the state by far,” Paxton said. “We have been delivering on average almost as many vaccines as Cobb and Gwinnett [counties] combined.
The board collaborates with local groups like churches to provide vaccine education to a larger audience and hold vaccination events. For instance, it partnered with Fulton County Schools (FCS) to organize two Super Saturday vaccination events at the Mercedes-Benz Stadium on Jan. 16 and Feb. 6.
“We organized a location and the distribution through the Fulton County Board of Health for all of the Fulton County employees who met the criteria, so the primary audience for events was our employees 65 and older,” Brian Noyes, the Chief Communications Officer for FCS, said.
With the help of qualified Fulton employees like school nurses, clinicians provided by the board, and nonclinical volunteers, over 700 employees and their spouses were able to get vaccinated. FCS organized a second vaccination event at the Mercedes-Benz Stadium for school staff through the FCBOH, since educators became eligible to receive the vaccine on March 8. Dubbed Project Vaccinate 2021, the event allows K-12 employees to get the first dose of the Pfizer vaccine from March 22-27 and the second dose from April 12-17. Through the previous vaccination events, Noyes realized the importance of having employees pre-schedule appointments so FCS could order the correct number of doses, and workers could defrost them on time for each appointment.
“The [previous events] were great test runs for us to do, a few 100 people to scale up to a few 1000 people for our upcoming events,” Noyes said. “What we learned from the first set of events going into the second one was that the pre-registration was key, and making sure that we knew how many people were coming.”
This time, those who qualify to participate in Project Vaccinate 2021, including part-time employees, employees of charter schools, substitutes, approved temporary employees, and community coaching personnel, had to reserve time slots on the FCS website by March 19. On the vaccination dates, schools are also switching to remote learning based on a predetermined schedule of when certain employees will get vaccinated to accommodate absences.
“Our logistics team decided that it was best to split it up over six days,” he said. “Elementary school [employees] are the first three days, middle and high school employees are the second two days, and then administrative staff and central office are that last day.”
Fulton County Schools shares a graphic through social media for new remote learning dates in order to increase staff vaccinations.
Graphic courtesy of Fulton County Schools, Special
Before the logistics team planned the vaccination event schedule, FCS sent out a survey to get an estimate of how many employees wanted to get vaccinated through the county. Over 60% of the 14,000 FCS employees indicated that they were interested. Although Project Vaccinate 2021 is not over yet, Noyes expects to vaccinate approximately 8,500 employees total based on the results of the interest survey, with over 1,300 people coming to the stadium each day.
“It's a very overwhelming response,” he said. “Educators have been publicly saying they want to have the vaccine, so when they have the opportunity, a majority of teachers want to receive it if they can.”
However, Supt. Mike Looney also emailed all employees encouraging them to get vaccinated outside of Project Vaccinate 2021 if possible, due to uncertainty over vaccine supply. As a result, many teachers, such as Northview language arts teacher Chloe Grimes, took it upon themselves to schedule appointments before Fulton’s vaccination event.
“It was a little iffy that they were going to be certain they had enough vaccines by that date, so I was like I might as well look and see how easy it was to find [an appointment],” she said. “The quicker that all of us get ourselves protected, we can get you guys back and a little bit more normalcy as well.”
While she agrees with the groups that Georgia prioritized in its vaccine rollout plan, Grimes felt extremely frustrated a few weeks ago because the state is lagging behind in terms of vaccine rollout.
“I felt like we were losing hope. One of the things that I've struggled with the whole time is just feeling stuck in this never-ending cycle,” she said. “We hear the vaccines were getting improved, so we got excited, and then they kind of took that out. [The vaccines] just kept dangling over us, and I felt like it got further and further away instead of taking any actionable steps forward.”
Jonathan Waters, another Northview language arts teacher, shares Grimes’ frustration, noting that out of 50 states, Georgia comes in 45th place for the percentage of distributed vaccines that have been administered, at 73%. On March 5, he ended up driving one and a half hours to Lanett, Ala., where both he and his parents received their first doses of Pfizer vaccine.
Jonathan Waters, Northview teacher and debate coach, takes a selfie with his vaccination record card after receiving the first dose of the Pfizer vaccine.
Photo by Jonathan Waters, Special
“Both Alabama and Tennessee were allowing teachers to get vaccinated ahead of Georgia, and they had no restrictions on where the teachers were from. My wife and I were searching on various websites and trying to find appointments as much as we could,” Waters said. “And we actually scheduled probably like four appointments at one time for the first vaccine, because we didn't know if one would be canceled.”
He attributes delayed vaccine rollout in Georgia to ineffective government administration and unstreamlined registration, as every website has a different process for scheduling an appointment. Waters believes registration can quickly become overwhelming for elders, many of whom are unfamiliar with the internet, recalling how he had to help his wife’s grandfather schedule a vaccination appointment at CVS. Grimes experienced similar difficulties with her older family members.
“My grandparents, my parents, and my aunts and uncles had to go sort through 10 different websites, and they don't have the skills to be able to do that necessarily,” Grimes said. “They couldn't even [schedule] their appointments, so I think just from top-down, we could have picked one way to do this, and maybe given a more clear plan from the get-go.”
She and Waters both emphasize the importance of getting educators vaccinated as soon as possible to relieve the burden online school has placed on working parents, students who need social interaction, and teachers who feel at risk of contracting COVID-19 working at school.
“A lot of people rely on school systems for taking care of their children during the day, so they can go to work. It's really hard to never know, ‘Is tomorrow gonna be the day where my kid can't go to school anymore?’” Waters said. “It's also important that teachers stay safe and feel safe in the classroom so that they can do their jobs effectively.”
He acknowledges that while it would be difficult for schools to enforce a vaccine mandate, all teachers should choose to receive the vaccine to protect their students and colleagues unless they have medical reasons not to. Based on Grimes’ and Waters’ experience, though, most teachers have been eager to get vaccinated. In fact, the language arts teachers at Northview all worked together to help each other receive the vaccine, sharing which websites they used to book their appointments and covering classes for teachers who were missing school to get vaccinated.
“We're all sending each other our selfies in the car with our weird band-aids on our arms,” Grimes said. “Everybody that I've spoken to has been very excited, and I do think the majority of teachers are excited to be taking this step forward.”
Chloe Grimes, a literature teacher at Northview, poses with her vaccination record card.
Photo by Chloe Grimes, Special
Although she does not anticipate major changes in what Northview will be able to do during this school year after teacher vaccinations, other than holding graduation and sporting events, Grimes is optimistic about having more students back in the classroom next year and feels as if the end of the pandemic is finally in sight thanks to increased vaccine availability.
“There was a renewed sense of hope, and there's more energy in the hall and in the school than I’ve felt in a long time because we like interacting with you guys, and we like learning from y'all,” she said. “We've missed that this year, and we know that this is one way to get closer to getting back to normal.”
