MCH Emergency Planning and Preparedness DC

In the District of Columbia, the Health Emergency Preparedness and Response Administration (HEPRA) within DC Health works in conjunction with DC Homeland Security and Emergency Management Agency (HSEMA) for planning and coordination of homeland security and emergency management efforts. These agencies work closely with our District, federal and regional partners to ensure that the District of Columbia is prepared to prevent, protect against, respond to, mitigate and recover from all threats and hazards.  The mission of HEPRA is to plan, implement and direct public health emergency preparedness and response for the District. In FY 21, the District continued its COVID 19 pandemic response activities and the Title V team was actively involved in providing leadership and support in response to emergent needs of the MCH population in the District.

COVID-19 Response

On March 11, 2020, the District of Columbia activated its Incident Command Structure and multi-agency Emergency Operations Center (EOC) stationed at DC Health.  The EOC reports directly to the District of Columbia Mayor Muriel Bowser.  The ICS structure includes a Planning Section, Operations Section, Cost Recovery Section, and Mission Support Section.  Each Section Reports to the Incident Commander, who is also part of the Executive Policy Group that includes the Mayor and DC Health Director.  Within the Operations Section is the Health and Medical Branch which is led by the HEPRA Senior Deputy Director and includes Group leads across DC Health.  DC Title V leadership is included in the District’s emergency preparedness planning led by HEPRA, as well as other staff in the Community Health Administration and across DC Health who are involved in MCH-related work.  In FY20-21, The former Title V Director served as the COVID-19 Vaccine Group Chief, while the current Title V Director served as the Epidemiology Operations Chief as part of the Epidemiology, Surveillance and Reporting Branch as well as the executive lead of the DC Contact Trace Force.  The evolving needs of at-risk and vulnerable women, infants, and children were assessed and considered in all emergency response activities from food access and personal supplies to housing support and childcare needs for pregnant women and mothers who needed to be admitted to the hospital to deliver or needed assistance during isolation/quarantine.  The Title V program also supported strategy and development for communications and outreach strategies to encourage vaccine uptake among pregnant women and address vaccine hesitancy among high-risk populations.

The DC Title V program was actively involved in the formulation of a pandemic response plan as well as providing oversight for grantees responsible for conducting COVID 19 vaccination activities in the District. The District received the first shipments of the Pfizer and Moderna vaccines approved by the EUA in the United States on December 13, 2020, and December 21 2020 respectively. The District strived for a dual focus of equity and efficiency in COVID-19 vaccine distribution. Programmatically, each of the three main avenues for vaccine distribution aimed for high access to those communities who have shared a disproportionate burden of the pandemic.

The District partnered early with retail pharmacies providing them with technical assistance, human resources, and public facilities (Department of Aging and Community Living Senior Centers and Department of Parks and Recreation Community and Recreation Centers) to help broaden their capacity for vaccine administration.  Another avenue of vaccine distribution was via the District’s Federally Qualified Health Centers and large Hospital Systems, where the healthcare providers conducted direct outreach to their patients. The District was one of the first jurisdictions to include all its FQHCs as vaccinators. En masse, these healthcare providers care for most Medicaid beneficiaries in the District. The last avenue of vaccine distribution is through place-based special initiatives. The District partnered with Community-Based Organizations and Faith Institutions to launch the “Faith in Vaccine” initiative in February 2021 where places of worship were sites of vaccine clinics. Additionally, through a partnership with the D.C. Housing Authority, DC Health partnered to implement place-based vaccine clinics at low-income senior housing buildings. Programs such as the “Senior Buddies Program” and “Homebound Vaccinations” brought vaccine access to the most vulnerable at their doorstep.

Pandemic Lessons Learned and Recommendations for Post-Pandemic Recovery and Beyond Health Planning in the District of Columbia encompasses Population Health Planning, Healthcare Systems Planning and Health Services Planning. Effective health planning begins with a shared understanding of the health trends and key drivers of health outcomes observed within a population.  The Community Health Needs Assessment for DC Healthy People 2020 established a foundation for this understanding and articulated the need to: 1) better leverage strategic partnerships and assets; 2) strengthen the health system by aligning governmental public health and clinical care services to address the social determinants of health; and, 3) improve coordination of a community-wide agenda focused on achieving health equity in the District. The District of Columbia regularly engages in comprehensive health planning, with the Mayor's Commission on Healthcare System Transformation (2020) as another example. The foundational level of these planning efforts is a collaborative Health in All Policies (HiAP) approach to health equity, intended to integrate and articulate health considerations into policymaking across sectors to improve the health of all communities and people. HiAP recognizes that health is created by a multitude of factors beyond healthcare and, in many cases, beyond the scope of traditional public health activities.  DC Health has an established vision for DC to become the healthiest city in America and operates under five strategic priorities aimed to achieve health equity. 

• Promote a culture of health and wellness

• Address the social determinants of health

• Strengthen public-private partnerships

• Close the chasm between clinical medicine and public health

• Implement data driven and outcome-oriented approaches to program and policy development.

Pre-pandemic, there were incremental shifts in clinical care delivery, payment models, and public health strategies to drive improved quality of care, create opportunities to identify and address the social needs of patients, and enable a broader reach of interventions through policy change.  The pandemic has highlighted strengths in the District’s ability to rapidly develop, modify, implement and evaluate programs and policies through data driven and outcome-oriented approaches.  It has also exposed opportunities for continued improvement towards the goal of achieving health equity. 

The COVID-19 pandemic response triggered a new mode of operating at both macro and micro levels and demonstrated how the District can plan, implement, monitor, and evaluate complex programs, service delivery, and policies at a much faster pace than pre-pandemic times. The response also demonstrated the importance of having a workforce that can be nimble and innovative enough to operate successfully through significant change and uncertainty. The importance of leveraging community partnerships and the current appetite for bold public health action at all levels including laws, regulations, and institutional policies was emphasized. DC Health, as the state health agency and the primary public health responder for this emergency, devised a framework for the recovery of the District’s healthcare ecosystem through five components of focus: health planning, health workforce, health information technology, health care facilities and community health services. Undergirding efforts to enhance health through these five components is the need for application of an equity informed and structural determinants of health lens, due to the limitations of public health and health care alone to improve health. Addressing health literacy and acknowledging the varying levels of interventions and “touch” needed to reach District residents is even more important now, due to the shift in health care from in-person health service to virtual environments. Related to this, we must expand reach to meet communities where they are, thinking critically about how various systems in place can adapt practices to engage individuals, for example not only through expanded hours and telehealth, but more importantly through cultural sensitivity. National recognition by the American Public Health Association (APHA), American Medical Association (AMA) and the Centers for Disease Control and Prevention (CDC) amongst other institutions, of racism as a public health crisis or threat underscores the need to recognize that cultural sensitivity and affirmation have been inconsistent in health settings and have contributed in part to the pre-existing, disparate health-seeking behavior and health outcomes among racial and ethnic minority populations, the vulnerable and underserved. Individuals who experience this discrimination or a lack of sensitivity are less likely to re-engage with the health care system and are at increased risk for higher chronic disease burden, and as we have seen with the COVID-19 pandemic, at a greater risk for disproportionate impact in large part because of that increased burden at the outset. Addressing these issues of racism and cultural sensitivity is important because of the disproportionate impact of COVID-19 on people of color for the achievement of health equity in the District. Moving forward in a post-pandemic era, state health agencies and health care systems should include more strategic alignment and proactive engagement with partners, including interagency and public private partnerships, and especially non-traditional partners to ensure inclusion of public health priorities, equity and coordination with resident perspectives. Health workforce considerations should include the creation of pipelines to ensure the integration of local talent as well as quality and efficient healthcare delivery through enhanced utilization allied health workers, including Community Health Workers (CHWs). CHWs resonate with communities and can be an important and sustainable strategy in health planning, promotion and community engagement; their roles should be examined for optimization, including clinical support and social need support. Given the shortage of health providers, certain procedures, processes or interventions that traditionally require specific oversight should be re-examined for more flexible supervision options. Location agnostic approaches need to be adapted by agencies and health systems (to the extent

Public Health Emergency Plans

 The Title V program is actively involved in the development of emergency coordination plans with other public health programs across the Community Health Administration (CHA) and across DC Health. All hazards planning is coordinated by HEPRA and lessons learned from the H1N1, Zika and Ebola, were used to help shape the planning efforts for COVID-19. The State Title V Director provides oversight on all programs in CHA including immunization, home visiting, WIC, cancer and chronic disease prevention and the Primary Care Office, which enables emergency response planning across these various domains.  The Perinatal and Infant Health Division Chief also provides direct oversight on the Newborn Metabolic Screening (NMS) and Newborn Hearing Screening (NHS) programs which helps ensure that emergency planning considers the needs of the MCH population.