MCH Emergency Planning and Preparedness DC

The Health Emergency Preparedness and Response Administration (HEPRA) within DC Health serves as the Agency lead for emergency planning activities. HEPRA works in conjunction with DC Homeland Security and Emergency Management Agency (HSEMA) as well as other administrations within DC Health for planning and coordination of homeland security and emergency management efforts.

DC Health and HSEMA collaborate 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 22, 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

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 FY22, The Title V team continued to support strategy and development for communications and outreach strategies to encourage vaccine uptake among children and pregnant women, and address vaccine hesitancy among high-risk populations COVID-19 vaccination efforts. The team managed multiple funded FHQCs and Community Health Centers in efforts to promote and support the vaccination of residents.

As part of the pandemic recovery, the Title V team partnered with the Immunization division in the Community Health Administration (CHA) to support vaccination campaigns for COVID-19 booster shots among women and children and other vaccination campaigns for the pediatric population in the District. DC Health Immunization Division focused on catching children up with their routine pediatric immunizations. In April 2022, CDC released the annual Kindergarten coverage report and DC ranked last out of all states for coverage of 2 doses of MMR (78.9%), 2 doses of Varicella (78%), and 5 doses of DTaP (78.8%). This data, combined with the enforcement of the immunization attendance policy led DC Health to partner with the Office of the State Superintendent of Education in launching a campaign, No Shots, No School, to increase vaccine compliance of students and schools in all grades.

The District continued to partner 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. In the last quarter of FY22, 14 new chain pharmacy vaccine providers were enrolled as COVID-19 providers in the District. That’s an addition to pop-up clinics, walk-up sites, mobile vans, and COVID centers operating at various points throughout FY21-22 to ensure that residents and non-residents had equitable access to the COVID-19 vaccine. COVID centers also distributed personal protective equipment (PPE) and rapid antigen tests to anyone who physically visited the centers. These items were available to everyone including the Title V population. As of March 1, 2022, 95.7% of residents were partially or fully vaccinated.

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.

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. By March 1, 2022, 95.7% of DC residents were partially or fully vaccinated. HEPRA and the Title V team believe that the efforts listed above were instrumental to high vaccine rates and thus continued some efforts into the end of FY22 and the first quarter of FY23.

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 toward the goal of achieving health equity. 

DC Health, as the state health agency and the primary public health responder for this emergency, continued to implement the 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 the application of 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 healthcare systems should include more strategic alignment and proactive engagement with partners, including interagency and public-private partnerships, and especially non-traditional partners to ensure the 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 of 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.

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 in collaboration with other DC Health administrations. All hazards planning is coordinated by HEPRA and in FY22 efforts were targeted towards promoting vaccination and the distribution of PPE. HEPRA has begun actionable plans toward strengthening partnerships with CHA to develop emergency preparedness messaging campaigns for CHA programs and their existing relationships with local community organizations. The DC Title V team looks forward to engaging HEPRA in FY24 and beyond to develop, strengthen, and evaluate emergency plans to ensure that the Title V populations are protected during unexpected circumstances.  

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 and ensures that emergency planning considers the needs of the MCH population.