As pressure builds to reopen schools safely for students and staff, a growing number of districts are no longer content to wait on the sidelines for vaccines. They want to administer the vaccines themselves.
On that restive landscape, the Anchorage school district has stepped out ahead of the pack, assembling a large-scale community vaccination program that’s responsible for a significant share of all the doses administered in Alaska.
Standing up the clinic has been a high-energy mix of logistics, imagination, surprises, and quick-pivot responses. But the Anchorage school system’s experience has key lessons to offer other districts as they consider or plan to operate vaccination clinics.
Some school districts have partnered with their local health departments to vaccinate their staffs. Dozens of large districts, represented by the Council of the Great City Schools, wrote to President Joe Biden, noting that their skill, facilities, and community connections position them to make an impact in the fight against COVID-19. Los Angeles Unified has been approved by its county to serve as a vaccine provider.
But Anchorage is one of only a handful of districts nationally so far to actually launch its own vaccine program. To bring its 42,000 students and 8,000 staff members back to buildings safely, the district knew that pitching in on community vaccinations was key, even though nearly all its own staff members are not yet eligible.
“A lot of our students live in multigenerational households,” said Jennifer Patronas, the district’s director of health services. “For families to feel safe sending their child back to face-to-face learning, vaccinating grandma and grandpa is a part of that.”
Helping vaccinate health-care workers and the elderly had two additional benefits for the district: It would give its nurses valuable practice with administering the vaccines, and enable the state to move more quickly through its eligibility tiers, opening the doors sooner to teachers and school staff, said Superintendent Deena Bishop.
Fall planning: flow charts and “what ifs”
Anchorage knew it would conduct a clinic for its own staff members when they were eligible, and began planning in November. They chose their headquarters—a former shopping mall with a soaring atrium in the center—as the clinic site. The space is no stranger to large, one-time events; it served as a polling place in November and an emergency operations hub after a major earthquake in 2018.
District leaders made sketches and flow charts to configure the space for the clinic. They applied to the state to become an approved vaccine provider. They imagined administering about 200 doses a day. They didn’t know then that they’d end up vaccinating close to 1,000 people a day.
There’s a deep well of military experience among Anchorage school district staff, and it paid off in planning the vaccine clinic. Tom Roth, its chief operating officer, oversaw deployment of 3,500 troops to Iraq as a battalion commander in the U.S. Army. Patronas, the health-services chief, served 20 years in the U.S. Air Force. They, and many of their staff members, know a little something about moving large numbers of people through service and supply stations efficiently.
Roth and Patronas played lead roles orchestrating district staff from many departments to set the moving parts in motion. The district’s risk-management and legal teams developed a consent form for clients that released the district from liability. Department leaders made sure everyone was trained and ready to go, conducting a walk-through practice just before the winter break.
During that break, they got a call from the state department of health: Could the district expand its role and vaccinate more health-care workers? The district agreed.
The district team refined its planning. They would need 15 to 20 of their 108 registered nurses to run the vaccine stations each day, plus about 20 staff members from other departments to move clients through the lines, into the vaccination stations, and then into the observation areas where nurses would monitor them for allergic reactions.
The district created 2,000 appointments on the state’s vaccine signup system. By the next morning, every appointment was booked, with hundreds more on each day’s wait list. Patronas noticed that most of the people who’d signed up weren’t even eligible yet: seniors, many in their 80s and 90s. She grabbed the phone to the state health department. Can we do this? She got the nod. Go ahead.
Countdown to clinic opening: making all the moving parts work
Dozens of tables and chairs were ferried in. People from the technology department ran power lines and set up computers in the main room and in the observation area, so people could sign up for their second doses while they awaited allergy clearance. The Wi-Fi was sufficient, since several hundred people normally work in the building. Supplies of masks and gloves were checked and replenished. Maintenance crews built space dividers from PVC pipe and plastic sheeting, and posted outdoor signs directing clients where to go. The communications staff created indoor signs.
At noon on Jan. 6, the clinic opened its doors. School security officers worked the lines outside, answering questions and troubleshooting. Portable heaters were hustled in to keep people warm. Inside, bus drivers and other staffers greeted people and funneled them into different lines to register or to wait for vaccines. At the 10 vaccine stations, nurses took health histories, injected doses, and entered data on each client. Custodial staffers disinfected each station as clients moved on to the observation area.
“A lot of this is about managing the movement of people, about taking care of them, being friendly, explaining things,” Roth said. “It’s that human connection.”
Within hours, it became clear that hundreds of people were showing up at the district’s clinic without appointments. Many didn’t have good computer access or understand how to navigate the tricky signup process. But there they were, hoping for vaccines. Suddenly, the district was running a walk-in clinic.
- Design your clinic for the least-capable technology users. Plan to have staff helping at computers for registration and second-dose appointments.
- Plan ahead for walk-in clients. Even if your clinic is appointment-only, you might get walk-ins. Decide in advance how – and whether – you can handle this.
- Set aside space for an observation area where medical staff can monitor clients for allergic reactions. You’ll need enough space for dividers and social distancing. Staff can also help clients schedule second appointments while they’re waiting.
- Assign sufficient staff to serve as helpers. You’ll need them to create a welcoming environment and guide clients through the process.
- Plan for sufficient bandwidth and computers for the clinic. Be prepared to step it up if you get far more clients than anticipated.
- Draw on all segments of your staff. This spreads the impact across departments, and capitalizes on a wide range of talents.
- Relationships with local and state health agencies are essential. Guidance and support from public-health professionals is key.
- Be proactive about equity. Reach out to faith-based groups and other local organizations that represent the diversity of your community.
The team pivoted quickly, adding 10 more vaccination stations and reworking its flow chart. Now there would be a check-in station at the beginning, where someone would direct those with appointments into a vaccine line, and those without them to registration tables.
The district realized it had overestimated its clients’ computer skills. The team had set up tables with computers where people could register or make second-dose appointments. But most couldn’t do that without assistance, so the team assigned someone to help at each table, said Tina Smith, an IT specialist in the health services department.
Superintendent Bishop, who worked some of the stations herself, said she often had seniors throw up their hands when they tried to manage the computers themselves. “A lot of times, it was, ‘I can’t even see the screen, honey, you just do it for me,’ ” she said.
Refining the plan for equity, allergies
The first days of the clinic also showed the district that it had to refine its ways of monitoring clients after their vaccines. It needed a way nurses could immediately differentiate those with lower risk of allergic reaction—those who had to wait only 15 minutes—from those at higher risk, who had to stay for 30 minutes. They tried handing each client an index card, but that didn’t work. They ended up pasting bright red sticky labels on the clothes of the higher-risk clients.
District leaders also noticed that most clients were white, in a district where most students are of color. Bishop alerted her equity department, which reached out to churches and faith-based groups, and Black sororities, and soon the clinic started seeing more Black and Asian clients come through its doors.
The district conducted a follow-up clinic on Jan. 28, and is conducting another, larger one this week, to give people their second doses. By the end of the day Feb. 3, the Anchorage school district had administered 7,394 doses of the Pfizer and Moderna vaccines, 13 percent of all those given in Anchorage—a municipality the size of Delaware—and 5 percent of the doses given statewide. Another round of first-dose clinics is scheduled later this month.
Moving into second-dose clinics
The second clinics were configured a bit differently, since no registrations were involved. Clients move more quickly through the vaccine stations, so the observation areas were expanded. Since elementary-age students are phasing back into school buildings now, the second clinics use more volunteer preservice nurses from local colleges to ease the load on the district’s own registered nurses.
Some education activists around the country are hoping that more districts embrace roles as vaccine providers.
“We are eager to do our part,” said Michael Casserly, the executive director of the Council of the Great City Schools, which represents 76 of the country’s largest districts. “It seems to me that the nation can use all the help it can get right now.”
Michael Magee, the president of the superintendents’ group Chiefs for Change, said that even though there are many things to think through, from liability to seamless coordination with a state’s vaccine data tracking system, he believes most districts can stand up their own vaccination programs, and have much to gain—and to contribute to their communities—by doing so.
Smith, Anchorage’s health-services IT director, said that was certainly her experience.
“It was one of the most rewarding experiences of my life to be able to give back to the community like that,” she said. “We do flu clinics, but they feel less urgent. The amount of gratitude was just profound.”
