Lacy Fehrenbach
Former Deputy Secretary of Health for COVID-19, Current Chief of Prevention, Department of Health, State of Washington
A Mile Wide and…A Mile Deep
Lacy Fehrenbach served as the Deputy Secretary for COVID-19 Response at the Washington State Department of Health. In this role, she advised the Secretary of Health, Governor, and other policymakers on key response activities and policies; provided leadership across the Department on public health activities in the pandemic response; and coordinated with federal and state agencies, tribal and local health departments, health care providers and organizations, community partners, and the private sector to adequately resource and carry out response operations during the emergency.
Getting Services to Everyone
Fehrenbach and her team partnered with Washington’s Accountable Communities of Health (ACHs) to develop community care hubs to support and connect people with services that helped them stay home and stay healthy during isolation or quarantine.
“We used all of the funding available to us to support COVID response efforts. At different points in time, we used funding from CDC as well as funding from different COVID packages that came through the federal government. Some aspects of our response were funded or reimbursed by FEMA dollars.”
Beyond trusted messengers, the other community engagement project we had is called “Care Connect”, which was a program to help people who were following our public health guidance, voluntarily isolating or quarantining at home, and needed some type of support to do that. When the case investigator or contact tracer reached out to them, as part of the interview, they would ask, ‘Are you able to isolate or quarantine at home?’ If not, we had facilities in Washington State where they could choose to go to.
Most people chose to stay home for quarantine or isolation, but many needed help with food, medical supplies, or other services in order to do so. These folks were referred to Care Connect.
“Food and health supply kits were commonly requested, but in some cases, we provided rent assistance or cash to help people who were worried that they would not be able to make ends meet.”
The program that provided these resources was run on the ground by community health workers who were linked into community care hubs in Accountable Community Health regions across the state. The CHWs were trusted members of the community and also people that could help build trust in government, build trust in the response, and answer people’s questions and connect them to the resources they needed.
“We still support that program and are trying to expand it for broader social and safety net programs to help people get whatever they need – housing, employment supports, behavioral health treatment — to get healthy and help their family thrive.”
A Bright Spot
Fehrenbach and her team worked to vaccinate as many Washingtonians as quickly and equitably as possible.
“Probably, one of the biggest successes we had was with the initial rollout of the primary series of COVID-19 vaccines in Washington State. It’s one of the most amazing things I’ve seen in my career to vaccinate 70% of adults, and most of them twice. Certainly, there are many things we could have done better, but I do think it was a very big bright spot in a pretty tough three years for our state and the world.”
With new vaccines being developed, the department of health worked with community-based organizations in advance of the vaccination rollout.
“I think we knew that whenever the vaccine became available, there would be some concern about how quickly it was developed, and the mRNA vaccines were a new type of product. We started educating the public before the vaccines were even approved and available and then planned for, and we were fortunate to get funding through a combination of state and federal dollars for a fairly intense media campaign, as well as a community engagement approach.”
Our communications experts describe it as ”a mile wide and a mile deep.” The “mile wide” was how broadly we ran our PSAs and social messages for the general public – for example, when the Seahawks were playing, or during the Apple Cup, or in primetime. We had a different level of investment than public health has ever had, so we were able to buy ad spots.
The “mile deep” was that we funded several dozen community-based organizations to help us find the trusted messengers, which might be people, a local print publication in that community, or a media account. They helped us use those trusted messengers to increase vaccine confidence in those communities.
“For community engagement, we started with a small group of maybe 30 or 40 organizations. Over time, as we got more resources through the pandemic, it expanded, and they were funded to help take messages and create culturally meaningful messages. The trust building started in summer of 2020 with health and safety measures like wearing masks, washing hands, keeping distance, and how and when to get tested. Then, it shifted to vaccine messages, including how the vaccines worked, where to get vaccinated, and what to expect, and – over time – to treatment messages. We provided support for translation to more than 30 languages.”
“As vaccines rolled out, we formed an even broader Vaccine Implementation Community Collaborative, comprising of members who are involved from many different sectors in uplifting communities that have experienced the devastating impacts of COVID-19. The Community Collaborative helped in co-designing vaccination recovery efforts with the goal of eliminating further harms on Black, Indigenous, communities of color and all those facing harm due to systemic racism and oppression.”
“Operationally, we also engaged multiple strategies and partners. The governor’s policy director, the Department of Health, and Challenge Seattle, a group convened by one of our former governors – Christine Gregoire – of the large employers in the region, and other private sector partners. The VACCS Center created public-private partnerships to support the administration of 45,000 COVID-19 vaccine doses a day in the safest, fastest, and most equitable manner. Private sector experts helped streamline our mass vaccination sites, build and refine our online vaccine locator, improve our vaccine ordering process efficiency, facilitate transportation to vaccinations, and more. By the time vaccine supply opened up, we were logistically ready to vaccinate more than 45,000 people per day in support of our goal. The willingness of everyone to lean in, be innovative, and work together made a huge difference.”
“In addition to our mass vaccination efforts, our community partners, including those community grantees and the Community Collaborative helped us set up small Care-a-Van pop-up clinics in those at trusted organizations or locations to help us close equity gaps. The Community Collaborative and Care-a-Van programs have since expanded to provide other health services like Mpox, flu, and childhood vaccines, chronic disease screenings, and distribution of naloxone for opioid overdose reversal among communities experiencing health inequities.”
Pandemic Planning vs Pandemic Reality
Washington had a pandemic plan posted long before the advent of COVID-19, but buy-in and adaptable guidelines were another story…
“There had been a big investment in pandemic planning, and the U.S. and all states had a plan, including us. The plans include tools for making some of the difficult decisions to prevent spread of disease, such as when you take the next level of intervention with non-pharmaceutical interventions, things like wearing masks or stopping mass gatherings or closing schools.”
“Washington’s plan had been on our website for a long time, and it said that we were going to have to do things like wear masks, and we might have to close schools or certain parts of the economy where transmission is happening or most likely. Absent the reality of a pandemic, people probably didn’t pay very much attention to that, because we got very little feedback at all over time on any of those strategies. As the pandemic went on, there was a lot of pushback around a number of those strategies, especially when there was a policy in place around them, whether it was mask wearing, or limited occupancy of businesses.”
“And the other thing that was not in that plan, or most any plans that I know of, is how you actually release or adjust non-pharmaceutical interventions over time. They were written in a way that said, here are all the things you can do to stop spread or slow spread. That helped in the late January through April or May 2020 timeframe. But that didn’t help us survive a respiratory virus pandemic that lasts for multiple years.”
“Even in late spring of 2020, as cases receded here, but when hospitals in New York City and elsewhere on the east coast were overwhelmed, and we were seeing mass death in multiple countries, there was already pressure to ‘reopen’ or get back to normal, and there were no guidelines or guideposts or roadmap for how to do that.”
Simultaneously, different approaches among states made it more challenging to implement a statewide pandemic response.
“There was not the level of coordination that we expected between federal, state, and local government, based on exercises or past pandemics or other health emergencies. What happened was a lack of consistency across states with states taking very different approaches. On one hand, we have some evidence now, in retrospect, about what types of things worked and didn’t work so well. However, in the moment it fed into division and partisanship, even creating conflict in some communities, and even capitalized on the fears that people had. This made it very hard to take any policy action.”
“Absent a consistent national approach, we looked to other states and countries to see how they were approaching the pandemic and found other states with whom we shared borders, similar pandemic response goals, disease trends and demographics to strategize and figure out how to approach complex decision making together with them.
“In Washington State, for many of our policies, we tried to coordinate with California and Oregon. There were a handful of other western states and Canadian provinces that we engaged as well as states from across the country that helped on certain aspects, such as school health measures. Even with this coordination, lack of consistency in messaging and approaches, made the response really difficult and damaged trust in public health and government.”
We remained focused on our state’s goals to reduce severe disease and death from COVID-19, ensure access to timely testing and treatment for COVID-19, protect the healthcare system while protecting our economy, vaccinating as many Washington residents as quickly and equitably as possible, and promoting resilience of our health workforce and the residents and communities in our state.