Whole Community COVID Vaccination Planning and Implementation with Champions of Our AFN Populations

1.       Clay County Public Health Center (CCPHC) located in Liberty, MO provides a wide range of services to all Clay County residents. Data from the 2019 US Census indicated that there were 249,948 people in 2019. 121,062 were males and 128,886 were females. There was a total of 59,938 people 18 years of age and under, 153,940 people were between 18 and 64 years old, and 36,070 were 65 and over. In 2019, about 12,000 Clay County residents were born in a country other than the U.S.

2.       In early 2020, COVID 19 pandemic cases were identified in Clay County. By the end of the year, nationwide COVID-19 incidence count topped 200.000 cases/day and death count surpassed 2,000/day. Seniors and people with underlying health conditions were the most at-risk for COVID infection, complication and death. Operation Warp Speed in coordination with Pfizer, Moderna and Johnson & Johnson manufactured vaccines that are highly effective in preventing infection, hospitalization, and death. The CDC implemented a phase and tier approach vaccine distribution and administration. Several people in the eligible phase and tier were facing barriers to receiving the life-saving vaccines. Before the vaccines were readily and widely available, CCPHC and its partners started discussing plans to administer vaccines to people who were eligible, including the most vulnerable and at-risk populations to reduce the high burden of the disease. CCPHC and Clay County partners applied the Whole Community (WC) planning approach on the premise that effective planning must include participation from all stakeholders in the community early on in the planning phases.  The team identified Champions of vulnerable, at-risk, and underserved populations.

3.       The goal of this initiative was to promote vaccine administration equity by ensuring that all Clay County community members have the opportunity to receive their dose(s) of the COVID-19 vaccine saving lives and reducing the suffering of our community members. To accomplish this end state, the first objective was to initiate a Whole of Community (WC) partnership approach with known and recommended Key Leaders, influencers, and Champions of Clay County's Diverse Communities (DC), Vulnerable Populations (VP), and Access and Function Needs (AFNs) to incorporate their experience and thoughts in developing WC plans and synchronizing WC efforts. The second objective was to identify three types of barriers (actual, perceived, and future) to equal and equitable opportunities to receive the vaccine and develop strategies to overcome the barriers. The third objective was to generate support from diverse community leaders, influencers, and champions to format, translate, and disseminate health-related messaging.

4.    Activities that were implemented include the identification of experienced points of contact to work with our vulnerable communities as well as champions for our DC/AFN/VP populations. CCPHC hosted a virtual meeting on January 26^th, 2021 to discuss the goals and objectives with a focus on three types of barriers: Actual (A), Perceived (P), and Future (F) Barriers. Based on barriers identified, champions went to work to develop solutions.  Many solutions were rapidly solved with the collaboration of the Operation Safe team.  Examples of solutions included how do we (as a Whole Community) solve transportation of our Senior Vulnerable Population (SVP) to the Operation Safe mass vaccination site with our Clay County Senior Services (which had AFN capable vehicles) and using our school district busses. Operation Safe was a high throughput health system composed of CCPHC, Clay County hospitals, city government and CERNER that activated mass vax clinics when vaccines were first rolled out from January to May 2021. CCPHC coordinated with senior housing facilities, schools, and city government to bus in vulnerable seniors with no transportation to Operation Safe clinics to receive their first and second doses of Pfizer vaccines. To increase equitable access to the COVID-19 vaccines breaking barriers identified by DC's key leaders and champions, CCPHC contracted with Heart-to Heart International (HHI) to provide mobile vaccine clinics at or near diverse community or vulnerable population neighborhoods. CCPHC Planner and volunteer planner worked with diverse community (DC)'s champions to format health messages on COVID mitigation measures and public health emergency orders in a way that is easy to understand by their community members. Some messages were translated and disseminated by community champions and posted on CCPHC website.

5. Results/Outcomes: In attendance to the Clay County vaccine distribution whole community effort meeting, were representatives from Liberty School, William Jewell College, Synergy Services, Metro Lutheran Ministries, Life Unlimited, Clay County Senior Services, YMCA, Spanish population, Vietnamese, Somali population, Clay County Emergency Management, CCPHC, and Jewish Vocational Services. Several actual and perceived barriers and possible solutions were identified. Through Operation Safe, 450 vulnerable senior citizens (who were provided a ride) were vaccinated. Through Operation Safe, several English as Second Language resident were served (vaccinated) using Stratus highly effective mobile iPads connected to a live vaccine trained interpreter. As of 11/30/21, Heart-to-Heart International (HHI) administered 2,078 vaccines at many locations throughout Clay County working with diverse community leaders and champions and other community partners. Several health messages were translated in Somali, Spanish, Vietnamese, Arabic, and Chinese and disseminated in these communities by trusted members.

6. The whole community approach framework has been successfully implemented due to identifying the right people (some of them were previously involved with the health department in other initiatives), building trust with them and involving them early in the planning and implementation processes. Community individual and organizational partners provided great input on identifying barriers to receiving the COVID-19 vaccine in the community they represent and proposed strategies to address the barriers. They also were involved in formatting and disseminating education materials and in vaccine uptake promotion. The process is o going and CCPHC is using the framework to work with faith leaders to promote COVID-19 vaccine education and uptake.

7. As mentioned earlier in point 5. The whole community planning and intervention approach helped to identify community champions. Marginalized and at-risk populations received improved access to the vaccine.

8. CCPHC website: https://www.clayhealth.com/279/COVID-19-2019-Novel-Coronavirus

1.   a.) Clay County Public Health Center is located in Liberty, Missouri. The county is part of the Kansas City Metropolitan area and had 249,948 residents, according to the 2020 Census. Whites comprised 86.2% of the population, 7.3% were black or African American, 2.5% were Asian alone. Hispanic or Latino residents comprised 7.1% of the population. Foreign born persons represented 5.1% (12,000 people). Persons 65 years and over represented 14.4% of the population (36,000 people). 8.4% of the population were with disability, under age 65 years. Persons without health insurance, under age 65 years represented 9.3%. 9.1% were in poverty. Source: County Quick Facts: Clay County Missouri, retrieved from July 2019 from https://www.census.gov/quickfacts/claycountymissouri

b.       Statement of the issue and health equity: In early 2020, COVID 19 pandemic cases were identified in Clay County. By the end of the year, nationwide COVID-19 incidence count topped 200.000 cases/day and death count surpassed 2,000/day. Seniors and people with underlying health conditions were the most at-risk for complication and death. Operation Warp Speed in coordination with Pfizer, Moderna and Johnson & Johnson manufactured vaccines that are highly effective in preventing infection, hospitalization, and death. The CDC implemented a tiered-approach vaccine distribution and administration system. Several people in eligible tiers were facing barriers to receiving the life-saving vaccines. Before the vaccines were readily and widely available, CCPHC and its partners started discussing plans to administer vaccines to people who were eligible and taking into account the most vulnerable and at-risk populations to reduce the high burden of the disease. Targeted vulnerable and at-risk population included seniors with no transportation, non-English speaking (English as second language) populations. According to US Census ACS 5-year 2015-2019, there were 12,000 Clay County residents that were born in a country other than the United States. CCPHC staff adopted the Whole of Community partnership approach on the premise that effective planning must include participation from all stakeholders in the community, including vulnerable, at-risk, and underserved populations.

The goal of the practice was to promote vaccine administration equity by ensuring that all Clay County community members understand the value and have the opportunity to receive their dose(s) of the COVID-19 vaccine saving lives and reducing the suffering of our community members. To accomplish this end state, the first objective was to initiate a Whole Of Community partnership approach with known Key Leaders and influencers of Clay County's Diverse Communities (DC), Advocates/Champions of our Vulnerable Populations (VP), and Access and Function Needs (AFNs) to incorporate their experience and thoughts in developing whole of community plans and synchronizing efforts. The second objective was to identify barriers to equal and equitable opportunities to receive the vaccine and develop strategies to mitigate them. The third objective was to generate support from diverse community key leaders or influencers to format, translate, and disseminate health messages in their communities. Through the implementation of the whole community intervention approach, the objectives mentioned above were achieved. CCPHC was able to conduct a community forum with diverse community and access and functional needs population key leaders and champions to brainstorm barriers that people in their communities have to receiving the vaccines and propose strategies to overcome the barriers. Following recommendations from diverse community champions, CCPHC and its partners implemented a couple of winnable battles. They bused in and facilitated the inoculation of 450 vulnerable seniors at Operation Safe mass vax clinics. They coordinated with Clay County Senior Services to provide seniors with free rides to Operation Safe clinics. Another strategy that was implemented was conducting mobile clinics where ESL and other AFN population live or congregate. CCPHC contracted with Heart-to-Heart International to conduct mobile COVID vaccination clinics throughout Clay County. 2078 shots were administered. Finally, several diverse community advocates contributed to formatting and disseminating health messages to their constituents to educate them of mitigation measures and promote vaccine uptake.

Past experiences addressing equitable access to medical countermeasures were limited: Mass prophylaxis operations served access and functional needs populations only if they were able to make it to the vaccination site. Wheelchairs were available for clients with mobility issues to help them navigate through the registration and dispensing or vaccine administration processes. Proprio telephone interpretative services were utilized to interact with ESL clients. Spanish and Vietnamese versions of the registration and dispensing forms were available for ESL clients. Pictograms and other sign language materials were available for people with hearing impairment. Contrast with current practices, past operations did not implement strategies to overcome transportation barriers that prevented vulnerable, marginalized, and low-income residents from receiving life-saving interventions even if they were eligible and willing to be inoculated. In the past, public health emergency response planning activities did not include representatives or champions of diverse community to advocate for their population. Engaging early diverse community key leaders and advocates and other partners in the current emergency response planning enabled CCPHC to offer equitable opportunities to residents for receiving vaccines, especially the most vulnerable ones by either facilitating transportation to mass vax sites or meeting them where they congregate or live. In addition to helping overcome transportation barriers, the whole community partnership planning approach helped to improve messaging and increase communication outreach to AFN populations by formatting health messages that are easy to understand and process.

2.       The current practice is an improvement because it addresses more effectively health equity. Previous emergency response planning involved traditional partners including emergency management, hospitals, and volunteer organizations with less emphasis in addressing barriers that prevent AFN populations from receiving medical countermeasures. The whole community participation strategy that describes the current practice derives from FEMA planning principle. Following the principle, CCPHC planners identified the right core team and engaged the whole of community in planning. CCPHC went further and engaged diverse community influencers in the execution of the plan. Some key leaders contributed to formatting and translating health messages and information that are easy to understand by their community members and helped spread the message in their community. Other influencers served as motivators and interprets during clinic operations.

According to FEMA planning principle, planning that is for the whole community and involves the whole community—is crucial to the success of any plan…. Community leaders have a keen understanding about their community's needs and capabilities and are a valuable stakeholder that can support the planning process in many ways. Community-based planning should also include notifying affected, protected groups of opportunities to participate in planning activities and making such activities accessible to the entire community (e.g., use of interpreters and translated announcements).” Source: FEMA, Developing and Maintaining Emergency Operations Plans, Page 4-4  https://www.fema.gov/sites/default/files/2020-07/developing-maintaining-emergency-operations-plans.pdf

In addition, Planning must include participation from all stakeholders in the community. Effective planning ensures that the whole community is represented and involved in the planning process. The most realistic and complete plans are prepared by a diverse planning team, including representatives from the jurisdiction's departments and agencies, civic leaders, businesses, and organizations (e.g., civic, social, faith-based, humanitarian, educational, advocacy, professional) who are able to contribute critical perspectives and/or have a role in executing the plan. The demographics of the community will aid in determining who to involve as the planning team is constructed. Including community leaders representative of the entire community in planning reinforces the expectation that the community members have a shared responsibility and strengthens the public motivation to conduct planning for themselves, their families, and their organizations. For example, it is essential to incorporate individuals with disabilities or specific access and functional needs and individuals with limited English proficiency, as well as the groups and organizations that support these individuals, in all aspects of the planning process. When the plan considers and incorporates the views of the individuals and organizations assigned tasks within it, they are more likely to accept and use the plan.” Page 1-2

3.       Engaging the Whole Community in Planning is evidence-based. FEMA, Developing and Maintaining Emergency Operations Plans, Page 4-1 to 4-26: https://www.fema.gov/sites/default/files/2020-07/developing-maintaining-emergency-operations-plans.pdf

1.       The goal of this initiative was to promote vaccine administration equity by ensuring that all Clay County community members have the opportunity to receive their dose(s) of the COVID-19 vaccine saving lives and reducing the suffering of our community members. To accomplish this end state, the first objective was to initiate a Whole of Community (WC) partnership approach with known and recommended Key Leaders, influencers, and Champions of Clay County's Diverse Communities (DC), Vulnerable Populations (VP), and Access and Function Needs (AFNs) to incorporate their experience and thoughts in developing WC plans and synchronizing WC efforts. The second objective was to identify three types of barriers (actual, perceived, and future) to equal and equitable opportunities to receive the vaccine and develop strategies to overcome the barriers. The third objective was to generate support from diverse community leaders, influencers, and champions to format, translate, and disseminate health-related messaging.

2.       Steps to achieve the goals and objectives: Identification of experienced points of contact to work with our vulnerable communities as well as champions for our DC/AFN/VP populations. CCPHC hosted a virtual meeting on January 26^th, 2021 to discuss the goals and objectives with a focus on three types of barriers: Actual (A), Perceived (P), and Future (F) Barriers. Actual barriers-barriers that someone knows prevents a person from receiving the vaccine; Perceived barriers- barriers that exist in other regions/communities that may exist in our communities; and Future barriers –barriers that would/could occurs as we move into the next phases of vaccine distribution. Based on barriers identified, champions went to work to develop solutions.  Many solutions were rapidly solved with the collaboration of the Operation Safe team.  Examples of solutions included how do we (as a Whole Community) solve transportation of our Senior Vulnerable Population (SVP) to the Operation Safe mass vaccination site with our Clay County Senior Services (which had AFN capable vehicles) and using our school district busses. Operation Safe was a high throughput health system composed of CCPHC, Clay County hospitals, city government and CERNER that activated mass vax clinics when vaccines were first rolled out from January to May 2021. CCPHC coordinated with senior housing facilities, schools, and city government to bus in vulnerable seniors with no transportation to Operation Safe clinics to receive their first and second doses of Pfizer vaccines. Schools and city government provided the buses and drivers. CCPHC and partners coordinated with Clay County Senior Services to provide seniors with free rides to Operation Safe clinics to get their COVID vaccines.  To increase equitable access to the COVID-19 vaccines breaking barriers identified by DC's key leaders and champions, CCPHC contracted with Heart-to Heart International (HHI) to provide mobile vaccine clinics at or near diverse community or vulnerable population neighborhoods. CCPHC provided HHI with a list of diverse community POCs (shared by partners) and senior housing facilities managers to coordinate vaccine promotion, registration and administration in their community. The Vietnamese POC assisted HHI in promoting and setting up the vaccination event in their community. They also served as an interpret during clinic operations, In addition, CCPHC Planner and volunteer planner worked with diverse community (DC)'s champions to format health messages on COVID mitigation measures and public health emergency orders in a way that is easy to understand by their community members. Some messages were translated and disseminated by community influencers and posted on CCPHC website. DC's influencers in the vicinity of Operation Safe clinic in North Kansas City helped to format, translate in Spanish, and disseminate messages to their community promoting Operation Safe clinics as they deployed mobile wireless IPADs connected to a Live Vaccine trained interpreter to assist ESL clients from the time they arrive at the mass vax site to going through all the vaccination stations.

   Results/Outcomes: CCPHC, partners and diverse community champions Identified actual and perceived barriers and possible solutions including: Lack of transportation (recommendations: Contract transportation services to pick residents up to vaccine clinics. Identify free/reduced rate transportation services that will guarantee round-trip for AFN accessible vehicles. Host clinics where vulnerable populations are or congregate); any contact with domestic violence victim's primary care physician could trigger location notification to the abuser if they have access to the health insurance for the family (current CCPHC and HHI registration does not trigger abuser's medical provider); lack of insurance (recommendation: Provide education in multiple languages that the vaccine administered by CCPHC, HHI and most of providers is free and also that some providers may charge an administration fee); language barrier for less than English proficient in: Registration, notification, vaccine reception, and vaccine administration (recommendation: Use interpretative services such as Propio, Stratus video that connect to a live vaccine trained interpreter); general diverse community education: opportunities to get vaccinated -when, where, how (recommendation: Community engagement with Key Leaders to point their communities to visit the Clayhealth.com website- recommended that all partners send Clayhealth.com link to all communities within their social media connections and through all graphic/poster outlets); a lot of our population is only at a 3rd grade reading level (recommendation: Take information from CDC and health department and develop or format materials that are understandable to them); lack of internet access. About 8% of county population does not have Internet or smartphone access (recommendation: Provide alternative methods for registration- preferably voice calls); undocumented residents are fearful to seek any type of healthcare (recommendation: Community engagement with Key Leaders to point their communities to visit the Clayhealth.com website- and highlight that no medical provider is needed to register and send this message via all available communication venues); vaccine hesitancy is an issue with all populations (recommendation: Review CDC websites and MO HSS websites for information on vaccine benefits. Promote vaccine facts and benefits using all means); vision impairment prevents internet access (recommendation: Telephonic registration and notification for 1st and 2nd dose); a degree of uncomfortableness traveling outside of the local community due to language and comfort (recommendation: Go to places where people are by activating fly away clinics); employer may not reimburse employee for lost time/wages to travel to receive the vaccine (recommendation: Go to places where people are, including workplaces by activating fly away clinics); registration that includes address may be uncomfortable for those who were persecuted/threatened in their native country (recommendation: Only request zip code when attempting to measure performance).

Through Operation Safe, 450 vulnerable senior citizens (who were provided a ride) were vaccinated. Through Operation Safe, several English as Second Language resident were served (vaccinated) using Stratus highly effective mobile iPads connected to a live vaccine trained interpreter. As of 11/30/21, Heart-to-Heart International (HHI) administered 2,078 vaccines at many locations throughout Clay County working with diverse community leaders and champions and other community partners. Several health messages were translated in Somali, Spanish, Vietnamese, Arabic, and Chinese and disseminated in these communities by trusted members.

3.   The practice is ongoing. The whole of community partnership programming started in January 2021 when COVID-19 vaccines were first made available for individuals in CDC phase 1 category: Long-term care facility residents and staff, health care workers, first responders and high-risk individuals. The meeting with community partners to discuss the goals and objectives of the practice was held on January 26, 2021. Representatives from Liberty School, William Jewell College, Synergy Services, Metro Lutheran Ministries, Life Unlimited, Clay County Senior Services, YMCA, Spanish population, Vietnamese, Somali population, Clay County Emergency Management, CCPHC, and Jewish Vocational Services Vulnerable seniors with no transportation were bused into Operation Safe mass vax clinic on March 1 and 29 2021. Heart-to-Heart international started running mobile COVID vaccination clinics in Clay County underserved areas on behalf of CCPHC in March 2021. They will continue until the end of the contract on December 31st, 2021. Afterwards, CCPHC staff will take over and conduct community vaccination events in areas of need. Prior to the meeting with community members on January 26^th, 2021, CCPHC was working Clay County Emergency Management to engage diverse community key leaders to format, translate, and disseminate key health messages. This activity continues as needed

4.   a) LHD's role: Clay County Public Health Center's staff and volunteer planner identified key leaders, influencers and advocates of diverse communities, access and functional needs populations and at-risk population. Some of them worked with CCPHC in past initiatives. Other were recommended by partners. CCPHC hosted the community emergency response meeting to strategize and synchronize efforts and plans to give opportunity to all Clay County residents to receive the COVID vaccine. As part of the whole of community partnership and planning practice, CCPHC coordinated Operation Safe vaccination efforts with Clay County hospitals, city governments and CERNER. CCPHC staff took the lead in coordinating transportation of vulnerable seniors to and from Operation Safe mass vax clinics. CCPHC leadership contracted with Heart to Heart International to conduct fly away COVID vaccination clinics in underserved areas where our diverse communities live or congregate. Finally, CCPHC staff engaged diverse community key leaders to process health messages and public emergency orders in a format that is easier to understand and digest. Diverse community champions translated and disseminated health messages in their communities.

Involving and engaging partners with diverse background in COVID response planning help to identify barriers and solutions to providing equitable opportunity to Clay County residents to receive the vaccine.                                                     

  b.) To ensure equitable, meaningful, and representative collaboration with target populations, CCPHC staff and volunteer planner invited key leaders and champions of our AFN, diverse community, vulnerable, and at-risk populations. Agencies that serve our target population were invited as well to be part of the whole of community response planning team to ensure that the needs of the populations they represent are met. They were given the opportunity to identify actual and perceived barriers that adversely impact vaccine uptake in their community and propose strategies to overcome the barriers. In addition to involving and engaging representatives of our target populations in response planning, they were engaged in the implementation phase. Some of them coordinated COVID vaccination clinics in their community, other helped to format, translate, and disseminate health information to promote vaccine education and uptake

3.       There are no start-up costs associated with this practice. Costs associated are staff time of the Epidemiology Program Manager, Health Planner, and the Community Health Promotion Section Chief. Other costs associated with the whole of community programming derive from mobile clinic operations run by Heart to Heart International (HHI) throughout Clay County. CCPHC contracted with HHI initially to vaccinate hard-to-reach, underserved, and marginalized populations where they are at from March 2021 to December 31, 2021. As of 11/30/21, the cost was $109,160. The expenditure was covered by federal grant funding. In-kind costs include volunteer planner hours who helped connect with diverse community points of contact and keep them engaged. He facilitated the whole community planning conference. Other in-kind costs derive from buses and drivers provided by North Kansas City school district, Liberty school district, the City of Gladstone, and the City of Excelsior Springs. The buses were utilized to transport vulnerable seniors with no transportation to Operation Safe mass vax clinics. Other in-kind costs include volunteer time from representatives of diverse communities that coordinated vaccination clinics in their community and help format, translate, and disseminate health messages and info to their communities

1.    Through the whole of community partnership and planning practice, Clay County Public Health Center (CCPHC) and partners approached emergency response planning through the lens of equity. By engaging community leaders and agency representatives that serve diverse communities in response planning, they were able to provide meaningful and useful input as they have a keen understanding about their community's needs and capabilities. They identified perceived and actual barriers that prevent their community members from receiving vaccines and they provided actionable solutions to overcome the barriers.

Through the WoC planning approach in March 2021, 450 vulnerable senior citizens were provided a ride to Operation Safe clinics to be vaccinated. Several seniors were very grateful to be able to get the vaccine and some of them were in tears as they felt safer and would be able to see their grand kids. Over 2,000 people that live in hard-to-reach and underserved areas were administered the COVID-19 vaccine. They include ESL clients, people with transportation issues, and people with disability. They received their vaccine where they live or congregate. Through the WoC planning framework, several health messages and information were formatted, translated and disseminated in diverse communities by community leaders and champions to inform, educate and persuade their members about COVID mitigation measures and the benefits and facts of the COVID vaccine.

So, in general our objectives were achieved

As a reminder, the first objective of the initiative was to implement a Whole of Community partnership approach with known and recommended Key Leaders and influencers of Clay County's Diverse Communities (DC), Advocates/Champions of our Vulnerable Populations (VP), and Access and Function Needs (AFNs) to incorporate their experience and thoughts in developing whole of community plans and synchronizing whole of community efforts. The second objective was to identify barriers to equal and equitable opportunities to receive the vaccine and develop strategies to mitigate them. The third objective was to generate support from diverse community key leaders or influencers to format, translate, and disseminate health messages in their communities

We found that there is tremendous value in this type of WC planning synchronization.  Relationships with champions are critical now and in future engagement and incidents. Effectively engaging the community in the planning and implementation process of emergency response effort is key to the success of any plan. In the past our emergency response planning and execution involved traditional partners that participate in mass prophylaxis operations at one or two specific sites. Members of the community were not involved nor engaged in the planning process. As a result, their needs were not met.

2.       Evaluation: Effectiveness was evaluated by participation of our DC/AFN/VP communities in receiving their vaccine. 450 seniors were provided transport to the vaccination site. Heart to Heart International vaccinated over 2,000 people (diverse community, AFN, and other populations). We followed up telephone conversations with our diverse religious leaders where HHI conducted on-site fly away” vaccine clinic and they indicated that from their informal assessment that up to 90% of their members have received the COVID-19 vaccine.

Also, about 20 diverse community/access and functional needs and vulnerable population champions attended the Clay County vaccine distribution whole community effort meeting and provided meaningful input. The represented Liberty School, William Jewell College, Synergy Services, Metro Lutheran Ministries, Life Unlimited, Clay County Senior Services, YMCA, Spanish population, Vietnamese, Somali population, Clay County Emergency Management, CCPHC, and Jewish Vocational Services.

1.    Lessons learned in relation to practice: In practice, it's challenging to engage new community leaders. Unlike traditional partners, community leaders with no prior working relationship with the health department has trust issue. It's important to build that trust by being visible in their community, attending festivals, ethnic and other community events. It's equally important to have them understand the value of the partnership to get their buy-in. They need to grasp what's in it for them. Also, since community leaders have day jobs, they may not be available to meet with health department staff for any programming on regular business hours. It's vital to be flexible and work around their schedule and meet them where they are at. It's important to provide constant feedback, especially before and after the completion of a task that was assigned to them

2.    Lessons learned in relation to partner collaboration: When working with partners with different background, especially community leaders, make sure to elicit and take into consideration their input. Once you get their buy-in, they are more likely to take ownership of the task or project at hand and run with it. It's important to get them engaged in the implementation of plans by assigning them tasks that are important to them and their community.

3.    Cost/benefit analysis: We did not do a cost/benefit analysis. With the assistance and collaboration of partners, whole of community response planning and implementation may not add cost to the health department.

4.    Sustainability: A successful whole of community (WoC) partnership and planning programing requires the commitment of community leaders and partners. CCPHC has maintained a good working with community partners, including but not limited to Clay County emergency management, hospitals, city governments, first responders, faith-based organizations, schools, Clay County senior services, civic groups, YMCA, businesses, and diverse community champions to respond to COVID-19 pandemic. CCPHC continues to build strong relationships and trust with diverse community key leaders and champions involving and engaging them in response planning and implementation of plans in their community. Existing diverse community influencers and champions such as Spanish, Vietnamese, and Arabic population point of contacts, are committed to format, translate, and/or disseminate health information and messages in their communities to promote COVID mitigation measures and vaccine uptake. CCPHC is reaching out to other diverse community leaders and religious leaders to build relationships and trust before involving and engaging them in COVID response or other initiative planning and implementation of the plans in their communities.

Regarding fly away clinics in underserved and low-income areas to vaccinate residents with transportation issues CCPHC's contract with Heart to Heart International will end on December 31, 2021. CCPHC has a strike team setup to take over and continue community vaccination efforts