The overall goals of the PODs are to provide COVID-19 vaccinations quickly and safely to reduce transmission, morbidity, mortality of COVID-19 disease; help minimize disruption to society and economy, including maintaining health care capacity; and ensure equity in access to vaccine to the entire population of Los Angeles County. The goal in the transformation to the community PODs is to become a trusted resource in specific underserved communities and create a safe one-stop shop” for nearby residents to receive community health services. LACDPH's objectives include ensuring accessibility to COVID-19 vaccinations, layering on additional public health services to respond to the needs of the local community, and serving as a trusted source to combat misinformation.
As vaccine supply began to flourish with multiple providers, plans were underway to convert larger mega PODs into smaller community PODs. Utilizing a health equity lens to examine the existing data coupled with willing facility partners, new sites were chosen that matched LACDPH's commitment in addressing systemic inequities as laid bare by the pandemic. LACDPH staff and partners ensured that there were no breaks in service when the demobilization occurred for the larger mega PODs while concurrently moving into the new community sites. With no gaps in service, the community sites opened without incident at new locations the next operational day.
To publicize LACDPH's presence in the community and increase vaccine uptake, small outreach teams were sent out by each POD to canvas neighborhoods while providing flyers and education. These teams were usually led by an experienced LACDPH Public Health Nurse (PHN) who listened to concerns from residents, answered any questions that may have caused vaccine hesitancy, and shared resources. The LACDPH Epidemiology (Epi) team also provided heat maps to strategically target outreach in neighborhoods near the PODs with the lowest vaccination rates. Further adaption of the outreach teams included a small team of clinical and nonclinical staff with the ability to provide vaccinations at local venue storefronts. With permission from the venue and supplies from the POD, staff registered and vaccinated willing residents on the spot. Examples of participating venues included faith-based organizations, apartment complexes, grocery stores, malls, and restaurants.
The incorporation of dispensing additional vaccines at the PODs relied on creativity and flexibility with the existing space, layout, and staffing. Due to different formulation and vaccine type, at its height, staff dispensed up to 9 types of vaccines concurrently - 6 Pfizer types due to various ages and formulation, Novavax, flu, and mpox. To minimize vaccination errors, a color-coding labelling system was utilized and, when space and staffing allowed, distinct tables with different staff focused on a specific formulation. LACDPH's Nursing Administration created training videos and provided in-person guidance to ensure staff was informed and felt comfortable managing a collection of various vaccine types. Supplying a multitude of vaccines ranging in age and type continued the goal of enhancing accessibility, while providing more value to the community by offering other vaccines in addition to those for COVID-19.
Providing free at-home COVID-19 test kits encouraged residents to be safer within their community. By removing the costs barrier, residents were more likely to test prior to gathering or when they feel ill, which helped to decrease community transmission. PODs received test kits from LACDPH warehouse and staff freely handed them out to residents. In April 2022, integration of the Test to Treat” program at selected POD sites for COVID-19 therapeutics referrals decreased barriers in accessing a medication that can help reduce the severity and length of COVID-19 symptoms. Staff oversaw a self-administered rapid COVID-19 antigen test and provided guidance as needed. If the test was positive, staff either provided them a Test to Treat informational flyer or connected them with the LACDPH Call Center that linked them to the LACDPH Telehealth services. From there, LACDPH Telehealth services performed intake and connected them to a provider to receive a COVID-19 anti-viral prescription if they qualified for therapeutics. In June 2022, to further streamline the process and remove barriers for residents, staff started to assist with the intake process at the PODs so residents can be connected to a provider in a more expedient manner. This intervention ultimately increased therapeutics uptake and access, with residents receiving guidance on how to navigate the system and having confidence that the medications received would be free of charge.
Partnering with other County departments, LACDPH sought to address some of the social determinants of health needs of the community exacerbated by the pandemic. For example, the LA County Department of Mental Health routinely deployed outreach workers to select PODs to conduct mental health workshops and provided referrals to services. The LA County Department of Social Services also deployed eligibility workers to certain POD sites to assist and educate residents about various social services programs. The DPH Nutrition Program coordinated the produce pick-up program at select PODs to address food insecurity in the community. At the PODs, these partners were featured in a prominent location with clear signage, so it was easy for residents to see the resources available.
Timeframe for Practice:
June 2021: Conversion of the mega PODs to community PODs; Community canvasing and outreach began
October 2021: Started providing flu vaccines
December 2021: Started distributing at-home rapid COVID-19 antigen test kits
February 2022: Started "Vax-on-the-Go (VOTG)"
April 2022: Launched Testing and Therapeutics referral (Test to Treat); Launched community resource tables in collaboration with partners
June 2022: Started produce pick-up program
July 2022: Started providing mpox vaccine
LACDPH led the way in the establishment of the initial large drive-through mega PODs and its iteration as the smaller community PODs. LACDPH staff played key roles in leading, managing and filling many of the roles needed for this operation. Initial POD planning required collaboration among a wide range of public and private sector partners, including immunization and public health emergency preparedness programs and emergency management agencies. Countless LACDPH departments and staff participated in executing the PODs. LACDPH also engaged across the entire County system (i.e., Internal Services Department, Fire Department, Department of Mental Health, Department Parks and Recreation, Department of Social Services, etc.) as well as California Department of Public Health to provide additional resources to ensure the program was well-rounded in serving the needs of the community. The collaboration between the specific cities and county departments has proven to be fruitful. Besides LA County Department of Parks and Recreation providing their facilities free of charge, the PODs were regularly publicized and incorporated into any special programming events hosted by the facility owners. Examples include Parks after Dark, the Harvest Festival, and city-led holiday events. These partnerships allows LACDPH to continue to push vaccination efforts and increase awareness of LACDPH's stable presence in the community.
The strategic POD location selection helped with ensuring equitable, meaningful, and representative collaboration with target populations. With the community outreach teams, LACDPH had the opportunity to network and connect with mainstays in the communities such as libraries, schools, senior centers, and faith-based organizations. Further engagement with residents was done to provide education and remind them that even if they are currently hesitant to receive the vaccination, there is an available place situated in the nearby community where they can receive reliable vaccine information and access vaccines when they are ready. LACDPH PHNs continue to assist with warm hand-offs to other County departments for residents requiring additional community resources. Local businesses supported LACDPH efforts by allowing staff to be stationed in visible areas to provide on-the-spot vaccinations as part of the VOTG outreach. This presented an opportunity to meet people where they are” and administer vaccinations immediately.
Funding for the community PODs is supported by a mix of federal, state, and local county dollars. Total funding to support the program from July 2021 to June 2022 was approximately $26.7 million dollars with about 63% associated with contracted clinical, logistical, and security personnel, 19% for county personnel, 12% for contracted ambulance services, and 6% for supplies/material costs. As LACDPH continues to look for ways to operate more efficiently, the budgeted/projected costs for the program from July 2022 to June 2023 is expected to be approximately $20.9 million dollars with about 72% associated with contracted clinical, logistical, and security personnel, 12% for county personnel, 12% for supplies/material costs, and 4% for ambulance services. Ambulance services will be phased out in January 2023. In addition, it is important to note that the above funding/budget does not include facility costs since partnering county departments, cities, and organizations provided physical locations for the PODs free of charge thus eliminating the need to incur real estate costs.
County and contracted personnel expenses continue to account for over 70% of the total program costs. The high percentage of personnel cost reflects the labor-intensive nature of the POD operation and the high salary cost to employ clinical staff including physicians, nurse practitioners, registered nurses, and licensed vocational nurses. Support staff with expertise in management, information technology, logistics, finance, and human resources, as well as registration and security personnel were needed onsite and offsite to assist with the POD operations.