The monumental challenge of distributing COVID-19 vaccines has been complicated by uncertain and limited supply, but the biggest challenge for one rural county on the Rocky Mountain Front is starting over with an entirely new health department.
Public health workers across Montana quit their jobs last year as they faced burnout and escalating stress from responding to the COVID-19 pandemic. That left public health departments missing key leaders. For one county, the situation was much worse.
Pondera County made headlines when its entire staff quit by November. At the time, former health department director Nicky Sullivan gave her take on the situation.
“The main reason that I resigned was just the lack of support from our county officials. They were some of the toughest ones that I was fighting against to wear masks and be those role models in our community.”
Months later, sitting in the county health department office, County Commissioner Dale Seifert said through his mask that he and his fellow commissioners have supported COVID mitigation measures. But he said commissioners didn't fully understand the massive workload public health staff were facing with contact tracing and case investigations until it was too late.
“We’ve restructured the Health Department now to where we’ve spread the load out more among the employees, because we were overworking them," Seifert said.
That workload now includes planning for how vaccines will get into the arms of locals across the rural county. The county has hired three new staff, but the health department sat empty for weeks, delaying those planning efforts. The county health department hopes to get its first shipment of vaccines this week.
The Pondera Medical Center, a critical access hospital in Conrad, has been able to vaccinate its staff and is providing some vaccines to county residents by appointment. So far, it’s kept up with vaccine efforts in neighboring counties in the early stages of Phase 1b. That phase includes people 70 years old and older, and people with select underlying health conditions.
“But I don’t think it was clear that hospitals would be doing [Phase] 1b," said Clinic Manager Cynthia Grubb. "Generally, population-based strategy is public health, but we’re in a pandemic and we’re all working together."
Laurie Freeman with the National Association of County and City Health Officials agreed. She said it’s important for county public health departments to have a larger vaccination strategy.
That means identifying remote vaccine distribution sites; determining how health officials will communicate with the community through newspapers, social media and other channels; or simply how people will fairly and equitably sign up for vaccine clinics.
Those details sound weedy, but Freeman said they will allow counties to quickly bolster COVID vaccine distribution as the number of available doses increases.
“It’s really important to have that backbone organization who knows their community deeply," Freeman said. "These local health departments work across public health in their communities on a day-to-day basis.”
Freeman said Pondera County isn't alone when it comes to staff turnover hampering their efforts to plan COVID-19 vaccine distribution.
She said roughly 200 public health leaders across the country have quit since the pandemic’s start. Across Montana, about nine public health leaders have left their jobs and an unknown number of support staff have left the public health profession.
“When we have that turnover, we are bound to see some associated costs with that turnover as well, in terms of our ability to keep the community safe and healthy and to keep doing this really hard 24/7 work to stop the pandemic," Freeman said.
She said that cost can come in the form of residents’ trust. If local health officials aren’t the ones clearly telling residents how the vaccination process will work in their community — or simply reiterating that these COVID-19 vaccines are safe and effective — people will look elsewhere for information.
Pondera County resident Carrie Doty said those messages haven’t reached her father.
“My father is 84 years old. He’s not health compromised, he still lives on the farm, he’s fine, but I want him to get the vaccine.”
Doty has seen her father turn to far-right cable news networks, which has left him skeptical of getting vaccinated.
Pondera County Public Health Nurse Shannon Elings acknowledged the delay in information-sharing with residents as she and other new staff work hard to get vaccines from the state.
“If and when people call in, we let them know we’re in the process of ordering it. That’s when we take down their demographics, get to know what group they'd fit into and we’ll just let them know as soon as we have it available when we can start scheduling.”
Elings said the plan for now is to vaccinate whoever is next on the waiting list, but that a more detailed vaccination plan is still in the works.