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DATE: |
December 5, 2023 |
08 |
SUBJECT
Title
AUTHORIZE COMPETITIVE SOLICITATION FOR AS-NEEDED COMMUNITY VACCINATION SERVICES, AND AUTHORIZE FUTURE FUNDING OPPORTUNITIES RELATED TO IMMUNIZATION SERVICES (DISTRICTS: ALL)
Body
OVERVIEW
The County of San Diego (County) Health and Human Services Agency (HHSA), Public Health Services, Immunizations Unit aims to eliminate vaccine preventable diseases by improving vaccine coverage for all San Diegans. This is done through evidence-based practices to address community needs, including vaccine management, technical assistance, evaluating regional immunization coverage rates, responding to outbreaks, disease prevention activities, health promotion, and management and analysis of information from the immunization information system. On May 10, 2022 (19), the San Diego County Board of Supervisors (Board) authorized a competitive solicitation for vaccine administration services for communities throughout the county. The contract awarded from the competitive solicitation provides community vaccination services for COVID-19 vaccines and other immunizations to those most vulnerable to severe disease outcomes, and is set to expire on June 30, 2024.
Today’s action requests the Board authorize the Director, Department of Purchasing and Contracting to issue a competitive solicitation for as-needed community vaccination services, and authorize the Agency Director, HHSA to pursue future funding opportunities related to immunization services.
Today's actions support the County's vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by establishing sustained capacity to increase access to vaccinations for vulnerable communities and increasing immunization rates countywide to reduce the risk of suffering, disability, and death caused by vaccine preventable diseases in infants, children, adolescents, and adults.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. In accordance with Board Policy A-87, Competitive Procurement, and Section 401, Article XXIII of the County Administrative Code, authorize the Director, Department of Purchasing and Contracting to issue a Competitive Solicitation for as-needed community vaccination services, and upon successful negotiations and determination of a fair and reasonable price, award a contract(s) for a term of one year, with four option years and up to an additional six months if needed, and to amend the contract(s) as needed to reflect changes to services and funding, subject to the approval of the Agency Director, Health and Human Services Agency.
2. Authorize the Agency Director, Health and Human Services Agency, to pursue future funding opportunities, if available, for current and future fiscal years related to immunization services.
EQUITY IMPACT STATEMENT
Today’s action will advance equity and racial justice through a data-driven population health approach that delivers immunization prevention and outbreak response services through trusted community partnerships and coalitions committed to addressing disparities and health inequities. The County of San Diego Health and Human Services Agency, Public Health Services, Immunizations Unit works closely with the San Diego Immunization Coalition (SDIC) to communicate and advance equity driven initiatives, outcomes, and health education. SDIC is a community coalition of 2,000+ individual immunization partners throughout San Diego County committed to its mission to increase immunization rates and improve the health of the county by raising awareness and providing education about vaccine preventable diseases. The Immunizations Unit will continue to pursue grants and funding opportunities that support efforts to eliminate vaccine preventable diseases in the most underserved communities. Underserved communities are identified through the health equity lens, the health equity zip codes, the Healthy Places Index quartile framework used by the State, outcomes from local data analysis on vaccine preventable disease cases, and disproportionality of vaccine coverage rates. Furthermore, the activities described in this request are planned and carried out through a health equity lens by employing linguistically and culturally tailored services.
SUSTAINABILITY IMPACT STATEMENT
Today’s proposed action aligns with the County of San Diego Sustainability Goal #4 of protecting the health and well-being of everyone in the region by providing vaccination services in community-based settings and sustaining capacity to vaccinate populations disproportionately affected by vaccine preventable diseases. This will be done through mobile immunization services which will improve access to immunizations, the overall health of communities, and reduce the demand of associated care services, while increasing the effectiveness of care providers.
FISCAL IMPACT
Funds for this request are not included in the Fiscal Year (FY) 2023-25 Operational Plan in the Health and Human Services Agency. If approved, this request will result in no costs and revenue in FY 2023-24; anticipated costs and revenue of approximately $1,500,000 in FY 2024-25; and costs and revenue of approximately $1,500,000 in FY 2025-26. The funding sources are the California Department of Public Health Immunization Local Assistance grant in FY 2024-25 and the Department of Public Health Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases in FY 2025-26. Funds for subsequent years will be incorporated into future operational plans. There will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
The Health Services Advisory Board reviewed this item at its meeting on November 7, 2023, and recommended approval of these recommendations.
BACKGROUND
On May 10, 2022 (19), the San Diego County Board of Supervisors (Board) authorized a competitive solicitation for vaccine administration services for communities throughout the county. Vaccines are one of the most successful tools for protecting the public's health and are critical in preventing many diseases and responding to public health disease events and outbreaks. The County of San Diego (County) Health and Human Services Agency (HHSA), Public Health Services, Immunizations Unit is tasked with responding to and investigating vaccine preventable diseases, and promoting timely and age-appropriate immunizations to all county residents to improve immunization coverage rates. A goal of the Immunizations Unit is to eliminate vaccine preventable diseases by promoting vaccinations across the county.
Over the past three years, the Immunizations Unit has played a critical role in the response to the COVID-19 pandemic through coordination of COVID-19 vaccine inventory, vaccine distribution, outreach and education, and collection and analysis of information about administered vaccinations within the immunization information system. Contracted community partners have been key allies in administering COVID-19 vaccines and other immunizations to vulnerable populations and responding to vaccine preventable disease risks. Several examples from recent years include Hepatitis A, measles, COVID-19, and mpox. For example, in 2019, while measles cases and outbreaks were occurring throughout the world, the Immunizations Unit conducted enhanced surveillance and actively engaged with the public and community partners in promoting measles vaccinations as a primary prevention activity. Despite outbreaks of measles occurring in other places in California, the County was able to confine the number of measles cases to only two confirmed cases and has not had any confirmed cases since 2019, which can be attributed to the efforts at maintaining high rates of immunization coverage. In 2022 during the mpox outbreak, the County partnered with the LGBTQ+ community and implemented strategies to address the outbreak including developing partnerships with community-based organizations, vaccinations, education, and outreach.
In early 2023, an increased number of hepatitis A virus infections above the expected baseline was identified in the county. The cases were noted primarily among persons experiencing homelessness. The County acted by expanding disease control and vaccination activities to prevent further spread of the disease. Through innovation and partnerships with over 50 organizations, the County was able to mitigate the spread of hepatitis A, prevent an outbreak, and protect vulnerable populations from the disease. Since February 2023, HHSA rapid response teams and the vaccination services contractor coordinated over 300 community vaccination clinics at priority sites, reaching over 3,800 individuals, and administering over 2,200 hepatitis A vaccines.
On April 1, 2021, the County was awarded $13,134,740 in COVID-19 Round 2 and Round 3 supplemental Immunization Local Assistance Grant funding for Fiscal Years (FY) 2021-25 through CDPH from CDC, for COVID-19 vaccination services. On May 4, 2021 (10), the Board authorized acceptance of this funding, which is primarily directed to support COVID-19 response and vaccination efforts. On August 17, 2021, the County received an additional allocation in the amount of $12,070,009 in COVID-19 Round 4 supplemental Immunization Local Assistance Grant funding for FY 2021-25 through CDPH from CDC. On October 5, 2021 (10) and April 5, 2022 (17), the Board authorized acceptance of this funding intended to provide critical resources to local public health departments for activities related to COVID-19 vaccinations, including increasing vaccination rates, ensuring safe administration of vaccines, increasing vaccine confidence through education, outreach, and partnership, developing community engagement strategies, supporting vaccination uptake in populations disproportionately affected by COVID-19 with lower immunization coverage, and efficient utilization of immunization information systems.
The COVID-19 pandemic highlighted existing inequities in health, including the unequal distribution of and access to health care resources. Widespread COVID-19 and influenza vaccination is a critical tool to protect the residents of the county from seasonal winter viruses. While vaccinations are now widely available through health care providers, the County has contracted with a vaccination provider to provide vaccination services focused on those who may not have a health care provider, are homeless or homebound, or are from communities disproportionately affected by COVID-19. The current contract for vaccination services for these communities expires June 30, 2024. From March 1, 2023, through August 31, 2023, 11,309 vaccines were administered to 9,490 unique individuals at 1,073 vaccine clinics. A competitive solicitation is planned to contract with community health service providers to provide as-needed mobile community vaccination services facilitated in partnership with local partner organizations. The overall goal is for the contractor(s) to coordinate mobile, community-based vaccination services and events with healthcare staff authorized to administer vaccination services, as well as other support staff, to safely and effectively administer routine, seasonal, and outbreak vaccinations, including COVID-19 vaccines, to infant, children, adolescent, and adult populations who are medically underserved or at higher risk for severe outcomes from COVID-19 and other vaccine preventable diseases. These populations include, but are not limited to, communities facing less healthy conditions, racial and ethnic minority groups, rural communities, residents and staff of congregate facilities, homebound or isolated persons, unhoused persons, under or uninsured persons, immigrants and refugees, and people with disabilities, or transportation limitations. The contractor(s) will provide coordination with community agencies and schools to host immunization clinics at locations convenient to the priority populations.
Today’s action requests the Board authorize the Director, Department of Purchasing and Contracting to issue a competitive solicitation for as-needed community vaccination services, and authorize the Agency Director, HHSA to pursue future funding opportunities related to immunization services.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports the Equity (Health) and Community (Quality of Life) Initiatives in the County of San Diego’s 2023-2028 Strategic Plan, as well as the regional Live Well San Diego vision, by building better health and protecting the health of our residents through a data-driven population health approach that delivers immunization prevention services through community partnerships and coalitions committed to addressing disparities and health inequities, and by ensuring fiscal management and contracting processes align with community priorities.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Interim Chief Administrative Officer
ATTACHMENT(S)
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