Read the letter Linn County Public Health sent to state officials criticizing 1-dose vaccine allocation

Below is the full letter sent to Iowa Department of Health leadership from an official at Linn County Public Health, who questioned the state's decision to allocate Johnson & Johnson vaccines to 'very high functioning and health literate professional populations.” In the letter - written by Tricia Kitzmann, community health division manager - officials called for the one-shot vaccine to be directed to vulnerable populations.

» MORE COVERAGE: In letter to state, Linn Public Health criticizes allocation of 1-dose COVID vaccines

Good Morning-

I would like to start by saying, we all have the same goal, and that is to get vaccine into as many Iowans as quickly as possible. Linn County Public Health is always thrilled to know when more vaccine is entering our community to ensure more Iowans have access to receiving the vaccine. Within the past week, I have learned that at the direction of the Governor's Office, several allocations of Johnson and Johnson vaccine are being provided to our community to targeted groups. Last week, I learned that Hy-Vee is receiving the Johnson and Johnson allocation of 3,200 doses specifically for Collins Aerospace employees. Yesterday, I learned that a large allocation of Johnson and Johnson is being set aside for college populations, and Kirkwood Community College is being considered for a large allocation. It is extremely heartbreaking to learn of these plans, as myself, as well as many others in the public health community, have been requesting, even begging, for several weeks for access to the Johnson and Johnson vaccine to use with our vulnerable populations.

Our manufacturers are tremendous, a valuable and essential contributor to our economy and community. They need to be vaccinated. However, these businesses and employees have the ability to work with pharmacies, healthcare providers and public health to obtain one of the approved two-dose vaccines. These are well established companies that have employees that have set schedules would easily accommodate planned clinics for the two-dose series. They do not need the only single dose vaccine on the market, which is in short supply.

College populations are equally resourced and capable. College students and faculty are easy to find, and have reliable contact information on file with their associated institutions. College faculty and students are educated and technologically savvy. Many are capable of locating vaccine through online scheduling portals and have adequate transportation and flexibility to make both first and second dose appointments. While it is nearing the end of the spring semester, there is still adequate time to administer both a first and second dose prior to the conclusion of the semester, if using the Pfizer or the Moderna product. Additionally, Community College students traditionally live near where they attend school. Post-semester travel that would spread COVID-19 is more concerning among other populations, not necessarily the community college student population.

LCPH has made several pleas to the Governor's Administration and even recently had a call with Liz Matney with the Governor's Office regarding the need for the Johnson and Johnson product to be utilized for our most vulnerable populations. Linn County Public Health and other local public health departments have spoken directly with the Governor's Office regarding the need to vaccinate those disproportionately impacted by social determinates of health or experience health inequities with a single-dose vaccine product. It is becoming increasingly clear that the Governor's Office does not trust local public health to identify and serve individuals in our community who are the most vulnerable. This includes persons who experience homelessness, substance abuse, mental health issues, barriers to accessing healthcare, or are from minority, refugee, immigrant or low-income families. I am struggling to understand why will the Governor's Office not listen to those that know their communities best and work with us to identify the best strategies to vaccinate our community, both manufacturing, businesses, higher education, and the most vulnerable and susceptible to barriers to accessing vaccine and experience social determinates of health.

Most of our businesses and manufacturers are connected to an occupational health clinic locally. Linn County Public Health previously developed a business registry that we marketed and shared across our community for all businesses, including manufacturers, schools, childcare providers, and other businesses within Phase 1A and 1B. This registry identified eligible populations and ensured our local business and manufacturing partners were connected to a vaccine provider or their occupational health clinic to access vaccine. These vaccine providers and occupational health clinics work with local businesses and manufacturers to accommodate schedules and ensure employees have access to health needs. The manufacturers and businesses have worked with their occupational health clinics to either have onsite COVID-19 clinics or ensure their employees can leave to be vaccinated. It has not been an issue to get these manufacturers and businesses the 2-dose series.

Higher education populations were not eligible for vaccine in Phase 1B, only PreK-12 staff and childcare workers. Therefore, concerted efforts to offer vaccine to faculty and students at colleges have not been conducted, as we have been focused on offering vaccine to eligible populations. As of Monday, April 5, we anticipate all Iowans 16 and older will be eligible for vaccine. Given notice, we could have been working with our local college populations on vaccination efforts, as we have close working relationships with all colleges and universities in Linn County. We work together on many other things, and are happy to serve our college and university populations as well, if allowed.

Why is the Governor's Office choosing to allocate the Johnson and Johnson COVID-19 vaccine to Hy-Vee to vaccinate very high functioning and health literate professional populations? Collins Aerospace is a valued business in our community. However, a large majority of these employees has been working remotely since the beginning of the pandemic and most do not have barriers accessing healthcare, transportation or mistrust the government. In fact, there is a CVS Pharmacy on the Collins Aerospace campus that is prepared, willing, and eager to vaccinate this population. This particular CVS Pharmacy began vaccinating Collins Aerospace employees with allocations from Linn County Public Health.

As we continue to see the weather improve, we know we have a very large transient and homeless population that will be difficult to provide a two-dose series. We have been working diligently with our vulnerable population subcommittee to identify needs of our community, and have identified leaders in each major vulnerable population group to help boost vaccine confidence and assist in setting up clinics. The majority of our vulnerable population leaders have said it is vital to offer the one-dose series to several of these populations due to the loss in follow-up, fear of government, trauma, access barriers and/or transient nature of the population. Those that are homeless or that live in transitional housing are difficult to reach. It will be extremely difficult to find these individuals 3-4 weeks later for a second vaccination. This population would greatly benefit from a one-dose series. Those in correctional facilities live in close proximity to each other and there have been several outbreaks in this population. The officers and staff that work with this population are at high risk due to the nature of the living conditions within these facilities. Inmates come and go, at times they are transferred out of county or state. Finding them for an additional dose of vaccine would be difficult. A single dose vaccine is the most appropriate vaccine to protect them and the community.

In a recent press conference the governor stated, 'According to Iowa's current vaccine administration data on race & ethnicity, 1% of Iowans receiving vaccine are African American and 1.6% are Hispanic or Latino. It is important to know that this information is self-reported and up to 19% of the individuals have reported their race or ethnicity as unknown. So while it is challenging to know exactly where we stand, we know absolutely that we still have work to do to reach these communities. Based on what we know about the impact social determinants have on health literacy and healthcare access and health outcomes, targeted outreach to minority and other vulnerable communities will better ensure that all Iowans have the opportunity to be vaccinated.”

Local public health professionals know our own community best and are the most appropriate to make the decisions on how to best vaccinate communities of color. Outreach clinics for specific populations with two-dose vaccine series that would be best served by the one-dose vaccine will place additional strain on these communities. Vaccination efforts are not just about providing the vaccine; it is important to address and remove the systemic barriers that are in place which make it harder for these populations to be vaccinated. Individuals will need to take time away from work, find transportation, and work around childcare issues multiple times to be vaccinated. Many of our low-income families, refugees and immigrants have trouble navigating healthcare systems, paid time off to visit a doctor or health clinic and have transportation difficulties. If we do not take all of this into account, we are not serving our community the best way possible. Many of the Hy-Vee Pharmacies do not have clinic times available to our most vulnerable, nor do they have the experience to understand the needs of these vulnerable populations. Making them come back for multiple doses of vaccines compounds the hardships that they already face day to day. Additionally, this puts additional strain on our community partners, as we need to find transportation services and interpreters for additional clinics for the second dose. If the Governor's office wants to make a real difference with improving vaccination rates to our vulnerable and diverse populations, then we plead with you, local public health must be allowed to determine which vaccine products should be targeted to our local community populations. Words mean nothing without action.

I, along with several of my local public health colleagues, am begging the Governor to allow local public health to make decisions within our communities on how to best vaccinate our populations. The Governor's Office does not have the depth of knowledge or expertise to control all aspects of a local public health response. Local public health professionals are trained, prepared, and ready to serve our community. Allow local public health entities to do what we do best, and work with our communities and community partners to make decisions at the local level that will positively impact our communities. Local public health is acutely aware of where outbreaks have occurred, and of the populations within the community that are at highest risk and most vulnerable. We work directly our community members, and have trusted relationships that we are able to leverage.

I am not sure what more I can do to express my concerns that the Governor is not allowing local public health to address health equity and social determinates of health with our most vulnerable populations.

I cannot, in good faith, stand with local leaders who represent our most vulnerable populations and tell them that their needs do matter, that what is best for them and their community does matter to our Governor. By not listening to the voices of those most vulnerable and doing what we can to meet their needs, we are reinforcing messages that those with privilege, such as those with secure employment, reliable transportation, access to technology, and stable housing, come before them. We are reinforcing the message that they cannot rely on or trust our Government or those with power to protect and serve their community.

Please continue to allocate the state's vaccine to local public health agencies and allow us to determine what is best for our community and those most vulnerable.

Thank you for your time - Tricia

Tricia L. Kitzmann, MPH

Community Health Division Manager, Linn County Public Health