With Mass Vaccination, Medical Volunteers Face a New Test
In theory, Alice Weisz retired in 2016. But in practice, the retired endocrinologist in Virginia Beach has had a busy year. Last January, as Covid-19 reached the U.S., Weisz volunteered to help the local health department field phone calls. By late spring, she was sliding swabs up people’s nostrils at drive-through Covid-19 testing sites.
In the fall, Weisz administered flu shots. And earlier this month, she found herself in the vacant ambulance bay of a Virginia Beach emergency medical services facility, giving shots of the Moderna Covid-19 vaccine to a roster of essential workers: a nurse, a dental assistant, a mortician. People “want it on video, they want their picture taken that they’re getting the vaccine,” she said. “Everybody’s feeling, ‘Yes, yes, I did it!’”
Weisz is a member of the Virginia Beach unit of the Medical Reserve Corps, a little-known federal government program, launched in the aftermath of the Sept. 11 attacks, that mobilizes local volunteers to assist with public health emergencies as well as day-to-day tasks like health screenings and community education. Today, the program’s rolls include more than 190,000 volunteers in 48 states as well as the District of Columbia and some territories. Since the pandemic began, hundreds of MRC units have deployed volunteers to help with the Covid-19 response. They have since logged hundreds of thousands of volunteer hours, often with little public recognition.
Now, as the mass vaccination campaign for Covid-19 begins, further straining overstretched health departments, MRC units are sending in more volunteers like Weisz to help with vaccination. In the months ahead, these volunteers may be one important part of the race to administer hundreds of millions of doses of vaccine in a short period of time.
But some public health experts close to the MRC say the program has suffered from neglect in recent years, and that it has sometimes been underutilized during the Covid-19 crisis, amid a disjointed federal government response to the pandemic. While some states, such as Virginia, were able to rush MRC volunteers into action early in the pandemic, with vocal support from the governor, others seem to have mobilized more slowly.
Some of that engagement may change with the Biden administration, which has signaled interest in expanding the role of MRC units in the response to Covid-19, including a mention of the program in its official national pandemic response strategy.
“You always hate to capitalize on a tragedy,” said Rob Tosatto, a retired U.S. Public Health Service officer who ran the national MRC program from 2003 to 2017. “But I really hope that this next administration will see what the MRC was, what it could be, and give it the support and life that it needs.”
After the Sept. 11 attacks, some health care workers headed to the disaster sites, eager to help. Their assistance was not always welcomed. These 9/11 volunteers, a 2005 report on the MRC, co-authored by Tosatto, noted, “meant well, but unfortunately their appearance at these scenes became problematic for the emergency managers and frustrating for everyone.” Emergency responders had little way of knowing who was actually qualified to help. Coordinating volunteer efforts on the fly was difficult, too.
The next year, then-President George W. Bush launched USA Freedom Corps, a federal initiative to encourage volunteerism. As part of the effort, he tasked Richard Carmona, then the U.S. Surgeon General, with finding a way to organize medical volunteers. “The president really had a vision that was correct, which was, how do we harness the great energy of all of these people who want to do things when our nation is hurting from something?” said Carmona. “And that’s where it all started.”
Carmona and his staff decided the program should be organized into independent local units. He also pushed for MRCs to have volunteer roles outside emergencies, helping with the day-to-day tasks of public health.
The program ran into some skepticism, said Carmona and Tosatto. Overworked local officials were sometimes reluctant to take on responsibility for coordinating volunteers.
Still, the program quickly grew, from a few dozen pilot chapters to hundreds of units around the country. The response to Hurricane Katrina, Tosatto recalled, helped the MRC prove its worth: In particular, thousands of volunteers in dozens of units provided support in the aftermath of the disaster. MRC volunteers staffed shelters for hurricane evacuees, worked in clinics in hard-hit areas, and delivered medical supplies to help with the response.
Today, according to the Department of Health and Human Services, there are more than 780 units nationwide. Many volunteers are doctors and nurses. Others are veterinarians, pharmacists, and dentists, and still others have no medical skills at all, often helping with logistics and administrative tasks. Like Alice Weisz, some MRC volunteers are retirees looking to contribute to the cause; others are students or people with full-time jobs.
Like many public health programs launched after 9/11, federal government support for MRCs waned, even as some local units remained vibrant. The federal budget for the program has dropped steadily — from budgets of $10 or $11 million per year to an annual budget, in recent years, of around $6 million. The program also moved from the Office of the Surgeon General into the Office of the Assistant Secretary for Preparedness and Response (ASPR).
According to a statement provided to Undark by Suzanne Sellman, a public affairs specialist with ASPR, MRC units are run locally and “are not federal assets.” But the statement, which Sellman said was attributable to an HHS spokesperson, noted that ASPR “supports the MRC network by providing technical assistance, coordination, communications, strategy and policy development, cooperative agreements, contract oversight, training, and other associated services.”
Tosatto, though, said a lack of financial support and institutional buy-in from the federal government has hurt the program. By January 2020, he said, the program was receiving only “minimal guidance and support from the national level.”
When Covid-19 arrived, though, MRC units began to mobilize. As early as January, some units were helping staff call centers, said Oscar Alleyne, the chief of programs and services at the National Association of County and City Health Officials, or NACCHO, which helps administer the program. “By March, we saw about 150 units had been activated,” Alleyne said. “By April, we had 250.” Data recently posted on an HHS website reports that more than 450 MRC units in 47 states — as well as Washington, D.C., Puerto Rico, and American Samoa — have participated in the Covid-19 response, logging more than 800,000 volunteer hours.
Still, it’s not clear policymakers were always well prepared to draw on the volunteer resources. “There are communities that I called, and people in leadership positions didn’t know what an MRC was,” Carmona said. Programs like MRC, Carmona said, can sometimes “become invisible” in between national emergencies.
Some critics also argue that the federal government has done too little to boost MRC units — even though the program is written directly into some government pandemic readiness plans. “I haven’t seen any push from the national office to highlight or promote the efforts of the MRC” during the pandemic, said Tosatto. Contacts involved with President Joe Biden’s transition team, he said, told him that when the Biden transition team had brought up MRC, “they were told, ‘Well, that’s not really something that we’re thinking about or concerned about for the response.’”
Kavita Patel, a health policy fellow at the Brookings Institution and former policy staffer in the Obama administration, raised similar concerns in a conversation earlier this month. “People just are not aware of it,” said Patel, who is also a primary care physician. “The people who need to make others aware of it in the government are, candidly, not respected and not able to.” Former Surgeon General Jerome Adams, who stepped down at Biden’s request earlier this month, she added, did little to publicize the MRC, despite the program’s historical ties to his office. “For reasons I still don’t understand,” she said, “he’s never talked about it, hasn’t made it a priority, and I don’t know why.”
Patel was an emergency responder during Hurricane Katrina, where she saw MRC volunteers providing care to people who had been displaced by the storm. She said she hopes the Biden administration will consider a federalized deployment of MRC volunteers, similar to what happened during Katrina, to help with vaccination in areas where the rollout has faltered.
The statement Sellman provided to Undark stressed that HHS directed more than $1 million to help support MRC units early in the pandemic, followed by $160,000 this fall, which NACCHO distributed as $5,000 grants to help units with their pandemic response. The statement noted that local, community-based work was the core of the program. “At this time,” the statement continued, “the MRC program is not planning to federalize MRC volunteers.”
There are signs the Biden administration may bring changes. The Friday before his inauguration, in a speech detailing his $20 billion mass vaccination plan, Biden said — without naming the MRC — that his administration would “expand the pool of medical professionals, including retired health care workers, who can administer the vaccine.”
And the administration’s 200-page Covid-19 response plan, released last week, says that the federal government will “work with state and local programs to support the Medical Reserve Corps,” as part of its efforts to “bolster support for state- and local-run community vaccination clinics.”
In the meantime, many MRC units across the country have gotten involved in the Covid-19 response, although not always without hiccups.
In New York City, the deployment of the local unit, which currently has around 13,000 members, appeared to have a somewhat rocky start. News reports from the spring detail how some eager medical volunteers, who made themselves available through the MRC and other volunteer initiatives, sat idle in the chaotic early response.
By early January 2021, as critics charged New York City with a too-slow vaccine rollout, City Councilmember Mark Levine wrote in a tweet on Jan. 3 that vaccination was “basically only occurring during business hours,” calling the pandemic a “war-like situation.” Levine announced that he would be pushing legislation to open more vaccination sites — and to “require activation of the NYC Medical Reserve Corps.”
By mid-January, New York City Medical Reserve Corps members were mobilized for vaccination. On a recent Thursday afternoon at a city vaccination hub in Bushwick, Brooklyn, 27 vaccinators — a mix of city employees and MRC volunteers — administered shots to a steady stream of elderly New Yorkers and essential workers.
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The city had turned a high school building into a clinic. The shots took place in the gym, with neat rows of tables under the basketball hoops. Each vaccinator had their own station, with a red biohazard bucket, a stack of vaccination cards, and a small vial of the Moderna vaccine. The vials had arrived early that morning, on dry ice, in a white Styrofoam cooler bearing a small sticker that said “Vaccine.” The site leaders stored reserves of the precious fluid in a classroom.
Vaccinators held up numbered green signs whenever they were ready to receive a new patient. The site vaccinated 1,000 people when it first opened earlier that week on Sunday. By Thursday, it was approaching 1,400 shots per day, with MRC members and city vaccinators logging 13-hour shifts.
Ilana Nossel, a psychiatrist in New York City, signed up for a shift on a recent Sunday at another city-run vaccination site, at a high school building in the Jerome Park neighborhood of the Bronx. Nossel joined the MRC after Hurricane Sandy, but that Sunday was the first time she was able to go out and volunteer. After “the helplessness of this year,” she said, “it felt like it would be great to have the opportunity to do something productive.”
Local news reports suggest that MRC units across the country — from Oklahoma to Connecticut — have been deploying volunteers to help with the vaccination campaign. In the past several weeks, many public health departments have also issued calls to enlist more volunteers to join MRC units and assist with the effort.
Some units are capitalizing on momentum that has been building for months. In Virginia, which has an active MRC program, Gov. Ralph Northam began issuing public calls for more volunteers in April. Since the beginning of the pandemic, the state has processed more than 8,000 applications according to Jennifer Freeland, who, as the state volunteer coordinator for the Virginia Department of Health, oversees the state’s 22 MRC units.
Freeland laughed when asked when her team had begun preparing for the Covid-19 vaccination. “We started training last February,” she said. “As soon as we had the pandemic, we knew that we were going to need to start training vaccinators, so we started training vaccinators in the core functions.”
More recently, Freeland said, they’ve been conducting online trainings for Covid-19 vaccination. Volunteer enthusiasm overwhelmed their videoconferencing software: “We maxed out the thousand seats twice,” Freeland said, “and had to bump up to a 3,000-seat room in Zoom.”
Exhaustion has been a major issue for public health workers during the pandemic. “This is overwhelming for all of us,” said Freeland. “To see people in the community just step up and be willing to help and come alongside us — I just can’t even tell you how meaningful that it is to us,” she added. “We could not — absolutely could not — do what we’re doing without our Medical Reserve Corps volunteers.” At many of the state’s newly launched vaccination sites, she said, large portions of the vaccinators and support workers are MRC volunteers. Their numbers are growing: Freeland said that she has received hundreds of applications just since Jan. 1.
Weisz, who joined the Virginia Beach MRC unit a couple of years ago, said she has been impressed with her fellow volunteers, some of whom volunteer on top of full-time jobs. And although she’s of retirement age, she said she was not nervous helping out on the frontlines. “It was great, actually,” she said. “Because, for my life, this is what I did: I helped people when they had problems.”