Episode 22:ÌýPartnering with the Federal Government to Fight COVID-19 with Laura Kemper and Nate Elias
Laura Kemper, Head of Federal Government Affairs, and Nate Elias, Head of U.S. State Government Affairs, join Field Notes to give a behind-the-scenes look at the efforts to forge a one-of-a-kind partnership with the federal government to procure and distribute the Pfizer-BioNTech COVID-19 vaccine to dialysis centers across the country.
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Brad Puffer:ÌýWelcome, everyone, to this episode ofÌýField Notes.ÌýI'mÌýBrad Puffer, on the Medical Office Communications Team atÌýÄ¢¹½´«Ã½ North America, and your host for this discussion today. Here, we interview the experts, researchers, physicians, and caregivers who bring experience, compassion, and insight into the work we do every day.Ìý
As we all know, a successful rollout of the COVID-19 vaccines is critical to our ability to end the pandemic in the United States,Ìýand also, to protect our patients with kidney failure who are at high risk of complications from the virus. Initially, many dialysis patientsÌýfoundÌýit difficult to get access to the vaccine on their own. Our company has long understood that direct allocation of vaccinesÌýto our patients in our dialysis centers was essential.Ìý
It was both a state by state, and then federal advocacy effort that eventually led to a national agreement and rapid vaccination of thousands of patients in often under-served communities.ÌýWe'reÌýgrateful to be joined today by Laura Kemper, Head of Federal Government Affairs, and Nate Elias, Head of State Government Affairs. Both Laura and Nate helped lead efforts to educate and inform policymakers about the risk of COVID to our patients, and our ability to help the most vulnerable get access to the vaccine.ÌýLaura and Nate, welcome toÌýField Notes.Ìý
Laura Kemper:ÌýThanks so much, Brad.Ìý
Nate Elias:ÌýThanks for having us.Ìý
Brad Puffer:ÌýPerhaps, we can start with you, Laura. Why was direct allocation to vaccine so important for us, and why were we in such a great position to have a successful rollout?Ìý
Laura Kemper:ÌýEarly on, we really knew the disproportionate impact that COVID was having on patients with ESRD.ÌýAnd also, how important it was to ensure our patients and front-line health workers were vaccinated. I think becauseÌýwe'reÌýsuch a large company with a national footprint, it really made sense to pursue a federal allocation, so that we didn't have to try and navigate the state by state.Ìý
We felt that we could deliver for the federal government by helping to quickly vaccinate a large population of vulnerable patients, and frontline workers. But really, our strategy was always to pursue this dual track, so state and federalÌýin an effort toÌýleave no stone unturned. And in terms of our positioning for a successful rollout,Ìýwe'veÌýhad such high success rates I think with other vaccine administration in the past, such as with seasonal flu vaccine, it really seemed natural that our patients and workers should receive the vaccine from us.Ìý
And given that we see our patients so often, we were ideally suited to handle this with minimal effort from the federal government. And really, the only thing that was missing was the vaccine allocation. I think the other important point was with Pfizer andÌýModernaÌývaccines that require two doses, we were able to ensure uptake of the second dose, since we see our patients so often. And this assurance I think was something that the pharmacies and the other sites of administrationÌýcouldn'tÌýoffer.Ìý
Brad Puffer:ÌýTurning to you, Nate, it seems like our patients getting the vaccine was really the biggest priority forÌýÄ¢¹½´«Ã½ North AmericaÌýfor a while. Was the mandate loud and clear from the top down?Ìý
Nate Elias:ÌýYeah, absolutely. Throughout the pandemic, even before the vaccines were available, much of theÌýdecision makingÌýauthority around treatment protocols, PPE requirements, medical transportation, you name the issue, were really ceded to the states and the territories.ÌýSoÌýsome of the states pushed some of thoseÌýdecision makingÌýauthorities even further down to the counties.ÌýSoÌýthroughout the course of the pandemic, for a year plus, we've been dealing with theÌýstate by stateÌýdynamic.Ìý
When the vaccines came out, it was very clear that it was once again, going to be aÌýstate by stateÌýprocess until we were able to get a national vaccination program with the CDC.ÌýSoÌýthere was no doubt that this became priority number one once the vaccines became available, is to do everything that we could within our power to make sure that our front-line health care workers and our patients got access to the vaccines as quickly as possible.Ìý
Brad Puffer:ÌýAnd Laura, how soon did that planning and advocacy begin talking to policymakers, for example. Were they receptive to our concerns about patients with kidney failure, and getting access to this vaccine as soon as possible?Ìý
Laura Kemper:ÌýWeÌýactually startedÌýour advocacy before even the first dose of vaccine was officially administered in the United States, which was about mid-December. We first approached Vice President Pence's Chief of Staff in early December explaining our capabilities as a company to be able to execute on a national vaccine allocation for the entire community of kidney patients. And we were lucky that actually, the very same day we met with Pence's Chief of Staff, Seema Verma, who was then the Head of the Centers for Medicare and Medicaid Services, she actually held a call that evening with dialysis providers where she agreed about the importance of vaccinating our patient population, I think, because they were seeing the same data that we wereÌýand she agreed in one of the meetings with the governors to explain the impact that COVID was having on our patients, and try to encourage them, as Nate mentioned, on the state level to consider moving our patients higher up on the list. Apart from those meetings, we also got connected with the CDC directly onÌýDecember 17, andÌýstartedÌýa number ofÌýconversations related to our capabilities to vaccinate patients in our centers. I think that was something that we had to overcome in helping to educate people about why our patient population was so vulnerable toÌýCOVID, andÌýneeded to be addressed at the same time as these other patient populations.Ìý
Brad Puffer:ÌýWell, as you mentioned Laura, it seems we recognize that back in December, this really was going to be at least for a while aÌýstate by stateÌýeffort. AndÌýsoÌýI want to ask you, Nate, what it was like when you first heard that we would have two vaccines with use authorization in December and January, and how hard was it to get the attention of the state health departments to get allocation of this vaccine for both our employees and then patients.Ìý
Nate Elias:ÌýThere frankly, was a lot of confusion and ambiguity amongst the states. And I thinkÌýtheyÌýwere the first to make recognition of this as we did outreach to the states. IfÌýyou'llÌýrecall, there were issues with the manufacturing and distribution process. And pretty much every state in the nation was saying that theyÌýweren'tÌýgetting enough vaccine to treat front-line health care workers. And just the entire logistics process of how the states ordered the vaccines, how they received it, how they distributed internally,Ìý-Ìýbit of a learn as you go process for the states as well.Ìý
So again, recall very early on the priority and the mandate from the federal government to the states was, get front line health care workers vaccinated. But it wasÌýaÌývery hospital focused effort at first, and the vaccines were flowing straight to hospitals.ÌýSoÌýif you were not aÌýhospital basedÌýhealth care provider, it did at the beginning put you in a little bit of a strange position as to how you got yourÌýfront lineÌýhealth care workers vaccinated.Ìý
SoÌýour outreach was, we have aÌýbuilt inÌýinfrastructure,ÌýandÌýaccess to our patients more than any other setting in health care. We have experience with vaccination,Ìýand we can very quickly, and safely, and efficiently vaccinateÌýall ofÌýour staff,Ìýall ofÌýour patients. And you can sort of cross us off your list.Ìý
And the response we gotÌýinÌýthe very beginning was, A, weÌýdon'tÌýhave enough vaccine to even do our front-line health care workers right now, let alone patients. And B, weÌýdon'tÌýhave enough vaccine to just give you your own allotment.ÌýSoÌýfor the time being, you're going to have to work within the system that'sÌýhasÌýbeen set up.ÌýSoÌýit was a little slow going at first, but it was for everybody, because there was a lot of just learning as you go with state governments, local county health departments, and the federal government.Ìý
Brad Puffer:ÌýAnd I know youÌýcouldn'tÌýdo that all alone.ÌýSoÌýit'sÌýreally impressiveÌýto think about how we did that advocacy in 50 different states. And my understanding is you identified essentially a state champion in every state who could try to navigate with the local health departments. Is that correct?Ìý
Nate Elias:ÌýThe state champions program was really the brainchild of our clinical operations team. And the dynamic we were seeing wasÌýreally twofold. Number one, this did become a very local, very granular process in a lot of different areas where the state further pushed things down to county health department,ÌýandÌýsometimes, even down to just very local hospital systems to administer the vaccine and make decisions about who could andÌýcouldn'tÌýget them.Ìý
SoÌýwe realized that our quickest path at the beginning was through some very local contacts. Our clinics all over the country already had existing relationships with their local county health departments for various reasons. The other thing that we needed to ensure was that every single one of our clinics was registered with whatever state immunization registry, or reporting registry, that that state required for us to be a vaccine administrator.Ìý
SoÌýwe did go to basically,Ìýa 50 stateÌýbyÌýstate champion team, where every state hadÌýaÌýsenior level clinical manager operations person that was that state's vaccine champion. It was their responsibility to make sure all that local outreach was going on from the clinic level to the county health department, and then also making sure that every clinic in that state had the proper registrations on file with the state, so that when we did have an opportunity to get the vaccine, we were ready to go, and thereÌýwasn'tÌýany delays in accepting vaccine and providing vaccines.Ìý
Brad Puffer:ÌýAnd Nate, I know eventually, we did have some breakthroughs and success statewide.ÌýStates like Louisiana led the way,ÌýandÌýMassachusettsÌýandÌýMinnesota. How successful were those early state wins? And did they help convince other states to come along?Ìý
Nate Elias:ÌýYeah, absolutely.ÌýSoÌýweÌýhave toÌýgive a big shout out to Louisiana. Louisiana was the first early adapter to the model. I recall being on a call with the chief health officer, the state of Louisiana, andÌýMike Asselta, the President ofÌý, and we laid out the opportunity that we provided, again, with the infrastructure that we had built into place, the frequency at which we saw our patients, highly trained staff that had experience with vaccines, and this physician, the chief health officer in Louisiana, he got it.Ìý
He and his team, they got it. And they said yes. We see the opportunity here.ÌýLet'sÌýdo it.ÌýSoÌýthey provided us a direct distribution of the vaccine for any remaining staff that hadn't yet been vaccinated, and our entire patient population who wanted the vaccine, and who were accepting the vaccine. And within the matter of a few weeks,ÌýweÌývery safely and efficiently with basically zero wastage of any doses, vaccinated everybody in the state of Louisiana in our system that wanted the vaccine.Ìý
And it really bore a lot of fruit down the line. And as you said, we started getting state by state here and there, other states recognizing the opportunity that this type of system boreÌýout.Ìý
Brad Puffer:ÌýWell, Laura, as Nate was in the trenches getting momentum with other states coming along for federal allocation, there were still a lot of states thatÌýweren'tÌýproviding direct allocation yet. As you were talking to the federal agencies in the White House, it suddenly changed with a new administration and inauguration. Did you feel like you had to start over in some respects?Ìý
Laura Kemper:ÌýReally, the good thing is, is thatÌýactually theÌýmajority of government functions with long term career officials who have been there for years, and who don't change when the administration changes.ÌýSoÌýwe wereÌýreally luckyÌýin that everybody that we had been meeting with at CDC from those earliest meetings in mid-December, they were still there once President Biden took office.Ìý
I think the issue for us certainly was that at the highest levels of the White House, there were newly installed political officials, especially with the White House COVID task force.ÌýSoÌýweÌýdefinitely hadÌýto spend time educating them about our patient population, and the importance of a potential federal allocation to us. We did feel that the transitionÌýactually offeredÌýus a bit of an opportunity, because itÌýpresentedÌýI think, a shift in thinking.Ìý
The Biden administration we felt was going to be more interested in potentially using federal programsÌýas a means toÌýreach broader populations, and target those most at risk So the transition opened the door for us we felt to make a renewed push for the importance of a federal allocation.Ìý
Brad Puffer:ÌýAnd how big a factor was the administration's focus, for example, on health equity on their decision to ultimately give us a federal allocation?Ìý
Laura Kemper:ÌýWe did spend a lot of time early on meeting with some of the newÌýstaffÌýat the White House helping them understand who our patient population is. And that wasÌýreally key, I think, for them. Because when they came in, and inherited this program of vaccine distribution, I think there was some criticism that minorities who were being disproportionately impacted by COVID, were also being vaccinated at a slower rate.Ìý
SoÌýwe really spent a lot of time trying to help them understand who our patient population is, even theÌýmakeupÌýof our 1A front-line health workers, and that wasÌýdefinitely key, I think, to helping us move across the finish line with getting a federal allocation.Ìý
Brad Puffer:ÌýNate, so how important was that federal allocation then for theÌýstate by stateÌýefforts. Because some of our states are now up to 60% or 70% of patients vaccinated, while other states,Ìýwe'reÌýstill only around 15%. This national rollout must have been hugely important to level the playing field.Ìý
Nate Elias:ÌýAs much as we try to educate everybody around the country, there are still some people that justÌýweren'tÌýquite understanding, for example, some of the challenges that our patients sometimes have with transportation. And we get responses back from the states saying, well, most of your patients should be eligible by now, because of ourÌýage basedÌýprotocols for vaccines. And we have mobile drive-through vaccine sites set up all over the state, so they can just hop in their car and drive-through, andÌýget a vaccine.Ìý
Well,ÌýinÌýa lot of cases with our patient population, itÌýdoesn'tÌýwork. AndÌýthat'sÌýwhy we were pushing so hard to be able to get the vaccine directly into our clinics, so that we could vaccinate our patients while they were in receiving their dialysis.ÌýSoÌýwe were continuing to push on this extremely hard on aÌýstate by stateÌýbasis.Ìý
But when the federal allocation was finally approved, it was a great relief to everybody,Ìýbecause we knew that at that point, that weÌýdidn'tÌýhave to deal with these differentials in protocols for the vaccine state by state, and we could just get everybody vaccinated. And it was just a huge sigh of relief for everybody.Ìý
Brad Puffer:ÌýAnd Laura, take us to that week. I mean, that must have been a huge week when we learned that we wouldÌýactually getÌýa direct allocation. What was the emotion behind that for you, and how quickly did we have to jump into action to really capitalize on this opportunity?Ìý
Laura Kemper:ÌýIt was honestly, a relief I think for all of us who had been working on this since mid-December.Ìý
We felt that we had the experience. We knew how to execute this.ÌýSoÌýit was just a relief that they had finally seen the value that we could bring in hoping to vaccinate our patients. Because we just kept having to keep up the drumbeat explaining why our patientsÌýweren'tÌýable toÌýaccess those sites. Nate mentioned transportation. WeÌýalsoÌýhave some digital literacy issues.ÌýAnd frankly, early on, patients were lining up in long queues at these federal sites to be able to receive vaccines. AndÌýthat'sÌýjust something that our patientsÌýaren't able toÌýdo.ÌýSoÌýwhat we really learned through all of this, and helped to educate the White House on, is that our patients view us as their primary care provider. And they ultimatelyÌýexpect to receive their vaccines from us.ÌýSoÌýit felt like a real win for the entire team to be able toÌýactually finallyÌýdeliver on something that we had been working on for so long.
Brad Puffer:ÌýLaura, how important was it that we cooperated so much with smaller providers as well. I know a lot of efforts have gone into training, educating, and distributing to smaller providers,Ìýbecause this was not justÌýÄ¢¹½´«Ã½ North AmericaÌýissue. This was an industry issue for all dialysis patients.Ìý
Laura Kemper:ÌýBill Valle, the Head ofÌýÄ¢¹½´«Ã½ North AmericaÌýalways said in every meeting that this was about the nationwide community of dialysis patients, and all of our front-line workers. SoÌýpretty earlyÌýon into it, we realized that it really needed to be broader than just the providers. So along the way, and I hesitate to call people out, because there were so many involved, but for instance, theÌý, theÌý,ÌýandÌýsome of the patient groups were involved. And we approached CDC and the White House with a solution for the entire industry.Ìý
And basically, we presented ourselves as willing to play whatever role that we needed to ensure that the entirety of the ESRD community, and workers were vaccinated. We also really spent a lot of time talking with members of Congress about this, who did get involved, and help to weigh in with the White House. We even had a few members ask questions about a dialysis federal allocation during a public hearing with the CDC director, allÌýin an effort toÌýjust continue the drumbeat.Ìý
It took a lot of meetings amongst the community. But I think the eventual unanimity of the industry, and in agreeing that this federal allocation wasÌýreally important, and a key to solving this disproportionate impact COVID was having on the patient population, that was key to our ultimate success in this.Ìý
Brad Puffer:ÌýAnd Nate, how has it been going so far? How is it state by state now? Are we seeing that playing field being leveled? And how successful has the rollout been within our centers?Ìý
Nate Elias:ÌýNationally, we have justÌýreally fantasticÌývaccination rates, both with the states had provided this vaccine already, and then layering on the federal allocation on top of that, I think we're really starting to get to a critical mass of vaccinated patients. AndÌýwe'veÌýbeen working very well with the states on the vaccination program now, turning some vaccine that we've gotten from some states back to them, talking now about how are we going to get small batches of doses of the vaccine to some remote clinics.Ìý
And really, and I thinkÌýyou'veÌýheard it loud and clear from our medical office, from Bill Valle, our CEO, and everybody else, I think probably just one of the biggest issues that we're facing right now is just vaccine hesitancy,Ìýand we're just encouraging everybody who can get the vaccine to get the vaccine.ÌýWe now have access to the vaccine forÌýall ofÌýour patients,Ìýall ofÌýour staff. And we want to make sure that everybodyÌýwho'sÌýwilling to get the vaccine is utilizing it.Ìý
Brad Puffer:ÌýPatients certainly trust our nurses, and our providers, and their advice, as well as their nephrologist.ÌýSoÌýeverybody working together to make sure that we overcome any vaccine hesitancy that might be lingering out there. Laura, any final words from you on seeing this finally come to fruition and this be successful with patients, and our staff getting the vaccine they need.Ìý
Laura Kemper:ÌýI was just so impressed. You know, even every time we were faced with a challenge, people just said, yes, and then I think went off to figure out how to make it happen.ÌýSoÌýeverybody had a very positiveÌýattitude, andÌýwere willing to pull together to make sure that we were able to make this a reality for our patients.Ìý
Brad Puffer:ÌýWell, Laura and Nate, this has been a great discussion. Thank you both for joiningÌýus, andÌýgiving a little behind the scenes look at our work to get our patients vaccinated as soon as possible, and to help end the pandemic. Thank you.Ìý
Laura Kemper:ÌýThanks so much.Ìý
Nate Elias:ÌýPleasure being here.Ìý
Brad Puffer:ÌýAnd to our audience, thank you for joining us. Please know that your feedback is always welcome. If you have comments on today's episode, topics of interest to you, or speakers you want to hear from, let us know by clicking the feedback link featured on theÌýField NotesÌýwebsite onÌýFMCNA.com. Don't forget, you can findÌýField NotesÌýon theÌý, orÌý, orÌýright hereÌýat FMCNA.com, where you can also find ourÌýannual medical report, and otherÌýfeatured articles.ÌýWe hopeÌýyou'llÌýcome back and join us. We have many more topics to discuss in the weeks ahead. Until next time,ÌýI'mÌýBrad Puffer. You've been listening toÌýField NotesÌýbyÌýÄ¢¹½´«Ã½. Take care everyone.Ìý
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