key: cord-0822487-cwz0jp4y
authors: Blacksin, Beth A.
title: Case report: Vaccine Brigade Chicago, Illinois: From founding February to July, 2021
date: 2022-03-30
journal: Public Health Nurs
DOI: 10.1111/phn.13072
sha: ffba148a40e44d26f0f796c56c77b85e7f34c17b
doc_id: 822487
cord_uid: cwz0jp4y

The COVID 19 epidemic disrupted every aspect of American life and imposed severe trauma as a result of lockdown, fears of disease or death, separation from and death of loved ones, and daily media coverage of the unfolding pandemic. The following case report describes the experiences of the Vaccine Brigade, a group of Public Health Nurses (PHNs) and other professionals, mostly retired, who organized themselves to provide assistance with vaccine administration in the city of Chicago and Cook County, Illinois. The report describes the founding of their organization in February, 2021 and their work to support vaccine administration in communities of color and other underserved communities. This case report presents a successful model of volunteerism, built on foundational principals of collective decision making, democracy and social justice. Its members developed existing social networks and skills they had learned during their careers as PHNs and activists to create a functional organization that could assist with the task of getting shots into arms.

The COVID 19 epidemic disrupted every aspect of American life and imposed severe trauma as a result of lockdown, fears of disease or death, separation from and death of loved ones, and daily coverage of the pandemic in the media. One systematic review of the literature found that during the COVID epidemic, the general population experienced unprecedented assaults on mental health. These effects included high rates of anxiety, depression, post-traumatic stress disorder, and general psychological stress (Serafini et al., 2020; Xiong et al., 2020) .

Early in the COVID 19 pandemic in the United States, many retired health care professionals tried to volunteer to work in NYC hospitals, the first urban epicenter of the US pandemic. Unfortunately, they confronted roadblocks and obstacles to participation in an already overwhelmed health care system (Hong, 2020) . Providing structures for volunteers to do their work during the pandemic became a national issue. In order to integrate volunteers, hospitals at a minimum would have needed a coordinating mechanism to incorporate their use-sadly, an efficient structure to integrate volunteers did not exist first in New York or later, anywhere across the United States. This case report describes an example of how volunteers became integrated into vaccine efforts in the city of Chicago.

These attempts to volunteer come as no surprise. Volunteerism as a practice is deeply embedded into the history of American society.

When Alexis de Tocqueville observed American society in 1830, he saw a public spirit demonstrated in their creation of a variety of voluntary associations to improve the common good (Tocqueville, 1838) .

Faith-based organizations, unions, social groups, membership associations and political organizations allow Americans to build community, pursue shared goals, and influence social and political affairs (Skocpol et al., 2000) . In addition, volunteers enjoy better mental health and decreased stress, as well as an expanded social network (Wilson, 2012) .

The following case report describes the experiences of a group of Public Health Nurses (PHNs) and other professionals, mostly retired, who have organized themselves to provide assistance with vaccine administration in the city of Chicago and Cook County, Illinois. The report describes the founding of their organization in February, 2021

and their continued work.

In late January, 2021, a small group of PHNs and activists responded to a call from a veteran public health nurse to come together to form a group that they named the Vaccine Brigade. These nurses created the Brigade because of its members' desire to be of service during the COVID pandemic. For a year, many of the PHNs had attempted to volunteer, signing up for the state medical reserve corps and the local health department's website, but had been frustrated by the lack of response. Despite the election of President Biden, the creation of the federal COVID Taskforce, and with it, a real plan to distribute vaccines, obstacles to volunteer participation continued with the initiation of the new vaccine campaign. Under-resourced, understaffed, and overburdened health agencies responded to a major pandemic with inadequate systems, and the country's longstanding failure to invest in disease prevention, address the root causes of poor health, and promote health equity made the nation less resilient (McKillop & Lieberman, 2021, p. 4) .

Public health departments, historically underfunded and lacking necessary infrastructure and staff, were hardly in a position to absorb volunteers.

As vaccine supply increased and became more widely available, public officials and some providers began to realize volunteer nurses could be useful in assisting with vaccination efforts. That became the Brigade's main mission; to help get shots into arms in Chicago's hardest hit areas, especially communities of color. Members had worked together in the state nurses' association, the women's movement, and other political and social justice campaigns. Each member knew at least one other member or sometimes several members of the original group.

Brigade members collectively possessed decades of activism and leadership in labor, political and community organizing experience so they reached out to networks and colleagues to build membership. Members attempted explicit outreach to colleagues of color as the initial group was majority white. An interview of one of the founding members by the local public radio station in March significantly boosted membership (Vevea, 2021).

On February 21, founding members created a steering committee with weekly zoom meetings. General membership meetings were held every 2 weeks, and members divided into committees: administration, vaccinators, outreach, and internal education. The steering committee discussed structure and function and how best to move forward. Decisions were arrived at through consensus building with an emphasis on a collective, democratic process. A group email account enhanced communication and then a website (www.vaccinebrigade.com) went live on March 21, 2020 to communicate the Brigade's mission to the public. One volunteer posted relevant information about how to join the Brigade and monitored the Gmail account so that anyone who sent an email expressing interest was sent a survey to assess their skills, interests and availability. Contact information was added to the evergrowing excel database. These forms of social media were deliberately chosen to be the most efficient and functional in reaching additional potential volunteers. Member expertise in administrative work was critical to tracking events and members; this group's capacity functioned as a key component to guarantee that the Brigade ran smoothly.

Overall vaccine organization and coordination was facilitated by a regional coalition organized by Partners in Health (PIH), a Boston based global not for profit whose main focus is to "collaborate with national governments to provide care and strengthen public health systems in areas including cancer and chronic disease, child health, emergency response, HIV/AIDS, maternal health, mental health, and tuberculosis" (https://www.pih.org). During the COVID-19 pandemic, PIH established a US initiative, with one hub in Chicago. PIH convened weekly zoom meetings, called the Chicagoland Vaccine Partnership.

The mission of the Partnership is "to advance equitable access to health solutions for all Chicagoans through its incubation, grantmaking and advocacy programs" (CVP, https://chicagolandvp.org). CVP became an important partner for the Vaccine Brigade.

These meetings were open to all, and grew to 160 participants, including city and county health departments, community-based organizations, funders, providers and advocates. Because of their international reputation, PIH was viewed as a trusted messenger, was in a position to bring together people together regionally, and to broker relationships across sectors. Each zoom meeting began with data updates on the current epidemiology of the pandemic as well as the status of vaccine administration from the city and county local health departments. These presentations were followed by a featured local organization's work showcasing exemplars of best practices so they could be duplicated. Challenges could be quickly identified and dealt with. Robust chat sessions allowed for the creation of real time connections among individuals and organizations. The common goal of equitable vaccine access by getting shots into arms to those at highest risk served as a unifying call to action.

As the Brigade participated as an active member of the Partnership, it learned about more CBOs requesting help. One coincidence was that a local funder 'saw' some of our members at the Partnership meetings, and the Brigade was offered an opportunity to apply for a small grant to continue its work and pay for expenses like the website, materials, badges and mailings. As the Brigade's reputation spread, members were asked to provide support and assistance to more organizations.

Through the Partnership, Spanish speaking Brigaders worked with Illinois Unidos, a consortium of over 150 public officials, health professionals and CBOs, with a focus on supporting COVID relief efforts in the Latinx community in Chicago and Cook County. One member, an expert in motivational interviewing, provided training in Spanish to CBOs about motivational interviewing, as well as answering questions at community meetings.

A more recent outgrowth of the CVP is participation in the Educators Roundtable, another city/county broad coalition of governmental public health, the Chicago Public Schools and a variety of youth serving organizations tasked with reaching out to youth and organizations which serve the 12 and up population. The Brigade's representative to that formation is a retired CPS principal and chair of the outreach committee.

In the beginning of the life of the Brigade, volunteering to give vaccines was still difficult; there were many bottlenecks and barriers. 

Vaccine hesitancy refers to ". . . delay in acceptance or refusal of vaccination despite availability of vaccine services. It is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence" (Macdonald, 2015, p. 4163 

Meanwhile, the Brigade leadership soon realized that actually administering vaccines was only one way to volunteer. Substantial work was required to publicize events and conduct outreach so community residents knew when and where to show up. This outreach-getting people Members were able to discuss issues like enrollment in primary care at FQHCs for uninsured clients, as well as provide information about other community benefits available during the pandemic like rental assistance, food assistance and other basic social services. Brigade members fluent in languages other than English were able to provide essential information to immigrant communities and/or non-English speakers.

In summary, over the course of 4 months, Brigade services provided in the Chicago and Cook County Metro area included vaccine administration, onsite logistics, turn-out as well as providing education to multiple agencies in both English and Spanish. In a summer report to its funder, the Brigade listed 43 different organizations it had worked with; many of these organizations held dozens of events that provided thousands of vaccinations. Members developed ongoing relationships with health care organizations and participants in local events because of their consistency of participation, leadership, and willingness to work.

At the height of the vaccine initiative, dozens of opportunities were posted on the weekly mailing to the group.

Providing services in a changed environment CDPH recently implemented a door-to-door canvassing campaign to identify unvaccinated people in communities with the lowest rates.

City canvassers are able to either make an appointment for those who want to get vaccinated, or arrange to have a vaccinator come to the home and give shots to up to ten people with a $100 VISA gift card as an incentive. As of July, 2021, the Vaccine Brigade was in the process of joining this new effort by meeting with potential partners, evaluating hyperlocal data obtained from CDPH and piloting door-to-door canvassing efforts.

Program evaluation is the systematic collection of information about program activities, characteristics and outcomes of programs to guide future activities (Patton, 2105) . People engage in activities to change the world, and evaluation helps participants understand if they are accomplishing what they seek to accomplish. Evaluation activities guide program choices for more effective future activities.

As part of program evaluation, the Brigade surveyed its members to determine future directions. The evaluation was sent electronically 

Nursing is a health equity and social justice profession, with a history of improving the health of individuals and populations by addressing social disparities (Rudner, 2021) and the spirit and work of the Brigade harkens back to the earliest days of public health nursing . Nurses assessed the situation produced by the pandemic and identified a need to broaden the scope of vaccine administration to the most underserved communities and communities of color. They created an interdisciplinary organizational structure to fill that need, reached out to diverse partner organizations, and then organized to help bring services to underserved communities to achieve vaccine equity. They developed new skills and gained new knowledge during the process, as they built a model that worked at that moment.

During the group's formation, members tried to increase its diversity by reaching out to nurse friends/colleagues of color. Many of these individuals were working in their community organizations and neighborhoods, and believed these spaces were a better fit for their vaccine work. Those relationships helped to steer the Brigade to opportunities for volunteering in minority communities, though most of these nurses (and others) did not join. However, while conducting community outreach, the group established connections and working relationships with diverse organizations across the city. The Chicagoland Vaccine Partnership, in particular, provided an opportunity to offer service to organizations of color.

Key to successful volunteer work is partnering with communitybased organizations. An overarching coordinating body like the Chicagoland Vaccine Partnership that can facilitate coordination and collaboration, as well as play a brokering role between governmental, non-governmental organizations, funders and volunteers is also a critical aspect of the work. Policy changes that enable the quick mobilization and integration of volunteers should be made at the local, state and federal level in preparation for the next pandemic.

Volunteerism is defined as "freely chosen" and deliberate helping activities that extend over time, are engaged in without expectation of reward or other compensation and often through formal organizations, and that are performed on behalf of causes or individuals who desire assistance (Snyder & Omoto, 2008 in Wilson, 2012 . Respondents' survey answers show they experienced the major effects of volunteerism-a sense of accomplishment, decreased frustration and isolation, as well as building a network (Wilson, 2012) . One limitation of the survey was that we failed to ask about the concept of social justice activism which fueled the work of many of its members, given their long histories of commitment of social justice causes and the ways they discussed their work informally at meetings and events.

The Chicago Vaccine Brigade serves as a successful model of volunteerism, constructed on the foundational principles of collective decision making, democracy and social justice. Its members built on their existing social networks using skills they had learned during their careers as PHNs and activists to create a functional organization that could assist with the task of getting shots into arms. Volunteers are never intended to replace a robust public health workforce. However, they may offer a useful expansion to a stressed public health infrastructure during crisis periods.

Author wishes to acknowledge editorial assistance of members of the Vaccine Brigade and Margarita Reina, MPH, Senior Epidemiologist, Chicago Department of Public Health.

I was a founding member of the Vaccine Brigade. Otherwise, I have no conflicts of interest.

Research data are not shared.

Beth A. Blacksin https://orcid.org/0000-0003-1601-1081

The use of motivational interviewing to overcome COVID-19 vaccine hesitancy in primary care settings

Civic engagement: School-based health centers and public health nursing

). [map, program description] Protect Chicago. The Impact of Protect Chicago Plus -Initial 15 Communities

Public health's falling share of US health spending

Volunteers rushed to help New York hospitals: They found a bottleneck. The New York Times

Racial and ethnic differences in COVID-19 vaccine hesitancy can uptake. MedRxiv: The preprint server for health sciences 2021

COVID-19 vaccination hesitancy in Hispanics and African-Americans: A review and recommendations for practice

Vaccine hesitancy: Definition, scope and determinants

Qualitative research and evaluation methods

Nursing is a health equity and social justice movement

The psychological impact of COVID-19 on the mental health in the general population

A nation of organizers: The institutional origins of civic voluntarism in the United States

Democracy in America: G

The impact of chronic underfunding on America's public health system: Trends, risks, and recommendations, 2021 (Trust for America's Health

Volunteerism research: A review essay. Nonprofit and Voluntary Sector Quarterly

Impact of COVID-19 pandemic on mental health in the general population: A systematic review

Case report: Vaccine Brigade