Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Lizelle Lirio de Luna, Director, Family Health Services
Subject: Amendments to the Agreements with Bay Area PL Services and Lookout Health Corporation to Implement Community-based Immunization Services
RECOMMENDATION:
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Adopt a resolution authorizing the Chief of San Mateo County Health, or designee, to execute agreements and any associated amendments with Bay Area PL Services and Lookout Health Corporation for the term of July 16, 2022, through June 30, 2023, in an amount not to exceed $3,560,000 between the two agreements.
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BACKGROUND:
The San Mateo County Emergency Operations Center (EOC) has been contracting for community-based vaccination services under emergency authorization since February 2021. To date, County-sponsored community/standing clinics have delivered 123,253 vaccines to residents. With the delivery of Covid-19 vaccinations expecting to continue through FY 2022-23, the EOC directed San Mateo County Health (SMCH) to enter into a competitive bid process to secure ongoing vaccine providers for the delivery of Covid-19 and other vaccinations targeting the County’s health equity neighborhoods and residents.
On June 1, 2022, a Request for Proposals (RFP) was released to 83 organizations, seeking partnership with an experienced contractor(s) that could provide a variety of vaccination services. Ten entities submitted proposals in response to the RFP. On June 23, 2022, the proposals were evaluated by a review committee that chose to elevate proposals from Bay Area PL Services and Lookout Health Corporation as the proposals most aligned with County need.
On July 26, 2022, this Board approved agreements with Bay Area PL Services and Lookout Health Corporation for the term of July 16, 2022, through June 30, 2023, in an amount not to exceed $1,545,000 between the two agreements.
There are four types of services included in these contracts:
1) Standing/Pop-up clinics with capacity for up to 400 vaccinations per day. Five standing clinics are currently co-located at San Mateo Medical Center sites and the YMCA East Palo Alto through the end of September 2022. The County will then shift to focused pop-up events that are mobile, to be able to meet local communities where they are at, until June 2023.
2) Congregate care facility clinics primarily focused on booster doses and preventing severe illness and death in these locations. The need for congregate-focused clinics may rise with the release of new booster guidelines.
3) Homebound vaccinations for residents who have mobility challenges that prevent them from getting to a vaccination site through their provider, a pharmacy or a community clinic. Homebound vaccinations are only offered after transportation is first offered to the resident and ruled out as an option.
4) Mass Vaccination at 500+ vaccinations per day is being included, in case a quick pivot is needed, but there are no current plans to implement this strategy.
DISCUSSION:
Additional funds in the amount of $2,015,000 are being added to the not to exceed amount in the existing Bay Area PL Services and Lookout Health Corporation agreements. This additional funding is to be used for Monkeypox (MPX) vaccinations and the updated Covid-19 bivalent omicron-specific booster vaccinations. It is estimated that semi-weekly Post Exposure Prophylaxes (PEP) clinics, as well as weekly large clinics, will be needed to manage the MPX emerging communicable disease outbreak. Demand for the updated Covid-19 booster is expected to be high, as all ages 12+ and older are eligible for the new booster. Standing Covid-19 clinics have reverted to a weekly schedule to meet the latter demand, with an estimated need to run clinics at this frequency of up to four to eight weeks. Cost estimates are based on the maximum number of clinics and number of vaccinations expected, as well as account for possible future needs; staff will assess the need for Covid-19 and MPX clinics and adjust service levels over time.
SMCH requests that the resolution authorizes the Chief of San Mateo County Health or their designee to execute all agreements and amendments with either of the two vendors, including those over $200,000, as long as all agreements and amendments do not exceed the total not to exceed amount of $3,560,000, in aggregate. This will allow flexibility in mobilizing the vendor, who is available and best suited to meet clinic needs at any point in time, as the community needs change with the trajectory of the Covid-19 and MPX infections.
The amendments to the agreements and resolution have been reviewed and approved by the County Attorney as to form.
Performance management will focus on the primary service the County expects Bay Area PL Services and Lookout Health Corporation to deliver-Standing/Pop-up clinics-and these vendors’ ability to close equity gaps. The impact of racism has led to a disparate health impact of Covid-19 on communities of color. Data from the Centers for Disease Control and Prevention show that Hispanic, Black or African American, and American Indian or Alaska Native populations in the U.S. are experiencing higher rates of hospitalization and death from Covid-19 compared to White populations. Together, the latter three race/ethnicity groups constitute approximately 27% of the County population (per 2021 California Department of Finance population projections)-25%, 2%, and 0.1%, respectively. The FY 2022-23 target for the proportion of vaccinations administered at Standing/Pop-up clinics to individuals from these three race/ethnicity groups is 54% of the vaccinated total, or twice their representation in the County population. This requires a 25% improvement from FY 2021-22, when 43% of vaccinations at Standing/Pop-up clinics were given to individuals from one of these three race/ethnicity groups.
It is anticipated that the percentage of vaccinations at Standing/Pop-up clinicals given to individuals from race/ethnicity groups experiencing disparate health impact (Black or African American, Hispanic, and American Indian or Alaska Native) will increase by 25% in the next fiscal year.
PERFORMANCE MEASURE:
|
Metric |
FY2021-22 Actual |
FY 2022-23 Estimated |
|
Percent of vaccinations at Standing/Pop-up clinics given to individuals from race/ethnicity groups experiencing disparate health impact (Black or African American, Hispanic, and American Indian or Alaska Native) |
43% 32,980/77,209 individuals |
54% 3,394/6,250 individuals |
|
Percent of vaccinations at Standing/Pop-up clinics given to Hispanic individuals |
42% 32,067/77,209 individuals |
50% 3,125/6,250 individuals |
|
Percent of vaccinations at Standing/Pop-up clinics given to Black or African American individuals |
1% 759/77,209 individuals |
4% 250/6,250 individuals |
|
Percent of vaccinations at Standing/Pop-up clinics given to American Indian or Alaska Native individuals |
0.2% 154/77,209 individuals |
0.3% 19/6,250 individuals |
FISCAL IMPACT:
The term of the two agreements is July 16, 2022 through June 30, 2023, with a total not to exceed amount of $3,560,000 between the two contracts. Of the total amount, $1,500,000 will be initially funded by the American Rescue Plan Act, subject to the application of and potential reimbursement from state and/or federal funds that may be made available in connection with the County's response to the Covid-19 pandemic. Two grants administered through the California Department of Public Health will fund services within Family Health Services (FHS). The Immunization Champions: Supporting Schools with Immunizations grant will fund $267,743, and the Immunization Assistance Program grant will fund $277,257. These grant amounts have been included in the FHS Adopted FY 2022-23 Budget. Funding is to be determined for the remaining amount, $1,515,000, pending release of future state and federal funds. There is no Net County Cost associated with the agreements.