In March 2020, at the beginning of the COVID-19 pandemic, Kristina Grabbe felt the importance of her chosen career in public health more than ever. As an epidemiologist, Grabbe knew what the impacts could be of an unchecked pandemic.
By the end of the month, the world was averaging nearly 60,000 new cases of COVID-19 per day, with 17,000 new daily cases occurring in the United States. As scientists rapidly tried to learn about the new pathogen, much of the world locked down, limiting movement and causing many people to lose their jobs.
“We didn’t know what the future would look like,” says Grabbe, a senior technical advisor at Jhpiego who was then supporting the organization’s global HIV testing and control programs. “But we knew something had to be done quickly.”
With a staff made up of public health experts who, like Grabbe, have backgrounds in infectious diseases and epidemic control, Jhpiego was well-placed to respond to this new disease.
“I had such a desire, as so many people did, to dig in and make a difference anywhere that I could,” she says, “and then right here at home, there became a real opportunity.”
Through Jhpiego’s affiliation with Johns Hopkins University and aware of our expertise in training community health workers around the globe, the Baltimore City Health Department reached out, seeking support for rapid hiring, deployment, and training of a large contact tracing workforce.
A partnership to save lives
“Contact tracing was one of the only things that could be done at that time, identifying people who had COVID-19 through testing and supporting them with isolation, and reaching out to their close contacts and getting them to quarantine,” says Grabbe who was chosen to lead the Jhpiego project. “It’s a technique we use for other infectious diseases, like HIV and tuberculosis, and it was certainly one of the key strategies used for containing Ebola, so we were very familiar with this approach.”
The work was put together as part of a multi-partner initiative known as the Baltimore Health Corps. With initial funding from the Rockefeller Foundation, the Johns Hopkins Bloomberg School of Public Health and others, and a cohort of partners, including, Mayor’s Office of Employment Development, Healthcare Access Maryland and Baltimore Corps, Jhpiego joined the citywide effort. Although this was Jhpiego’s first experience implementing a U.S.-based health program, the organization rapidly developed and implemented a course for contact tracers. From August 2020 through June 2021, Jhpiego helped hire and train over 200 people, all of whom had lost their jobs or had their work substantially affected due to COVID-19’s economic fallout.
Responding to changing needs
But as the city’s pandemic response shifted, so did Jhpiego’s work. When the COVID-19 vaccines became available in the United States in December 2020, the city health department focused on getting shots in arms. They again looked to Jhpiego to prepare vaccination workers and build a team of community health workers for mobile vaccination clinics.
Jhpiego was also asked to assemble a team to support, manage and advise the vaccine response, which focused on reaching nine priority communities and was known in Baltimore as COVAX. These Jhpiego staff became core to the city’s vaccine response and worked within the health department and alongside both clinical and community partners.
One of these new staff members was Klara Annibal, program coordinator for the pregnant and lactating women’s VALUE Community, one of the nine priority populations identified by the health department and community members.
“My role was to understand the challenges and obstacles related to efficiently reaching mothers,” says Annibal. “I was the link between the community, the mobile response team and their clinical partners . . . to make sure vaccination clinics were accessible and equitable for mothers.
“Women are so vulnerable in pregnancy and the COVID-19 pandemic was adding extra anxiety,” she says. “It was important for us to be mindful of how they processed information, to meet them where they were in the journey and to provide the right outreach and engagement.”
One of the ways Annibal’s team did this was by holding community baby showers. At these events, they gave away supplies for new babies, educated mothers about the vaccine and offered vaccinations.
The VALUE in community engagement
The VALUE Community coordinators worked to build true engagement between communities and the health department—and trust in the health system. “There’s absolutely no way to touch a population and make sure you’re connecting with them without them being absolutely, 100 percent part of the process from the get-go,” says Benjamin Cramer, who coordinated consultations with people living with disabilities. These types of consultations, held with each of the nine VALUE communities, ensured everyone had equitable access to vaccines.
The COVAX team has brought the Baltimore City community together by empowering people to advocate for themselves and their community during a time that has been uncertain and even a bit frightening.”COVAX Program Coordinator Joy Davis
“We have taken a community-oriented approach to providing people with verified information and encouraging them to engage with our team and other systems and to ask questions,” says Joy Davis, the program coordinator for the older adults VALUE Community.
This community-centered approach helped the city health department reach 80% of the eligible population with at least one dose of a COVID-19 vaccine by February 2022, a milestone in protecting the people of this city against the worst outcomes of COVID-19.
“Jhpiego was an indispensable implementation partner,” says Rebecca Dineen, Assistant Commissioner, Maternal and Child Health, Baltimore City Health Department. “With years of global public health program expertise, Jhpiego was able to quickly understand and staff the vaccine access response. In addition to playing a key advisory role throughout the whole response, Jhpiego also developed an incredible resource of training tools and materials for sustaining the work long after Jhpiego’s departure.”
Jhpiego’s support for the vaccine program is now winding down and we are doing what we do with ministries of health all over the world—solidifying local ownership by fully transitioning work to the health department. As new variants arrive and outbreaks occur, the health department will continue to support ongoing contact tracing, testing and vaccinations. And with the approval of vaccines for children under five years old, the vaccination campaign is being expanded to include them.
“We started this COVAX project with the mindset that, ‘It’s Baltimore Versus COVID’ and it is only because we rose up as a city and joined hands to address our challenges together that we were able to have the impact we did,” says Grabbe.
“I really cherish the opportunities and the partnerships that have come out of this work. And knowing we did something to help Baltimore City residents, well—that’s the true joy.”