Mobilizing transportation to Increase
COVID-19 vaccination
4 February 2021 Webinar

Transcript
Table of Contents
Introduction .......................................................................................................................... - 1 Dr. Janelle Routh .................................................................................................................. - 3 Dr. Oscar Alleyne.................................................................................................................. - 7 Scott Bogren ....................................................................................................................... - 10 Panel discussion.................................................................................................................. - 11 -Introduction
Speaker: Amy Conrick, Director, National Center for Mobility Management
Good afternoon, everybody. Thank you so much for joining our webinar, we're delighted to have you join
us for this important topic during a very challenging time. I am Amy Conrick, the director of the National
Center for Mobility Management, or NCMM as we call it. NCMM is a technical assistance center fundedby the Federal Transit Administration. We work daily to promote customer centered mobility strategies topromote good health, economic vitality, self-sufficiency, and community
I would like to share with you are my thanks to the Federal Transit Administration for its help inorganizing today's webinar. Danielle Nelson, in particular has been a huge support. And I'd also like tothank Wendy Heaps of CDC. Without her I can honestly say this webinar would not have happened. So
thanks to both of you very much. I appreciate all your support.
In our agenda for the afternoon, we have a really good panel set up of experts for you to talk to and hear
from: the Centers for Disease Control and Prevention, the National Association of City and County Health
Officials, and the Community Transportation Association of America. Followed by that we have an
equally distinguished set of panelists, including a representative from the University of Massachusetts
Medical School, the Texas Department of Transportation, Spartan Transportation, the Office of Emergency-1-Medical Services at the National Highway Transportation Safety Administration, and Allegan County,
Michigan.
So before turning to our opening panel, I would like to let you know that due to unforeseen circumstances
FDA could not be with us today. As we know, the COVID-19 public health emergency has prompted thetransit industry to reimagine how it delivers essential services. Transit agencies across America haveanswered the call in many ways through what we call incidental use, in partnership with other local
agencies: by delivering meals, providing special service for older adults to access grocery stores, andparking Wi-Fi-enabled buses in communities that lack access to the internet to support student virtual
learning. These are just a few examples we have gathered on incidental uses of transit.
It’s particularly important to know that recent funding to rural and small urban areas can support thesetypes of local partnerships. On March 27, 2020, the CARES Act provided $25 billion in funding to support
the transit industry response to COVID-19. The follow-on Coronavirus Response and Relief Supplemental
Appropriations Act of 2021 (or CRRSAA as we call it) provides $14 billion to support the transit industry
response to COVID-19. Funds are provided at 100% federal share, with no local match requirement.
The FTA is encouraging transit grantees to partner at the local level to provide essential services to theircommunities. The FTA’s policy on incidental use allows for all FTA-funded vehicles, assets, and realestate—regardless of the funding source—to be used to support essential services when that use does notinterfere with transit service. More information about this is available on FTA’s website through its
COVID-19 recovery fact sheet [https://www.transit.dot.gov/ccam/about/dot-fta-hud-pih-partnership-covid19-recovery-fact-sheet], the link to which is shown in #1 and posted in the chat window. FTA has also
provided answers to specific, related questions through a series of FAQs, the link to which is shown in #2
and posted in the chat window https://www.transit.dot.gov/frequently-asked-questions-fta-granteesregarding-coronavirus-disease-2019-covid-19] I’d like to particularly call your attention to these FAQs:• CE10, which addresses the question “Can public transportation assets, such as vehicles andfacilities, acquired with FTA funds be used for non-transit activities in response to COVID-19?,• and FAQ CE4, which responds to the question ”Can CARES Act, CRRSAA funds or Urbanized Area
Formula Grants (Section 5307) and the Formula Grants for Rural Areas Program (Section 5311) ,administered under the provisions of the Emergency Relief program (49 USC 5324) be used for theoperating costs of essential services such as meal delivery? You will find answers to thesequestions in the FAQs accessible through these links.
• Note that the period during which these operating expenses are eligible for reimbursement forthese incidental uses has been extended to January 20th, 2022.
You can see more examples of these incidental uses at the NCMM URL shown in #3; that link is also
being posted in the chat window. [nc4mm.org/ccam]
And now, with the COVID-19 vaccine becoming more widely available, we know transit agencies canplay an important, specific role in increasing access to the vaccine. This may include:oooCreating local partnerships and developing strategies to increase vaccinations – whether
that’s transporting public health nurses to vaccinate homebound residents or transporting
community members to vaccination sites;
Identifying opportunities to align FTA-funded public transit assets, such as vehicles andbus stops, with community needs during the public health emergency and beyond;
Sharing data to measure capacity, gaps in services and community needs.

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And identifying opportunities to leverage federal funding from the Coordinating Council
on Access and Mobility (CCAM) member agencies to meet community needs resulting
from the public health emergency. The CCAM Program Inventory, available through thelink shown in bullet #4, identifies 130 Federal programs that are able to provide fundingfor human services transportation for people with disabilities, older adults, and/or
individuals of low income.

FTA FAQ CE18 is particularly pertinent with regard to vaccinations. It responds to the question, “Are FTA
funds available to provide transportation to or from COVID-19 vaccination sites?” The answer is yes. See
more details within the FAQ itself.
If you are a transportation provider and have any questions about these uses of transit during the COVID19 pandemic, I encourage you to reach out to your state department of transportation or FTA regional
office.
One final note. NCMM is working with the FTA to collect and publicly post examples of the manydifferent types of partnerships that have occurred already related to the COVID vaccination efforts. You
can view these in the link which is shown on this screen and is also being posted in the chat feature. As
you begin or continue your collaborations in your community, please share those examples with us at
NCMM at the email shown in the slide [info@nc4mm.org] so we can add them to these tables too.

Dr. Janelle Routh
Dr. Janell Routh, Co-Deputy of the Implementation Planning Unit of the Vaccine Task Force, Centers for
Disease Control and Prevention
So good afternoon, everyone. Thank you so much for asking me to join today to provide an update on
COVID vaccines and our vaccination program and efforts.
So okay, let's take a look at where we're at right now. As of February 1, I can say we've distributed now
over 50 million vaccine doses, and 27 million persons have received at least one dose, and over 6 million
have received their second rollout is occurring in all 50 States and across our US territories. And notsurprising there slightly more Pfizer that's been distributed. It was authorized a week earlier. I just wanted
to say all in all, I'm really proud of the vaccination efforts in these jurisdictions to get vaccine out the door
to the first group suggested for vaccination. They've distributed more vaccine in six weeks than they
typically do in six months.
So as you probably know, there are two vaccines that have received emergency use authorizations, or
UAS after careful FDA review. The first is Pfizer BioNtech, which is a two dose regimen given at least 21
days apart, and the second is Moderna, another two dose regimen given at least 28 days apart. Bothvaccines were tested in 10s of 1000s of adults from diverse backgrounds, or adults and communities ofcolor. Data from the clinical trials demonstrated that both vaccines were approximately 95% effective andpreventing COVID-19 disease, and both have favorable safety profiles.
One thing to note is that we don't currently know how long the protection for receiving a COVID-19
vaccine might last. But I can say that there is ongoing work at CDC to help answer this question.
So who is the vaccine being distributed and administered to? I'd like to think about this as an early phaseand then a later phase. So in the early phase, we've got a limited supply of vaccine. And we're carefully-3-focusing on certain priority groups. In the case of vaccine rollout, we really focused on health careproviders, long-term care facility residents, and getting vaccines out to public health clinics so that they
can get the shots into arms. But later in the distribution as our vaccine supply increases, we are reallyworking to get the vaccine distributed to broader populations and through a more wide variety ofadministration sites, which we’ll focus on. Again, I think about this in two ways: that rapid efficiency but
also ensuring equity. For example, pharmacies, mobile units, federally at health centers, and through massvaccination or large out patient clinics. So we're really giving the population a variety of places to choose
from, that really suits their needs.
So as we look at the slide, I do want to remind all of us that that vaccination program is dynamic, and it
will always require ongoing reassessment as vaccine supply and demand and the epidemiology of thepandemic change to really inform the timing of expansion out to subsequent groups. ACIP and CDC haveendorsed the guiding principles, again of that efficient distribution, and as well as jurisdictional flexibility
for vaccination programs. So while the slide does focus on different phases and the respective
recommended populations, such as phase one a with health care workers and long term care facility
breath We've really given jurisdictions the flexibility to administer this guidance in the best way they see
fit for their populations. Most jurisdictions now are rolling into phase 1B and 1C populations consisting offrontline essential workers and persons greater than 75 years of age for 1B, and then greater than 65 for
1C. And 1C also includes people with high risk medical conditions. We're really hoping that the additionof two more vaccines this spring, we'll be able to begin moving into that phase two, which is really where
all persons greater than 16 years of age will be eligible to get vaccinated.
So while CDC and ACIP, this national vaccine recommendation, we understand there is a level of local
adaptation as I mentioned, that jurisdictional flexibility. Our guidelines were not meant to be walls or
barriers between those phases, but just meant to support the prioritization of people at high risk for
exposure or at risk for severe disease. And I feel like we've always anticipated there will be overlap
between these phases. So while we're sort of emphasizing within each jurisdiction, a phased approach,it's not necessary for them to completely or fully administer vaccine to all eligible persons in one phase
before progressing to the next. And certainly if there are extra doses that would otherwise expire or be
wasted. We are emphasizing that it's important to administer those to persons that may be designated for alater phase, but who happened to be in demand for vaccine and implementation challenges will definitely
vary from one jurisdiction to the next.
So when and how jurisdictions move through phases will vary. And I think probably many of and we've
certainly seen a variety in the way that jurisdictions are both distributing and administering their vaccine
allotments.
So one group in particular, we need to ensure access to as our rural communities, I think, who are of
special interest to the group that's gathered here today because they really constitute a group that we haveto think carefully about mobilizing transport recommendations. We know that rural communities are eachunique in our geography and population. And this slide is certainly overgeneralizing. But it does serve as astarting place to think about how to best get vaccine out to these areas.
Generally, rural communities are disproportionately older with lower income and more underlying healthconditions. Many communities are considered highly vulnerable based on CDC social vulnerability index,
which includes factors such as housing, transportation, economics, and language. And those factors canbe very helpful in determining how best to support these populations. rural healthcare is also often
strained by shortages of healthcare personnel, which limits access to both primary and specialty care. And
it's often strained due to hospital closures when there aren't enough personnel. public infrastructure is also
limited in rural areas.
-4-And then finally, our rural population may also have limited transportation resources. So I think that's why
we're all here today to really talk through some of those challenges.
So I know there's so much information that can be found at our fingertips these days, some of which canbe conflicting. Our CDC website definitely has facts to counteract these common myths and I'm reallyangry Encouraging everybody to go to the CDC website and get as much information as you can around
vaccination and the vaccine products. So some of these facts that we like to get promoted out widely into
our populations include.
So getting vaccinated can prevent us all from getting sick from COVID-19. People who have gotten sickwith COVID-19 may still benefit from getting vaccinated. That's a key message that we really want toemphasize. Even if you've had COVID, please still do make your vaccine appointment. COVID-19
vaccines will not give you COVID-19. They are not live virus vaccines. And so that's not a concern. And
then they will also not cause you to test positive on the COVID-19 viral tests like PCRs. And I know that's
important too, because many of those tests are being required for certain forms of transportation.
So I wanted to mention a few words here about safety. The safety of COVID-19 vaccines is really a top
CDC priority. And these vaccines are being held to the same safety standards as other routine vaccines.
We have several experts and independent groups that evaluate the safety of vaccines being given to
people in the United States. I want to run through how we've evaluated and continue to evaluate these
COVID-19 vaccines.
So before any vaccines receive authorization or approval, the FDA carefully reviews all of the safety datafrom this clinical trials. And then the Advisory Committee on Immunization Practices, or ACIP, which isan independent body of experts, reviews all safety data before recommending their use. FDA and ACIP
have qualified scientific and clinical experts, which minimizes the conflicts of interest. They are the ones
reviewing those data. And after any vaccines are authorized to use, both FDA and CDC continue tomonitor their safety. And here we've got a couple of systems: one that's been long standing and one that
we've just put in place for the COVID-19 vaccines.
So first is our vaccine adverse events Reporting System, or VEIRS. This is a national system that's been inplace for many, many years that collects reports from healthcare professionals, vaccine manufacturers andthe general public of any adverse events that happen after vaccination. If there's a signal, meaning there
are reports that are unexpected or reports that appear to happen more frequently than then we feel likethey should, we follow up immediately with an investigation.
And the second system we put in place specifically for COVID, though we'll continue to use it moving
forward is called V-Safe. It's a new smartphone-based after vaccination health checker for people whohave been vaccinated. It's a really innovative program that uses text messaging and web surveys from
CDC to check in with vaccine recipients after vaccination. It can also provide second dose reminders if
needed, and telephone follow up to anybody who reports a medically significant adverse event. This isreally exciting. And if any of you have gotten vaccinated yet, or will you will be offered to participate andbe safe. It's absolutely voluntary. And if people are followed up on a certain cadence up to one year after
vaccination, again, to build that database of a very complete safety profile for both vaccines. We've hadover 2 million people join the V-Safe program. And so I encourage you all to sign up when you go foryour vaccine appointment.
So I think this is one of my most important the slides in the deck. These vaccines do appear to be highly
effective. We still have additional prevention tools that remain important to limit the spread of COVID-19-5-and control the pandemic. So it's that combination of getting vaccinated and continuing to follow CDC
recommendations to protect yourself and others that will really offer the best protection from COVID. So I
do want to emphasize, continue to wear your mask. Continue to practice social distancing, stay at least six
feet away from people, avoid crowds and poorly ventilated indoor spaces. And always, always wash yourhands. These recommendations are will continue to be reevaluated as the vaccine program moves
forward.
So, right now, we are emphasizing that these nonpharmaceutical interventions still remain in place evenin persons who have been vaccinated. But like I said, we're continuously looking to see where and whenthese got this guidance will be relaxed. So it's really going to take some time to vaccinate everybody in
the United States. And that’s why it's really important to continue to use these tools to keep ourcommunities safe.
With that, CDC has developed really a mountain of resources to help navigate and teach communities
about COVID vaccine and vaccination. Interestingly, we've developed specific toolkits to address certain
key populations, more are on the way and we're always looking for recommendations about where you
would like to see specific information. So please visit cdc.gov to see what's available to help you talk inyour communities.
I also wanted to point out to this group, particularly we have what we're calling our essential workers
team, which is a team within my unit that is staffed with experts from NIOSH, who can help us think
through strategies for specific worker communities. So we'd like to offer that up as a resource. Thank you.
Questions for Dr. Routh
1. So it seems like a couple of questions said that, yes, they got they signed up when they got the vaccine,they signed up for the V-Safe system, and that it worked really well. But a couple people said that thatwas not offered to them. Do you know how that might work in different communities?
Answer: Well, that is good feedback. And I will say, one thing that we really need to put in place this,
we've done a really good job getting vaccines out the door and into communities and clinics. But one
thing we need to do is make sure that those providers are practicing best Immunization Practices. And
so one thing that we will be doing in our jurisdictions, is to do some supportive supervision to go out
and make sure that clinics are offering the full complement of vaccine services that we're expectingwith COVID-19 vaccine. So I appreciate you bringing that to my attention. And that's something that
we can do a reminder on our jurisdiction calls that we have with all 64 of our jurisdictions make aspecial note to say, ensure that providers are offering V-Safe. So I don't like hearing about that. But I'm
glad that I heard so we can do something about it.
2. Has there been any guidance or recommendations targeted specifically to persons with disabilities ordisability groups?
Answer: Yes, so in fact, we have just released some guidance on persons with disabilities andvaccination. I mean, what I can do a circle back with the specific link to our website. But as I was
talking about, in our unit we have that essential workers team. We also have a team that's dedicated todisproportionately affected adult populations. And we have a subteam that is working specifically on
guidance for persons with disabilities. So let me see how we can get that information over to you.
3. People are still struggling to reach into the public health kind of structure, especially from thetransportation side. But if you could help us understand, again, that public health structure and what-6-

does that look like? I've heard that you should talk to the incident commander in emergency
management. I mean, what is what's our best outreach strategy?
Answer: So, we at CDC, work with our jurisdictions, essentially, those are our partners hand in hand to
implement a variety of programs, including the COVID-19 vaccination program. our jurisdictions are
juggling many things, as we all are, they are responding to COVID outbreaks in their communities.
They're providing testing, they're doing contact tracing, and at the same time, they're rolling out the
COVID-19 vaccination program. So understandably, they're a bit overwhelmed.
I do think if you have suggestions or would like to partner with your public health departments, it is still
best to contact them directly, I think, they're in the best position to understand the needs of theircommunities and how people on this call can assist.
I mentioned a couple other things. One is that I think everybody has heard the new administration's
call for a really whole of government approach to the vaccination rollout. And to that end, our partners
in FEMA have become much more active in the vaccination space. And I think we'll be assisting withmore of these vaccination rollout, again, at supporting the jurisdictions, right, so it's all about ourgovernment partners, really supporting the jurisdictions. And I think it's, it's also with private partners
supporting our jurisdictions. So I think as FEMA enters the space, we may see more opportunities forpartnership, because they come with so many resources to be able to share with the states in terms of
personnel, in terms of, physical support to get vaccine, clinics, mobile clinics, etc, stood up and out thedoor. So I think that is really going to open up some additional opportunities.
I will also say that, again, we have our essential workers team that sits in my unit, and I think they arevery eager to partner with organizations. I think of information flow there as bidirectional. So on the
one hand, we would like to push information on vaccination out to those organizations, but at thesame time, we want to hear from you. Maybe things you have to offer challenges that you're facing,and how we can help.

Dr. Oscar Alleyne
Dr. Oscar Alleyne, Chief of Programs & Services at the National Association of City and County Health
Officials (NACCHO)
Thank you very much and we really do appreciate the opportunity to be. Here, as was mentioned,
NACCHO, the National Association of County and City Health Officials, is representative of the 3,000
local health departments across the country.
And our goal is to essentially provide both technical assistance as well as guidance and support and bethat local voice of public health at the national level. This particular public health landscape photo choiceillustrates two quick things for members of our audience who may not be familiar with us. In particular, it
shows the degree of the variance in governance structure: some of our health departments are in statesthat are home rule, others are centralized, and others have a mix between state as well as local control.
But on the right, it really illustrates the diversity of our membership. And if you notice, the 6% of ourmembership are actually those that are categorized as large or big size health departments or big cities, forlack of a better word. But yet while there's 6% of our membership that represent a larger population
expanse based on having very dense population growth, etc., whereas the medium to small healthdepartments are larger in the sense of force, the numbers that we have in our membership. But of course,-7-

they're representing more frontier, more suburban, and other rural communities to that extent. This shows
the balance between a health department that may have a staff size of seven versus one that has a staff
size of 500.
Now, with that said, we also wanted to really illustrate even pre COVID, the extensive work and valuethat our members have rarely been engaged in around immunization and the vast experience they've had,In fact, 88% of our members have actually indicated their skill sets, both in experience in providing
childhood immunization and adult immunizations. And I can tell you this from personal experience,
being at a local health department for over 16 years, we recognize the value and the commitment ofengaging in both the provider community, the community as a whole around the role that healthdepartments play in providing these vaccines, and ensuring that they have a community that is covered for
vaccine preventable diseases.
So as a result of that, we also want to highlight that within any kind of activities, you cannot do this alone.
There's a strength and value of engaging partnerships. And public health departments recognize one key
point, everything is local. So to that extent, we know that there at least 29% of our health of our members
who have developed formal partnerships with transportation for various aspects of their delivery of healthservices.
We know that they have been engaged in both programs such as CDCs Hi-5 programs such as complete
streets, and even other elements that address chronic and other social conditions to that extent. So we justwanted to highlight the value and the commitment in recognizing that while some have formal
relationships, there are far more that actually do engage with the transportation communities.
So NACCHO has highlighted and has made available through our resources, etc, have large amounts ofdata and communication around what we are doing in our immunization programs to truly amplify,
strengthen the provider technical assistance, providing those model practices, and really underscoring
where there are those best practices that identify how individuals are able to work much better within
their communities address the issues such as accessibility, mobility, as well as vulnerable and otherpopulations.
So as we pivot more specifically around, especially the more COVID times, we have been really
embedded with respect to addressing the local initiatives to increase vaccine confidence with respect to
COVID, as well as addressing those areas of vaccine hesitancy. And they may say, Well, what is thedifference?
One, we have to make sure folks have a better understanding as to what the vaccines are, and how wehave to really provide an opportunity to strengthen and ensure that is equitable access. And on thehesitancy side, we recognize that people have some preformed and sometimes misinformed perceptions
about the vaccine themselves. So we're really trying our best to really support our members in that regard
as they try to engage the communities and their partners and stakeholders to that effort.
Now, as our members are engaged with the response, so if we have the national organization, whether it'sin identifying situational awareness, I am working with partners and stakeholders, such as the partners
who are hosting this webinar today, and really interfacing with the federal communities in a way to truly
recognize what their membership needs that on the ground as they are rapidly deploying their efforts inboth addressing the impact of the pandemic, as well as the shift and into the mass vaccination efforts.
So we've tried to convey that role and provide these tools. So on our page, we've engaged in both thespecial task force on data/ GIS, we provided virtual communities for peer to peer exchanges, and sharing-8-

of information, this contact tracing efforts, and essentially identifying those stories from the fields where
local communities have been able to highlight their successes in both the application as well as thecommunity engagement practices.
We recognize that once the pandemic hit, that pretty much put a slowdown in a lot of the public healthservices. So we've able to actually see from our members, what impact that that had initially with respect
to their ability to maintain immunization practices. But it also allows us to look at high level operations,and around what statements and policies are going to be important to maintain immunization coverageduring a pandemic. And we have featured several immunization themed webinars to address what those
local needs are and what those success stories have been, and where are highlights and challenges thatthey can address.
But I'm just going to be very blunt and honest, we recognize that there's issues around supply, so supply,high demand, there's various and how vaccines have been distributed by state. There's complexities instorage and handling. Of course, there's concern about one dose versus two dose, and of course, how toreally be on front of the changing guidance and issues, as we mentioned before, around hesitancy andmore importantly, the concerns that have been raised around equitable allocation.
So to that effort, we've been working to really truly help understand and provide our both our members
and our partners with an with a clear picture as to what to help departments do, how have they been able
to assess the preparedness? What are those partnerships that have been developed to truly support thateffort? And the value therefore, of the partnerships both include that if the regional health care coalition ismeeting, you bring your transportation, emergency management, your hospitals, your health carecoalition, and others to the table, and you basically work together to identify where are your vulnerable
populations, and what's going to be necessary. We've also provided a directory of our local healthdepartments for folks and other partners to use to ensure that they connect with those communities andthose folks on the ground. And lastly, we also have our state affiliates, which are State Association ofCounty City Health officials, which provide a much more robust interaction as to what this healthcare
partnerships and collaborations can bring to bear when brought together at the table.
And as nature of the national organization, we've been providing both consultation as well as funding
opportunities to really help advance our members and increase their capacity to really be strong andresilient. We've had members that have been able to roll out vaccines in 24 hours once they havereceived them. We have members that have integrated with their homebound communities to ensure
whether it's EMRs and others, they can actually deliver services and vaccines to those communities thatare in need. We have also members who will recognize that, there's a partnership that can be deployedaround how you focus on Independent Living communities or home care providers, etc, in a way to really
address the strength of partnership and how transportation can play a role in that effort. Thank you for theopportunity to present today.
Questions for Dr. Alleyne
1. I think a burning question, especially on the part of public transportation is, who do we talk to in our
local public health? agencies? Some of I've heard stories of people saying we've reached out but justhaven't heard back. What is your and I know that public health is incredibly busy, but what is yoursuggestion?
It is a valuable point, especially, we've been seen as a national organization, everyone's reaching out
saying, what they what can they do, what they what can they help, we've actually started to have
conversations with the state and the National chambers of commerce to see, instead of waiting for folks
to ask, it's like, well, what can we do? Or what do you need? how can we bring these communities-9-together to ensure that there is kind of a triage of information and support. So when, whereas you may
try to reach out to the local health official, whether it's a commissioner director, there are other seniorleadership within health departments, whether it's at their emergency preparedness coordination, theEEOC, their director of patient services, or in some respect, trying to ensure that your main touchpoint
illustrates the value of what you bring to the table and where those pressing needs. So I would always I
would always say, try to flex between either the administration function at a health department, or atleast some of the support and staff that are going to be your point person with respect to externalinteractions that can really get you to that direction.
2. Can you provide any examples of a successful public health and public transportation partnership
related to the COVID-19 vaccination effort?
Answer: Most certainly, as well, as alluded to before, we've had members who, for example, Kane
County, Illinois, who've been marketing, partnering with health care providers to really get the folks
who are not necessarily able to get access to two vaccines by coming out to the health department—so
tried to develop that particular interaction. Others we know have employed, the use of, for example,
the ambulance services, the travel type of electronic, right app, the ride sharing, and as well as some ofthe patient transport services. To use that as a solution to get to those folks who may have mobility
issues or maybe older and infirm, and not necessarily able to come out and stand in line or make it to ahealth department vaccination sites.
So New York City and others have done things similar to that extent. Miami we know has used similartypes of efforts around being homebound and how they can really employ the value of thetransportation services. There's another aspect as well, when you think about the not only specificallyfor COVID. But as we have this primary focus on COVID. There's the other pieces of the puzzle, theother programs and services where transportation can essentially assist in some of those backfilling
efforts, especially things such as pregnant moms and getting them to their providers for visits, othervaccination efforts that will be important to maintain travel, immunization, disability, and diabetes andother case management programs. So there's several aspects, whether it's COVID only, or COVID. Plusthat I think the transportation partners have really can benefit from interaction with our members. And
we've seen a few success stories to bear.

Scott Bogren
Scott Bogren, Executive Director of the Community Transportation Association of America (CTAA)
Thank you all. Scott Bogren. I'm the executive director here at the Community Transportation Associationof America. And I was asked to tell a little bit about what we do. But more importantly, I think our vision
for how our members can link in this. I can't think of a more important job right now on the part ofmobility providers all around the country than connecting at risk populations, rural populations with thevaccine.
CTAA is a membership association comprised of rural public agencies, which are typically incommunities rural communities under 50,000 population. We are have a lot of small city members whose
populations are urbanized areas between 50 and 200,000. We have a robust nonemergency medicaltransportation membership group. These folks are providing service to Medicaid. They work directly withhospitals, they're working with managed care organizations, they are transporting non-emergency patientsfor all manner of therapies and others. We have a lot of members who are engaged in specialized- 10 -

transportation, largely of all older adults and people with disabilities. We also have tribal transit members,
systems that are run by volunteers, systems that focus on veterans. And I also wanted to mention that bothstate departments of transportation and state transit associations are all active members of our association.
And, our members tend to serve the country and their communities with fixed routes, scheduled
timetables, kind of very traditional, but just as many of them are actually engaged in on-demand services
that someone can call ahead. The older version of on demand usually included 24 or 48 hour notice;
we've now entered the time period where 24 minutes is too long. an on demand is on demand. And thenall of these we've got public agencies, private sector, providers, nonprofits, all of those are in the mix ofkind of our membership.
56:05
And really, it all goes to our vision. And since our inception in the late 1980s, CTAA and its members
have been trying to make services community based, and what we mean by that is responsive to thecommunity, rather than asking the community to be responsive to the transportation provided. And that's
an important distinction, because I think those skill sets and that understanding is what's going to allow a
lot of our members to really engage well with the vaccine distribution process.
our members are known for being flexible, responsive, fully accessible to all forms of disabilities. CTAA
was a champion of the Americans with Disabilities Act from its very beginning. And we believe that all
forms of public transportation must be fully accessible.
And what we're really seeing happening in our industry, it was happening a lot before the inception of thepandemic, it is also happening in the middle of and will gain steam afterwards, is the notion of how wepull together different modes within a single community, make them work in concert for customers,
passengers—mobility management. The National Center for Mobility Management, certainly is one very
important way.
And the other way that we see really mobility and our vision changing is becoming a lot more outcome
based. What is created from the trip, what outcome in the community, whether it's somebody working,somebody has access to a vaccine, health care, how do we how do we put all those together in ways thatmake sense. All year during the pandemic, we heard from our members about how they were changing
their operations, to respond to what the community needed. In fact, in early January, over 25%, a quarterof our rural members talked about service data added during the pandemic, most of those services, notsurprisingly, were along the lines that Amy has outlined earlier: food access, grocery access, access topharmacies and prescriptions. And what that told us was eventually, when we got to the idea of a vaccine,
if you can't get out for food, it's probably not going to be easy for you to get out to get vaccinated whenyour time comes. And so we kind of saw this demand coming. And we're doing everything we can right
now to connect together our membership and the vaccine distribution.
FTA has been a wonderful partner in providing funding, the Congress has provided funding, FTA has
provided really flexible structure under which we can do this. And so now we're to that point where
we’ve got to stop talking about it, and we got to start doing it. And I think this is this is an important
discussion we're having right now.

Panel discussion
Moderated by Scott Bogren, Executive Director of the Community Transportation Association of America(CTAA)- 11 -

We've got a great panel. And I think we're starting we're going get into some of the meat of the topic here,
in terms of how do we make this happen? We're going to talk to some transit providers who are alreadymaking it happen in terms of these connections. And I'm excited about the discussion here.
I'm going to start off with Dr. Sarah McAdoo. Dr. Sarah McAdoo is the Population Health Capstone
director at the University of Massachusetts Medical School in Springfield, Mass., so out in closer toWestern Mass. And she is a member, importantly, of the Springfield vaccination force where she works oncommunity outreach and education. The question I really have is what best practices have you learned
that you think apply to how transit and public transit connects to health care that can help assist in how
we can now focus that connection on vaccine distribution?
Dr. Sarah McAdoo, Population Health Capstone Director at the University of Massachusetts Medical
School – Baystate; member of the Springfield Vaccination ForceThank you, Scott. Just to provide a little bit of context in the role that I play as you mentioned, I also lead a
lot of the work around community-based education for our medical students. And what's interesting aboutthat is that it's brought us to the table with community partners, both in urban and rural communities. And
we've had the pleasure and the privilege to work with many community partners who are doing
innovative or creative work, especially with very low resources.
So one of the things that we've had the privilege to do this work in one of our rural communities, is our
medical students are learning about how transportation is a social determinant of health. And it's reallysurprising to them how critically important it is, how mobility and transportation truly determine access tojust about everything in a rural community, not only health care, but then the other determinants of healthsuch as education, employment, and other social engagement, that it's important for health and wellbeing.
So one of our education partners is the Quaboag Connector actually, it has been a project that has beendeveloped with a Community Development Corporation. So when someone had asked earlier, how doyou get through the public health departments, sometimes also, a Community Development Corporation
may have already been bringing coalition members to the table that includes a health department or
includes the particular health, leaders in that particular community.
So thinking about the question that you asked, there were a few things that kind of came to mind, because
this is sort of something that we're thinking both in the urban, but specifically in the rural populations. So
one thing that was mentioned earlier is leading with equity. I know that sometimes we're promoting
expediency or equity, can overstate that. It's critically important to look at equity, because sometimes
states may be rewarding those that can distribute the vaccines fastest to the largest number of people, but
in reality, I think we can really do both. And using this equity lens is important in rural communities,
because of what was said earlier, the disproportionate impact it has on people who are low income,disabled, older.
The second thing that we noticed is leveraging those established relationships and connections. I don't
think what I'm going say today is going be magical things. I think it's just showing how that could work at
the local level. So in the rural community of were in the Quaboag region where we are, we were fortunate
enough to come to a coalition that already existed, the Quaboag Regional Coordinating Coordinating
Council. So they already existed, and they had already been working on transportation gaps. And they
have everyone from, senior centers, town officials, state and regional transportation organization,
academic medicine, schools, community members. And this group also has a really good relationshipwith policymakers and legislators and is connected to the larger view of transportation in general in that- 12 -

region and across the state. So look for established coalitions that are already doing this work. I really
believe in not redoing things, find where it's already happening, it's happening well and connect to that.
So one of the things that we say is, “Do what you do best and connect to the rest.”
Two other things I wanted to mention is identifying community assets. The Quaboag Connector is one
example of that. So this is what we call a found pilot. This was already happening in the community. And
it's important to support what's already happening because you're building community capacity, not justfor the immediate time, but also for the future.
And then the last thing is, consider utilizing a multi-pronged transportation response. This is really all
hands on deck, like the transportation and food that were mentioned earlier. And what we're looking at is
vaccine sites at local organizations, easiest to get to by car and drive through vaccinations. That's the low
hanging fruit. But on top of that, setting up vaccine sites along the Regional Transportation Authority fixedroutes, filling in the gap with either paratransit or for us its our local connector, which is, looking at
developing some strategic stops. And we might be able to capitalize on that and also provide on-demand
services.
And then I think one of the most important things that we're recognizing is complementing it with mobile
health services, or many communities might have that. So a mobile health clinic to meet residents where
they're at. So now this is a gap of, if you can take any other transportation method, I think it was
mentioned earlier, going to the community or going to the residents. Well, the interesting thing about themobile health services, and we are actually, literally rolling one out come the end of March into April, isthat you are going to, whether its housing areas where there's a few people already in housing, you cancoordinate them safely coming to that service, and you're maximizing compliance, because you're able todo the two doses coming back to the same site. And the other part is that mobile health clinics also cancollaborate with other organizations locally to bring other things that people want—food and otherservices, that it's important for health and well being that region.
Dan Wedge, Executive Director of Services for Allegan County; Public Information Officer for the County
Emergency Operations Center, and acting administrative liaison to Allegan County Public Health.
Next up is Dan Wedge. Dan, thanks for joining us today. My question for you, Dan, is you're a transit guy,
but you've clearly got your foot firmly placed in this notion of emergency operations. And I think that's animportant activity that a lot of our members and a lot of the transportation people here takes them a little
bit out of their comfort zone. So my question is, like, how has that connection helped? Your agency,
which I know first did a lot with the COVID-19 testing, and is now going to be working with the vaccine?
Sure. Well, thank you, Scott. Well, I think first of all, you're right, I've had the advantage of having that
long-term partnership with emergency operations. The benefits that has brought is, coming into thispandemic is having that relationship in place.
I think one of the things I'll just follow up on the last discussion was think of transit as an asset. And sowhen the emergency operation is looking through their resources, because they basically are a core
support agency to public health. And so through the pandemic, they're the ones out there looking for
those resources. And so I would encourage agencies who maybe are having a difficult time, reaching
public health, start with your emergency management, division and express the services that you canbring to the table as a resource. Make them well aware, and let them have that, connection with publichealth because most likely, they're meeting with public health on a regular basis to understand what
unmet needs are there.

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And so, when you talk about how has my relationship with those two agencies helped to the pandemic, it
is being able to open their eyes to what public transit could do and what role they can play in meeting thisneeds. And through that, I've been able to serve in a number of different capacities. as you mentioned
early on, we did the COVID testing, we did drive through testing, they had other testing locations thatwere set up. And it just became apparent that, a drive thru process at transportation was just a good setup.
We had the facility to do it, it's located in an industrial park. And so we had room to stack vehicles andjust go through that process. And that worked quite well.
From there, I was invited to be part of the Vaccine Task Force, as public health was actually creating plan
for rollout once vaccines became available. And that panel, or task force consisted of public safety, we
had medical, both our EMS medical control directors, our public health doctor, we had of course
emergency management, public health representatives. And we looked at a number of different things,
and being able to be at the table, part of that discussion enabled me to, make sure that transit wasn't left
out of the equation.
And fortunately, because our county has a requirement on an annual basis to test our emergency response
to nuclear incidents, basically the template was there, and we had arrangements already set up with local
schools to do evacuation to those locations. So it became very easy to take that and modify that to
vaccination centers. And so we worked with many of our local schools with the idea that these locations
would be spread out throughout the county, trying to limit transportation to within 20 minutes of each ofthese different sites. So basically, we can cover the whole county, once all sites are up and running with a
20 minute or less transportation or commute.
The other barrier that we discovered early on is, seniors, being able to access these sites, but more
importantly, even signing up for this. And so, through a partnership with our community action agency,
our Commission on Aging, public transit, we've kind of developed our own partnership to address how
can we reach out to those that we’re already serving, and help get them connected to, to sign up andregister for the vaccine. And so we've been developing some strategies, in addition to what public healthis doing, how public health has an easy to navigate sign on their webpage, but as many the older
populations can sometimes struggle with that. And as such, they've also got a hotline, where people cancall in, that hotline is very active. And we just feel that's another benefit that, public transit can bring,
because we're already connecting to these different agencies. So I'll leave it there for now. And I havemore to share as we go.
Eric Gleason, Director of Public Transportation at Texas DOT
Next up is Eric Gleason. Eric is the Director of Public Transportation at Texas DOT. And to give you somecontext of Texas, that is one of the largest rural groups of rural operators in the nation or in the state ofTexas and Texas DOT has also done a lot of work over the years in the empty space, working with
Medicaid and kind of coordinating efforts of health care and transportation, all of which clearly are goingto play into this.
So first off, welcome, Eric. And thank you for joining us today. What do you see kind of your role in therole of Texas DOT with how the vaccination is working at the state level, and then trying to bring theassets that Dan was just talking about, to the attention of the right people at the state level?
Sure. Well, I certainly appreciate the opportunity to be on the panel today. And I think before I start, I do
want to recognize on both public health side and the transit side that the absolute craziness of this timeand how busy everyone is, on the public health side. Just the absolute pressure cooker for people we need
to work with, while they're just focused on trying to get such a limited amount of vaccines out and- 14 -

distributed and in the arms of 25 million Texans. And the rural transit districts of the state that are
struggling anyways, with a pandemic, to have this opportunity and how to take advantage of it.
But let me let me speak to your question in a couple of different ways. I think for any state DOT, one of
the most important things to understand is what is the rollout model for vaccine distribution in your state?
Texas has taken a very decentralized approach to that. And it is it is a model that relies on local publichealth departments, and local emergency management operational structure to accomplish it. And sounderstanding that, I think, allows you to know what you need to do at your level and how to get folks
engaged at the local level.
So at the state level, we made a connection across to our Department of State Health Services. And we
don't necessarily have a strong history with that particular Health Services Branch of Texas, the nonemergency medical transportation is actually in a different organizational silo. And so this was a newreach for us. And so we introduced ourselves, we identified the resource and the opportunity we thoughtthat the rural transit systems represented to help them in their efforts to elevate their vaccination levels out
in the rural areas of the state.
We know that over half of the trips every year that occur on our rural transit systems are medically related.
We know that the current transit providers are going to know these people who need to get to thesevaccination sites. And beyond that we have CARES Act money to fund the transportation of those folks. So
it just seemed like a perfect opportunity for us to introduce ourselves to those who were organizing the
distribution effort.
And because of the decentralized nature of it, our efforts with the state health element of this have been
largely focused on getting information to their folks about rural transit services in the state. I'll give you an
example of that. The call centers that the state is operating for the vaccine program, all the call center
operators have a direct link to find a ride program that basically will allow them to put the county ofresidence in and they can provide the caller with who their public transportation provider is. So we're
helping them understand the opportunity, but giving them some information that they can use then if they
are asked about that.
From the funding standpoint, the Commission just took action just last month to award the remainingbalance of our CARES funding. And as a part of that action, they identified supporting access tovaccination sites as a key priority for them in how rural transit districts use those funds. And then I think
more specifically working with rural transit districts,
I think, the message is, it's got to happen locally, and go get it. I think it's going to take initiative on thepart of the rural transit districts to step in and step up and make their presence known. I think that theextent that we've been promoting regional coordination, regional public transportation coordination forthe better part of 15 years here in the state, that we have a lot of well established connections already. We
also have a strong tradition here in Texas, of rural transit districts supporting local emergency management
and emergency response plans, hurricanes, wildfires, snow, whatever it might be
Brian Baker, Transportation Director, Spartan Transportation Services, Levelland, Texas,
Brian Baker, who has joined us as the transportation director at Spartan transportation services inLevelland, Texas, a 17-county service area. His operation is housed within a community action agency inLevelland. And Brian, really the question is, tell the folks what you've been up to, in terms of positioning
Spartan to take people to vaccines and the progress you've made thus far.

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1:26:57
Sure. Thanks, Scott. Thanks for having me here today. But really, before we take anyone, anywhere with
the COVID-19 outbreak, our focus was on making our transit system safe. We've always focused on
making our transit system safe, but it was driver training, it was the ADA, it was passenger assistance, it
was emergency evacuation maintenance plans. And it's still that today with the addition of virus
mitigation.
And so we took a really aggressive approach to actually mitigating the virus. We started back last
February, with research, of course, implemented drivers protective equipment, temperature checks,
enhanced cleaning, of course, all the things you hear, cleaning between every group of passengers,
between every passenger, but then also procuring some actual virus mitigation technology. There's someknown companies in the industry out there with some really, really great equipment that we were able topurchase and install on every single vehicle. And that's air purification devices that literally will kill thevirus. It's filtration devices, it's disinfecting equipment that's permanently installed. It's antimicrobial
treatments, driver barriers, all these things. So those are done now. And then we took a very aggressive
approach to letting the public know that that's number one. Those things are done, you can be safe on atransit vehicle and our service area.
And so now with the vaccine effort, we did take a pretty large initiative here, like Eric Gleason said from
DOT. We've always had great relationships with our emergency management departments. Texas is huge,
but it's also very local, especially in rural counties. Letting them know that we're offering fair free rides tovaccination sites, and putting that information out there, prioritizing those trips. And then basically, Scott,we just flooded the zone.
Eric also mentioned that Texas has had a strong regional coordination over the last 15 years really, and so
we know our 2-1-1 folks, we know the folks at the veterans organizations, we know the economic
development corporations, the managed care organizations, the workforces, the headstarts, thecommunity health centers, Texas Workforce Commissions, Association of Governments. We just literally
got the information to every single one of those. And then county judges began putting plans in place, sothat they knew when a vaccine came to their county that we would be there. Of course, social media,
social media is a big one. That's how your local news organizations are going to pick it up. And that's
what's happened here. They found it on social media and said, “Hey, we'd like to do an interview.” AMradio ads, telling about our safety protocols, as well as that fare-free ride to the vaccination sites.
Another thing we did to reach those folks that are homebound that you talked about, or folks that may not
be able to get out early on in the pandemic, we were assisting food banks and other agencies with foodbox deliveries. So through those connections we made there, we now place a flyer in every single foodbox that continues to go out. That gets information to folks that may not have other ways of getting
information. And then as of this week, Scott I think Dr. Ruth mentioned it in her in her presentation.
Infrastructure in rural areas may be scarce sometime. We've got a pretty newly constructed facility, andwe're actually holding the first vaccination clinic tomorrow at our at our facility Levelland Texas.
Clary Mole, Jr., EMS Specialist, Office of Emergency Medical Services, National Highway Traffic Safety
Administration
Our last speaker is Clary Mole Jr. Clary is an MS specialist at the Office of Emergency Medical Services at
the National Highway Traffic Safety Administration or as they're known here in Washington, DC, NHTSA.
And, Clary, I think the key question that the folks on the line would really like to have your expertise andinsights on is how do they reach out if they weren't already established, like Dan was with an EEOC? How- 16 -

would you advise transit folks to initiate, as Eric said, seize the initiative, initiate these kinds ofconversations that ideally can end up with the kinds of solutions we just heard, where in a rural area, atransit facility ends up being a place where the vaccinations are being delivered.
1:33:22
Sure, the best thing you can do is reach out to your EMAs, your emergency management agencies, thoseare going to be at the state and local level. And they've already built out relationships with the community
sectors because the community sectors represent the 15 emergency support functions of the Emergency
Operations Plan. Two of those are transportation and public health. Public Health is in emergency support
function 8. And because they're part of the emergency operation plans, those EMAs—emergency
management agencies—already have that ready to go and ready to provide the information to transit
agencies if they want to get involved in the distribution of the vaccinations. If you're unsure about how to
get in touch with your local, then the best thing you can do is reach out to your local or state police entity.
And they'll be able to essentially assist to give you the contact information you need to get with that EMA
so they can provide you access to those people who need your resources.
1:34:27
And once you made that contact, we've heard a lot of hearing in this panel discussion about transit as an
asset that may be needed. How do you articulate the asset that you have? And the funding that you haveto Brian saying I'm providing these trips fare free? How would you suggest that part of the equation ishandled?
1:34:54
Well, as has been mentioned already, I'll go ahead and iterate it. Unmet needs assessments are being
done constantly by emergency management agencies, they'll be able to tell you what you can do, they'll
be probably thrilled that you reached out and contacted them and said, Yes, yes, we can use you, please,please let us have access to your resources. So I don't think that's ever going to be an issue during an
emergency or crisis or disaster, whatever we're going through transport is, number one, on the emergency
support functions.
1:35:30
It is and I thank you for sticking with us and providing those insights. I do really feel like for many of us, inthe transit space, particularly rural agencies, human service, transportation delivery systems, NEMT
operators, this is our moment. We've worked a lifetime to build up a network of services, and never morethan right now is that needed. And so, if you heard nothing from the last half hour, please seize theinitiative. Reach out your services, your operations are an asset, you have the funding to do this, and, andwhat better role to play to explain the value of public transit, then play this role in getting our nation
through this pandemic and through this health care emergency.

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