A rural county in Washington state hasn't wasted a single Covid-19 vaccine dose. Here's its secret

A rural county in Washington state is lapping the field when it comes to distribution of the coronavirus vaccine.

A big part of the reason Kittitas County says it is outpacing the vaccine rates in the state is that it's had a lot of practice in triaging and managing disasters, especially wildfires.

"We're a fairly rural county, and we get significant weather events, mostly wildfires," said Rich Elliott, the deputy fire chief of Kittitas Valley Fire and Rescue. "Our county has a 25-year history of just sort of everybody -- the hospital, the school districts, law enforcement, fire agencies, federal state partners -- we just cooperate."

When the coronavirus pandemic started and there was a need for personal protective equipment and testing, groups working with the emergency management center banded together to respond.

Now the cross-functional team of essential workers and volunteers are working to distribute the vaccine and it's working, says Elliott, who is in charge of vaccine distribution for the county. In fact, he says a single dose hasn't been wasted.

The story is different across the country. The United States is struggling to get the precious vaccine into arms, with supply issues, logistics challenges, long lines and crashed appointment sites. As of Friday, 16.2 million Americans, about 4.5% of the US population, had received their first dose and about 2.8 million people are fully vaccinated, according to the Centers for Disease Control and Prevention.

Washington state has distributed more than 335,000 vaccines, which is 48% of the delivered doses given, according to the state's Department of Health Covid-19 dashboard, as of January 18.

While Kittitas County has given 53% of its current vaccines, the county has vaccine clinics running through next week to deliver a new batch of more than 2,000 vaccines, according to Kittitas Valley Healthcare. With all of the appointments taken, the county estimates having 97% of their doses administered by the end of next week.

"The infrastructure that we have with everybody communicating, everybody willing to be flexible and play whatever role's necessary and an understanding of (incident command system) and emergency operation centers gives us the framework to do it," Elliott told CNN.

Fighting fires brought lessons for vaccine rollout

When you're fighting large fires, you have to act fast and resources can change in a flash, so learning to change plans and stay flexible is part of the job, Elliott said.

"In fires, we make do, and you build plans around what you have available, and what the priorities are," Elliott said. "Those change almost daily at wildland fires because the risks change, the weather changes, all of those things are changing, and you get more resources, or you get resources taken away from you."

Shifting resources and changing priorities are similar themes when it comes to fighting the pandemic.

"The same thing is true with this Covid," Elliott said. "We need vaccine in people's arms, preferably as close to the priority order as we can get, but this is only going to go away with vaccination and people being respectful of the public health guidelines. And until we get there, the economy is going to be a wreck and people are going to die."

In incident command, Elliott explained how he and others give enough guidance and flexibility for teams to make their own decisions. Give them guidelines and let them "operate inside the fences," he said.

"We stress that repeatedly is you're not supposed to tell people how to do your job," Elliott said. "You're supposed to tell them what the objectives are, give them the resources, give them the time frame, and then stay out of their business."

In fighting fires and Covid-19, Elliott says it's important for local leaders to do what they believe is right for their community. If something doesn't pan out right, you have to be willing to accept the consequences, he said.

"Don't wait for it to be perfect," Elliott said. "You're not going to get all your answers, you're not going to get every answer to every question. It's incumbent upon leadership at the local level to take reasonable risks."

And when it's possible, make decisions on the local level, he said. Large jurisdictions are just a "series of smaller units," like hospital districts within a large county, he said.

"I think we need to trust each other a little bit, give each other a little bit of grace and recognize we're all trying to work towards the same thing," Elliott said. "The more local you can let the decisions be made in that distribution process, the more success you're going to have."

While Elliott has had success in his county, he doesn't want people to think he's got all the answers.

"I don't want to sound like we have it all figured out because we don't," he said. "There's nights I'm not sleeping really well."

How they've had 'zero doses wasted'

The county received more than 2,100 doses of the vaccine earlier this week and it has already assigned a name of a person to each one of those valuable vials, Elliott said.

That may not sound like a lot to someone in a big city, but it's a lot in this county. Located in central Washington, Kittitas County has 48,140 residents, according to the state's Office of Financial Management.

"We're over 95% distributed for the vaccine that we have received up until this week," Elliott said. "Because we just got a huge shipment of the vaccine, after Friday of next week, we'll be back well over 95%. When I say 95%, the vaccine is either in people's arms or people have a hard date when their appointment is because you have to space the first and second doses out."

Kasey Knutson, a spokeswoman for the Kittitas County Public Health Department, has been letting the public know when vaccine arrives, who is eligible based on the current vaccine phase and how to get appointments. She's also in charge of getting volunteers to help with distribution.

During phase 1A of vaccine distribution, which included high-risk health care workers, high-risk first responders and residents and staff in nursing homes, the county had extra doses left over, she said.

On short notice, the emergency management center lined up 102 teachers to come in and get vaccinated, Elliott said.

The cross-functional team identified teachers, who are in vaccine phase 1B, as a group who would quickly be able to respond, Knutson said. The network for reaching teachers easily already existed through their school systems.

Some teachers may have been vaccinated earlier than anticipated, but the overall goal was to make sure that some high-priority group got the vaccine, and it didn't go to waste.

Elliott explained that sometimes there are extra doses with the Pfizer vaccine when it's mixed together, which local pharmacists are preparing in Kittitas County.

"You just don't know how many extra doses, so you have to have this flexible pool of people sort of waiting in the wings on 10 minutes notice to get the vaccine," Elliott said. "We did it with teachers."

Spacing out the vaccine doses is important for the Pfizer and Moderna vaccines, both of which the county is using. The other part involves figuring out the logistics from traffic control and patient flow to paperwork and administering and monitoring vaccinated patients, Knutson said.

"We want to make sure that when we get people in for the first shot, that we already have a system in place, and we can guarantee that those folks are going to come back through for the second round," Knutson said.

One of the biggest challenges the county and many around the country face is that people want to get the vaccine as soon as possible, Knutson said. But, vaccination will be a long process.

She said she's been busy with vetting volunteers and making sure they do everything they can to avoid burning out the staff so the vaccinations can go on. Next week, the goal is to distribute 215 vaccine doses a day at two clinics, she said.

"We are really aware of how eager people are to get their vaccinations and we want to just guarantee folks that we are effectively getting the vaccine out, that we're not stockpiling it and we're not going to waste the vaccine," she said.