Fort Stewart-Hunter Army Airfield sits about 40 miles southwest of Savannah. Ga. and is home to the 3rd Infantry as well as armored, aviation, and artillery brigades. During the day, the Fort, which is the largest army installation east of the Mississippi, hosts more than 53,000 soldiers and civilians. As the public health officer in charge, retired Major Dr. Robert Heininger was responsible for designing and implementing policies to help ensure the health and fighting capability of everyone on the base.

Now the medical director of Philadelphia’s Public Health Management Corporation, a nonprofit that operates five Federally Qualified Health Centers and provides 127,000 visits to 27,000 patients annually, Heininger is applying lessons he learned while in the military to help administer as many Covid-19 vaccines to his patients, and the community he serves, as possible.

Central to his leadership philosophy is looking for opportunities to train as much as possible, so as to work out problems ahead of time, and make sure staff are confident in their skills and mission.

“In the military, anytime you have an opportunity to turn something into a training opportunity, you do it,” Heininger said to Direct Relief. He gave the example of how he used to take flu vaccination drives on base and in the local community as a chance to practice “giving out a ton of something, should the time come.”

So when the pandemic carried into the fall, Heininger decided to use his clinic’s flu vaccination program as a trial run, or using the military term, PODEX (point of distribution exercise) for the Covid-19 vaccine.

“We vaccinated thousands of patients through the fall with the flu shot but we can vaccinate tens of thousands this winter and spring with the COVID vaccine,” he said.

“It’s a low staff, high-volume model,” he said referring to both flu and Covid-19 vaccination programs.

“The biggest challenge we face is staffing. The U.S. health care system is built to be efficient. It doesn’t have a lot of extra in it, it doesn’t have a lot of waste. It’s not really built to flex well, to increase staff. We saw that early on with PPE. Eventually, they started making more masks. But, you can’t make a nurse overnight,” he said.

Being able to use his staff most effectively to treat as many patients as possible necessitated practice, and for the former major, having a realistic environment was a benefit.  “We were fortunate to have inclement weather in the fall, which forced us indoors,” he said. In addition to having clearly defined processes, another benefit of the trial run was identifying potential snags ahead of time, such as weak Wi-Fi that could delay the registration of patients.

Adapting To The Community

Though the overall philosophy could be transferred from his military days, the specifics had to be adjusted to fit his patients. Whereas Ft. Stewart is in a rural area and many of the local residents have cars, PHMC serves an urban population many of whom do not have access to a vehicle. This necessitated a change away from the drive-up model he instituted on the base.

“You always have to include the end user in your process. You won’t understand their barriers if not,” he said.

Heininger also discussed the value of having experienced staff members train other staffer members, as well as standardization in the vaccine distribution process, as being key elements in making sure a low staff, high volume model is effective. Using a “training the trainer” model, trained staff counts go up exponentially.

PHMC is using a walk-up line system, where patients go from station to station, and then to a socially-distanced monitoring area for 15 minutes – where a group can be watched for side effects by one staff member, which frees up others to work other parts of the line.

PHMC has already administered hundreds of vaccines and anticipates that it will have administered 1,450 doses, including some second doses for patients, by next week. Heininger said PHMC stands ready to help make up for some of the load that was to be carried by the now-closed vaccination site at the Pennsylvania Convention Center.

Along with logistical considerations, Heininger also shared his thoughts regarding the more complicated aspects of distributing the vaccine.

“We have competing priorities and we have to figure out what’s most important. With Covid vaccines, the greatest sin we could commit is wasting doses. That’s the North Star we hang onto,” he said.

Once a vial is opened, providers only have a limited time to use the remainder of the doses. While saying that they want to make sure people who should get the vaccine first, as indicated by the Pennsylvania Department of Health guidelines, are indeed getting the vaccine first, Heininger brought up a situation when someone does not show up for their appointment.

“Maybe the security guard is on scene, so we’ll vaccinate the guard. You’re putting someone out of order priority but its better than wasting a shot,” he said.

A Potluck, Not A Professional Kitchen

Heininger said that going forward, one of the crucial pitfalls to avoid is duplication of services.

“Public health is not a professional kitchen where you’ve got Gordon Ramsey yelling orders and everyone knows what they have to do. It’s more like potluck dinner where everyone brings their own dish, you don’t want to duplicate effort. The worst thing we can do is step on each others’ toes. My advice is to not conflict with each other and to outline jobs and responsibilities,” said Heininger, who worked as a waiter and cook before becoming a physician.

Reflecting on the more general parallels between his military and public health service, beyond planning and training, Heininger pointed out the shared nature of each role.

“They’re both lifestyle choices, it’s a calling,” he said. That’s not something I’ve had to instill, it’s there with the people I get to work with everyday. That commitment, that we’re going to have to do vaccines after hours. I can ask my folks to do that because they’re committed to this work,” he said.

“This is a once-in-a-lifetime chance to really give back to really participate in a solution. Public health is often for granted and military is often taken for granted — both are essentially volunteer forces. We’re getting to do what we trained for,” he said.

Public Health Management Corporation was a recipient of the Pfizer Innovation Award in Community Health: Addressing Infectious Disease in Underserved Communities grant.