good morning everyone we are this is the house health care committee we're meeting on friday january 29th hard to believe it's already january 29th but friday january 29th at 10 30 a.m and this morning we are getting together to hear follow-up from the department of health around the appropriations that were made to help address health disparities using the covid or crf covid relief fund dollars and with us this morning is the deputy commissioner of health uh tracy dolan uh welcome to the house health care committee i thanks so much i'm going to i think that's i'll turn it over to tracy and then we'll hear her presentation and have time for some questions we will be adjourning at uh 10 25 or 11 25 pardon me 11 25 so people know that okay great thanks so when i first got this request it was around actually our vaccine plan and equity um so that was mostly what i prepared and then i think yesterday i got the update that it was around the funding and how we distributed that and so i've combined both but i've housed it under um equitable i have vaccine access but i've got slides that talk through the funding and where it went to so i hope that works yep that's fine thank you great so i'm going to share my screen i'm not great at doing that um oh it says the host disabled my screen sharing hi tracy you should be able to share now okay great okay let me find my um all right and uh just give me one minute here oh it's tricky with all of the bars you can't get at everything you think you can get at so give me one minute i can't quite get at everything i want to um which is unfortunate because i can't get in this into a mode where you can see it without notes so i'm going to see if there's a way i can move this bar up here if you can just give me one moment sorry sure sure and i will be of no technical assistance but i'm sure there may be others i think it's the screen on top in the orange area you have a screen there to your left yeah you see the screen a little bit go to the right no not that far not that hard okay for the staff meeting in the orange area to the left of that you see uh the icon going down and then you have the little screen i think if you click on that that'll give you your video uh so right now i'm i'm i'm sharing my screen and i'm in my presentation what i can't get at right here right here right on it whole box on a pedestal whole box on a stick oh you know what i think you're seeing something different than i'm seeing right now possibly because what i've got my i've got my cursor over something called design in my PowerPoint presentation so can you see my screen right now and does it say equitable access to vaccine yes it does okay what i'm trying to do unfortunately is to get this presentation without all the notes right but because i can't get to the upper bar because the black bar over supersedes it i can't get to a proper view and my apologies i'm going to see if i can troubleshoot that unless anyone knows how to troubleshoot that tracy if you if you go all the way to the bottom all the way to the very bottom of the the the view here yeah all right go all go to the right right before the volume bar go all the way there's a little box with a on a stick if you hit that i think it'll do what you want yeah unfortunately i don't see that i'm going to let call lean take control of my fantasy if she can get me to a to a presentation that allows uh this to be the view lean say you're in you're in the same spot that i'm in there we go thank you so much story i couldn't get to it can you hear me now everyone yes we can right um all right so i could will access to vaccine that we're that's what we're going to talk about today my apologies it's a different title uh this is a presentation we used a few days ago can we go to the next slide all right i think maybe i uh i play with the next slide um so why do we need specifically to have a vaccine plan for vermonters of color racist systems impact um health negatively we know COVID-19 exacerbates existing health disparities i think you probably saw in an earlier presentation to you that our COVID-19 rates among people of color in vermont the infectivity rates are at least three times higher depending on the subset of the population so we know that we've got higher infection there's mistrust in public health and health care systems we have recess settled refugees when we talk about different groups avanaki vermoners and other communities of color that have specific health care access issues so they're not all the same issues sometimes it's language sometimes it's mistrust um sometimes it is uh transportation um lack of under education about it etc there's a variety of reasons um and it shows up differently for different groups and so we did receive guidance from the social equity caucus the racial equity task force and the director of racial equity to learn more about what we need to do uniquely on our vaccine plan we saw um with our testing um that we needed to do some things differently with contact tracing um we had to do things differently and um so we did begin to put money out to the community to get better partnerships to understand more and work more um in a more personal way with some of these communities to make sure we were doing things differently and then as our vaccine plans started to develop we realized early on we need to do something different again um building on those partnerships let me go to the next slide there we go so our first strategy um was to survey the community to inform the vaccine implementation strategy so that's what i was just talking about our second strategy was to compile qualitative data from community partners representing these priority populations to inform vaccine access communication and translation strategies and our third was to fund trusted community partners to provide technical assistance outreach and support with messaging so i'm going to try to move from this screen and Colleen i'm going to ask are you able to minimize so that i can open a different file so i can show how we've used the money so far um what are you trying to do i'd like to minimize this because i need to get at another file and i sure um yeah and i'm sorry team i apologize i'm gonna request remote control again if that's okay yeah i thought that's what you had sorry okay great all right so i'm gonna i'm gonna i'm gonna hopefully minimize this so i can get at other files and are you able to call me and do that for me if not you can give it back to me and i might be able to play with it and figure it out uh yeah it's not going to let me because at the moment you are just sharing your powerpoint so okay um we're going to have to go back to your choice of screen shares and select another document okay that's what i'll try to do now um i'll go to new share that's it good and um here we go let's see if this works all right um let's see if i can can you see this screen looks yes all right i'll try again um not full screen but we can we can see it you can see some of it yeah and unfortunately um we just had it and it appears to be gone so we'll have to we'll just have to ask you to be patient while i find that again so a new share um what happens if i show all windows here so it was here and i clicked on it and now it appears to have gone yeah i'm gonna end your screen share and then maybe you can just see if yeah starting over just yeah that'd be great and let's see if i can um find an exit full screen and i'll get to my document that way thank you yep okay all right i have the document here so i'll go back in and try screens share again maybe maybe that's the way to go we're on zoom all right let me share screen there we go i see it so i'm sorry that this is as big as i know how to get it right now um i don't know if you can see it well enough but i'll try to read it out so these are um the crf awardees through december and then i'll try to speak to the rest but over the last probably 16 months we've awarded 1.5 million dollars out into the community around equity um are you able to see this i can see the first slide great i think is a series of slides yeah because this has this document been shared with colleen to post on our website on our web page can that be done yeah do you need that right now uh well we'll follow it on the screen if you had it colleen could post it in people who had their they could follow it on their own device okay colleen how would i do that right now hi colleen how would i do that right now um you can either send it directly to email it directly to me or you can uh email it to sarah greek oric i think she's reaching out to you about um getting them as well okay i think he's able to have it on the screen share as well but yeah so i did just um there we go i'm sending it to you now um and what's your address colleen c mc govern mc gov c mc govern yep at ledge dot state government or dbt sorry dot us right dot us thank you so it is c mc govern at ledge dot state dot vt dot us good sending it now okay so i'll just walk through it so um the first organization is abanaki helping abanaki they were awarded 117 thousand and this is a statewide reach um they coordinate food security programs for the no pagan band of the kosu gabinabi people and this funding was to provide food cards and support for the renewable meat source program and services supplemented by crf will be available to all abanaki for monters another organization was the church of east arlington 10 000 um the reach was washington county provided 400 community support kits to assist older adults and people with disabilities in staying healthy and safe during the covid pandemic five kits would be available to provide customized support and resources for each individual and kits included covid 19 safety cleaning self hygiene warmth and food insecurity we also supported the clements family farm 80 000 um this is the only black led 503 nonprofit organization in vermont offering arts and culture programs led by vermont artists of african descent funding supports black and bliss wellness arts series includes visual virtual art sessions distribution of wellness art kits and survey results report unperceived outcomes of wellness we also supported the community health services of adison county open door clinic for 26 000 hiring bilingual spanish speaking outreach assistance to support farms and providing on-site testing outreach and education developing a clinically accurate contextually and culturally specific covid 19 public health messages consulting with epi as needed and assisting the state to culturally broker care and prevention strategies related to covid 19 we also supported um dr mercedes avila through spectrum spectrum is the financial agent there for 247 000 and this is the cultural brokers program providing integrated prevention education and care they also conducted focus groups so we could understand more areas of need um and health disparities exacerbated by covid 19 also provided three training sessions on cultural and linguistic competence to the hoc staff the hoc is the health operations center that's the center that's running our pandemic response at the department of health we provided 41 000 to the family room um that's burlington winewski providing emotional support and crisis prevention and intervention to immigrant and refugee families with young children basic needs um including culturally significant foods and then the northeast kingdom community action for 55 000 providing food access to isolated communities in essex county and older adults facilitated online support groups for lgbtq youth in the nek i think there's a hand i see you yes could you for the northeast kingdom the community action 55 000 you know how they spent it other than yeah it's it's what we described here so this is increased food access okay um phone and internet access facilitated online support groups so that last bullet is the last couple of bullets in each column are the the ways they were spending it thank you thank you the one mask initiative um and that reach was the old north end providing quality masks to those who need them um outright vermont 90 000 providing emotional support and care to 200 plus isolated lgbtq youth around the state the funding supported technology and internet access for peer support mentoring professional service and health and resource information the racial justice alliance for 80 000 host a series with community partners like vermont interfaith action public access institute vermont medical center and others um rise vermont um reducing in the richmond bolton area reducing social isolation and provide improving i'm sorry access to health services to older vermonters by creating a laptop lending program also coordinated online activities virtual community events telehealth and remote gatherings with friends and family and the special olympics 14 000 provided virtual bi-weekly athlete engagement sessions twin pines housing it was just a $5 000 grant training equipment and internet access for isolated seniors also gas cards for medical appointments united way of ruttland county 56 000 new partnership there facilitating outreach and engagement work of service providers in ruttland county that serve older vermonters and people with disabilities the sub recipient will plan and host trainings on implicit bias for first responders social workers and educators united way of windham county 122 000 facilitating ongoing outreach and engagement work of social justice service providers so they can liaison into identified vulnerable communities experiencing COVID-19 related health disparities uvm extension bridges to health um 94 000 collaborating with local health care entities to explore and where possible facilitate increased access to flu vaccines across vermont and collaborating with local health care entities to support testing of farm workers arriving to work in vermont and the vermont disabilities developmental disabilities council 28 000 addressing social isolation and increased access to appropriate PPE and health information for vermonters with developmental disabilities providing 2 500 kits that contain masks hand sanitizer plain language COVID information and plain language flyer about the flu vaccine and how to access it there's a little bit more um that i want to share that just came in separately on a uh on a message that is not on this slide so let me get that for you in addition to the crf funding and all of this adds up to 1.1 million we have these agreements out of another grant which is our cdc money 100 000 to africans living uh in vermont a alv um association of africans living in vermont 100 000 to us cri um and that was the refugee that that used to be called the refugee uh resettlement uh 66 000 to vermont performing arts league 66 000 to the multilingual task force and 229 000 to spectrum which is the fiscal sponsor for the land cultural brokers program so that total is 661 000 um so in total a million and a half dollars have gone out to community-based agencies in the past year or less actually probably the past um i had said 14 months but actually that money came in it took a while to get out it came in late so probably the past eight months or so okay representative he has a question um yes thank you i i guess i'm a little bit interested in a little bit more on how the grantees and amounts were selected i don't remember quite frankly the exact language that ended up in our bill last fall because the senate changed it but it's actually not listed on your list but i had spoken with um sarah chessborough and uh the only grant that was targeted for psychiatric survivors was for 15 000 they presented a proposal for 72 000 but 15 000 was the only thing that went out for um psychiatric survivors and i noticed a lot of the other grants were to were not to um member of the affected community led uh programs which had been one interest of ours and which um vermont psychiatric survivors is the only uh statewide organization that does that so just looking at the other grants the amounts involved and who was targeted um that certainly raises a question for me yeah does you want to understand how we did this is that what you're asking kind of the process well yes the process and how we ended up with a result that seems to be a real disparity compared to what the legislature requested and uh and the list of grants that i see and obviously i don't know about other requests and so forth i happen to be familiar with this one because i work there yeah so we um we put the information out widely that the funds were available we attached the legislative language so they understood what it was for with the focus definitely on the covet 19 aspect right the mitigation prevention support of um that work and um and then uh basically bids came in um when i say bids these were these were proposals um we did not require them to be very lengthy or very complicated we gave a pretty simple outline and then um a team reviewed them um and and made selections based on the funds available so we did try to give funding to everyone who applied who was able to speak to the connection back to covet 19 because we do need that connection back because that is attached to uh to the federal funds um but in in other cases like in the case of your organization some organizations put in for funding that was much greater than we um provided based on the balance of what we had and where we felt the impact was most significant and we looked at the data to see which groups were at highest risk based on our infection rates and we made decisions as best we could um balancing all of those pieces yeah that's the best response you can give at this point it when you look at the overall list it certainly does not seem to reflect um the legislative um priorities and directives so so can i ask a separate question then represent page um there there are no as i understand it there are a number of there were several grants listed to united ways uh which uh which i understood their directive was to pass it through to local organizations within their within their areas um do we have uh an accounting of what they where they sub granted the monies to i will have to get that for you what i have right now are the grants that we put out i don't have the list of sub grants here but i can get back to you let me just note that yeah because i remember particularly for when the windham county united way the question was because again one of our interests was trying to get monies to organizations which actually were for individuals affected and who were run by or impact or affiliated directly with those impacted communities that was a priority and united ways obviously are not that but but they but i was told and i understood that they became the avenue because they were more familiar with being able to move these monies into organizations either led by or clearly affiliated with affected community so it'd be very useful for us to understand what happened with those those grants in particular sure uh uh represent page yes um to follow up with uh with chair lipper the money is going to say like the united way how much are their administrative costs out of out of the 1.5 million that you spend to these various communities how much are they spending on on administering these funds so how much actually is actually going to these communities to do the good work that that we would like to intend to do yeah so when we put money to the organization are you asking for example when we put it to outright vermont how much they retained to administer the program that they were doing is that your question are you asking or united way that sort of thing yeah yeah yeah i think it different for different organizations we did allow for staff costs clearly um and i don't know i would have to look different organizations may have had different amounts um under the broader category of admin but we recognize you do have to administer and staff a program although staffing usually falls under direct costs so i'll check in and see uh what the general range of admin percentages were so actually it would be less than 1.5 million i guess it'd be interesting to know how much actually did go to those communities do the good work that we intend to do yeah 1.5 million did go out of our department into the organizations that work directly with these communities and or are run by these communities and that was really our goal as well and so the money in our in in our assessment really did get to the communities that needed it but in in developing programming it does cost a little bit to actually implement for example a alv that is an organization that represents the people that they serve and are are made up of those people the multilingual task force is another one outright Vermont is another so uh in from what our assessment was of the organizations that we're applying they were organizations that worked with and in many cases were made up of the the communities that they represent but i'll check in on any administrative costs and just see but our expectation is that there would need to be some administrative costs for an organization to be able to report back to us to be able to spend effectively they do need to spend a little on administration because we do need that accountability represent Peterson yes thank you um i don't know what part of money this 1.5 million comes from is this federal money uh cares so it's all federal yes crf was some of it the corona relief fund and then some of it was an ELC grant which is um a grant that we get for enhanced laboratory capacity but it was uniquely expanded in order to address health disparities as well and around COVID-19 specifically so the CDC released a large grant and is releasing now part two of that which is enhanced lab capacity but uniquely for COVID-19 with direction to us to address health equity and to get money out in this way in order to ensure for example uptake of vaccine ensure testing ensure that contact tracing is effective in these communities and that these communities are able to get the education get the access that they need it does in some cases allow us to address equity more broadly as well it gives us a little bit of wiggle room so it was both crf and enhanced lab capacity fund one of these groups have to show you in order to get money what do they have to prove to you to get a part of money from them they submit a proposal and they have to show what they're going to do with the money and what outcomes they expect to get and this is all about COVID relief who went to food and necessities I hope right that's not all food necessities it was about COVID relief broadly but it was also about health equity so as I mentioned some of the activities some of it was around training and cultural competency so that when people go into communities they're doing it in a way that makes sense for that community some of it was around ensuring less isolation and more social connection so mental health aspects so some of it was basic supplies but a lot of it was other types of activities to address unique needs of these communities okay thank you you're welcome so can you can again can you um it's it's been some time since we finalized the crf dollars but as I as I'm recalling it help me help me others if I'm got this wrong but somehow I remember it ended up being $750,000 of crf dollars or was it half a million I'm trying to I'm trying to in my head reconcile the numbers between the special grant that you that the health department received where we were I think we initially had the house had advocated for a million dollars and we were at the time I believe told that half a million dollars was available through that special grant from the health department representative can you help me with that if you remember there there were two there was the early bill and the later bill yeah and I think the combination of those two bills just the specific cares act appropriation rather than the other money which didn't come through the legislature was 1.25 million the combination of that's what that's what I'm trying to sort out because I think I think the total dollars appropriated from crf dollars plus the money from the special grant is a greater amount than what we're seeing accounted for here right this 1.25 being accounted for I think is specifically the crf that we appropriated as opposed to the other funds that you're referencing and which I think Tracy referenced in some things that were from the forgetting the name of the anekfema funds for example the additional some additional emergency funds as well but what I can do is go back to our business office and see the breakdown and get that back to you I know that some of it came from what you uh appropriated some of it comes from our ELC and then there were a couple of other pots including emergency funding out of FEMA so we've been taking different pieces in order to enhance this equity work right right do you so you mentioned the say again the special grant there was a large special grant that uh had to do with I mean had a name that didn't seem to yeah it's it's our ELC grant and I'll get you the full proper name yeah it's it's our enhanced lab and surveillance capacity grant basically it's a core grant that the departments always get and every department in the country got a very big enhancement of that to actually do testing and vaccination and to do all of the laboratory and epidemiology pieces associated with that so that's another grant that comes in it's focused a lot on data reporting systems but it allows for um health equity work as well and so we used some of that grant to enhance the health equity work as well yeah it'd be helpful for for us to understand what portion of that was used and how it was used because when we when we negotiated frankly with the senate uh it was in the first round uh we were assured from the department of health that I believe a large portion as I recall five hundred thousand dollars of that grant was available for the types of projects and outreach that the house and the senate both felt were important in terms of direct outreach for health disparities so it you know a lot was going on we were doing a lot over a short period of time uh it would be helpful for us to just try to understand what did happen so yeah is your concern redundancy that that we had a grant but you also allocated funds as well my my my my question really is did the full amount that we anticipated being appropriated or being granted out did it actually was it granted to community groups yeah I believe I believe it was we pushed hard I mean we were shaking the trees it's a lot of money for smaller organizations to absorb know that yeah yeah but we pushed hard to get it out you know we also obviously want organizations to take it who can actually manage it and so we you know we had to work through that like are you able to spend down in this way but I think we did I I believe I was in meetings where we were checking on that but I'll double check and make sure we got right up to that place okay well I do recall uh I have some conversations about those issues subsequent to the uh appropriations being made yeah so I have a another related question is that of course a lot of this at the time was operating under December 30th 2020 deadline for uh actual having to use or encumber the money appropriately in order to not have it clawed back and with the um do you know if any of the if these groups were if they were not able to uh identify ways that they would as December 30th approached if they had not been able to document the use of the dollars were they with the extension that was given by the subsequent federal law were those organizations uh given the ability to continue to expend those funds as they had indicated beyond the December 30th deadline I checked in a couple of weeks ago about this but I will I'll firm it up and it's my understanding that they were actually able to spend it down we had been monitoring and working with them closely and most of them spent a full amount by December 30th but I'll double check and make sure that that's completely accurate for the whole group but um I assumed also like we all did that there would be a big amount of unspent because it is a large amount to go into small organizations but we pushed it and um worked with them a lot early in the beginning and they got you know and they were also quite aggressive about their spending and their plans and so I believe the majority was um committed and spent by December 30th and I'm assuming and of course that there would be a follow-up report we expected from each of the grantees to the department yep is there a period of time in which those follow-up reports are expected they are usually do at the end of the month after the budget period so I believe they'd be due at the end of January but I'll check in and we can get that report to you okay great I don't know if you wanted me to talk about the ongoing work for Vax and I'm sorry I framed around that because that was the first request that came in and it was a little less clear um and my apologies for that I think there was some miscommunication we were interested in both issues and it was later and I understood that there had been a miss okay communication about what we what our interests are we we I believe I mean we are interested also in the vaccine outreach to communities marginalized communities and high-risk communities as well um yeah maybe if there's more that you have can help us understand because one of the questions I because the question has been posed to me uh now that the the vaccine rollout has become clearer yeah in Vermont and perhaps you can clarify or you in a position to clarify for us the general overview which I understood yes healthcare workers trot priority and I believe are we at the point where healthcare workers have how far along are we in terms of reaching healthcare workers and then and then there was a lot of discussion about high-risk health with people with underlying health concerns but I believe that that shifted yeah I can talk to you through that yeah so I understand that we're now where we are but I don't want to lose sight of because then the question has come what about outreach to the BIPOC community who obviously was hugely impacted disproportionately impacted and how does that fit within the health department's vaccine rollout plan currently I can describe that should I do that now I'd appreciate if you would okay yeah so the implementation plan around priority populations um we at CDC first started talking about group one a one b etc and at the beginning we were thinking in line with CDC around that um and then as we looked at our own data there's a request and I agree can we take the slides down so we can actually see each other on the screen at this point yeah thank you yeah sorry um so uh as we looked at our data we shifted our priorities a little bit based on our data at the time that the vaccine was arriving you know that we were having some significant outbreaks in the long-term care facilities and we were having increased deaths and it really caused us to look carefully at what our mortality data was and our mortality data showed that hands down the biggest risk was being an elderly remontor we saw mortality of 90 percent in the 75 plus population no 90 percent in the 65 plus population and I think 80 percent of the mortality was 70 plus so we definitely saw where the risk was um and so after one a which was health care workers and residents and staff and long-term care facilities we said then we would move to not a one b not essential workers not front line we would move right into what we call phase two which is the age categories um and so the age categories which we're in now are 75 plus and then we'll move to 70 plus and then 65 plus in the meantime that group one a will remain open um so it won't close those are health care workers some of them might be hesitant and might come on a little bit later a hospital could hire a new nurse so one a just remains open but yes most hospitals have done the vast majority of one a and so you'll see overlapping phases so next week hospitals will become our partners for the 75 plus but in the meantime they're completing any one a and then that'll just remain open you know there'll be a trickle um they also started on 75 plus in their inpatient and outpatient because for some of them who are finished one a early rather than waste vaccine we kept them moving so they were doing some 75 plus in inpatient outpatient um now once we get through the age groups and each group remains open so just like one a remains open 75 plus remains open so when we move to 70 if you're 76 you can still get your vaccine you know so and the other reason we're doing these smaller age groupings is that we want to be able to make sure that we actually have enough appointments for everyone every time we open it so in other states you're seeing waiting lists and confusion in our state when we opened up on Monday we literally had enough appointments in the system for everyone in Vermont 75 plus who wants the vaccine which is amazing um and it really decreases the chaos when we open for 70 plus we're hoping for the same kind of thing having enough appointments in there so that people aren't scrambling and wondering but they can actually get their appointment when they call in now once we get out of those three age groupings 75 70 and 65 we're going to move to the chronic conditions phase and the chronic conditions are those largely defined by the CDC we tweaked it a little bit for example CDC put in the group of smokers that makes the group so large that it doesn't become a manageable group so we'll probably drop that but mostly it's the conditions identified by CDC and when we say high-risk conditions we don't mean conditions that make you really sick because lots of conditions do that what we mean are uh pardon me what we mean are conditions that if you were to contract COVID-19 those underlying conditions would make your outcomes much worse so there's a selected group at the same time we open chronic conditions that's when we also say BIPOC not a chronic condition but a high-risk condition a high-risk social vulnerability will also be in that grouping so right now if you're a person of color and you're 75 plus 70 plus 65 plus of course you're in but also when we get to the chronic conditions phase our hope is that any age in that BIPOC community because we know the infection rate is much higher and they're at different risk will also be included we haven't figured out all the logistics on that but our plan is that by the end of the chronic conditions phase we've also done the majority of BIPOC who would be willing to be vaccinated so that's generally what the phases look like and I'm going to pause and then I can talk about how we've done unique outreach right now with BIPOC and some of the things we're doing right now with the BIPOC communities to ensure that equity okay I'm I'm just going to take my position as chair and say that frankly I've repeated numbers of places that I actually have appreciated Vermont's approach because when you see the chaos in many other states and the raised expectations that cannot possibly be met with the limited supply of vaccine that's available right now it's it's it I've appreciated the decision to prioritize those at highest risk of of death and then of infection so I think I think there's many of us who appreciate that at the same time uh we as legislators have been being approached by various constituents and constituent groups saying for instance of the I think one of the most vocal groups right now are teachers saying we are in schools we are we're feeling left out of this process most of us are not going to be in that high rate high age range when do we get the vaccine and why are we not being prioritized I I would just like to give you in the Department of Health a chance to articulate I think you've articulated broadly but to articulate that in a particular issue yeah you know the governor still has not landed on whether or not we're going to be doing groups of workers in that way right now our focus is the elderly and as you said we really look at mortality and morbidity not just infection so teachers for example don't appear to have higher risk than actually anyone else in Vermont when we look at surveillance testing that we've been doing the rates are just very low and we're surveilling really you know the teachers on a weekly basis in a rotating fashion and the rate of positivity coming back for teachers is very very low I think we've had I can't remember the I think 39 or 40 teachers positive out of 23 000 tests so it's a very very low rate and and as you know generally the age grouping doesn't put them at high risk for the mortality morbidity not saying it can't happen because of course it's not as mathematical as that but that's not why we're not including teachers right now it's not because they're not getting infected it really is about stopping people from dying and since we started vaccinating we're already seeing deaths go down in long term care facilities it's literally about stopping that from happening but as we move through the chronic disease group I think the governor you know may consider other groupings but there we haven't landed on what the process will be beyond the chronic disease group by then we will have reached a lot of Vermonters we will we will have reached by the end of the chronic conditions group hundreds of thousands of Vermonters so it will be a smaller group by then and I don't know yet what the governor's thinking but we are giving him the science and we're trying to inform this as best we can about reducing risk another group that I've heard from I think others have as well as family saying I have a family member who is at high risk for because of the under I mean very high risk because of the underlying medical condition they may be immunosuppressed they may have and they're but their age is never they're never going to get within any of the top three age bands why do they have to wait they have to wait because we're looking at a population level and our numbers tell us that the people who are most likely to die are 65 plus regardless of underlying condition once we get 65 plus done then once we move to that other group the data tells us that's the second most likely group and so we're not doing exceptions we have said no across the board we've said it kindly and compassionately but once we go down the road of exceptions it becomes incredibly challenging to say yes to one and no to another because everybody has a very compelling case we're getting calls we're getting files from doctors we're getting lawyers letters that are explaining conditions to us on a daily basis and we really just have to stick with the science if this was a very small community and 660,000 feel small but it's not that small we could maybe tailor but we're a state and we have to go by population okay thank you and I realize that we may want to come back to this at another time as well given the time limitations we have this morning and all of what we're trying to cover I'm going to turn to represent down to you and then represent Peterson and very very quick I I appreciated your verbal description of how the priority system is working in terms of the BIPOC community and it sounds very responsive but it would be great to have that in a little written summary or bullet points to share for people who have been asking about that yeah it's actually in the slide deck as well once in later slides that describes the strategy too okay and and that's not the outreach strategy but in terms of the description you gave about how they fit into the yeah I believe so that that's in the slides okay yeah I believe there's a bullet that explains by the end of the chronic condition phase our expectation is also to have completed BIPOC yeah so so if you um those slides are not on our website yet so okay you can forward them as well thank you yeah I it's the slide deck that I just forwarded to Colleen and my apologies for not affording it earlier thank you okay represent Houston then represent Gina yes thank you just so I'm I'm clear here so we know the people in nursing facilities and those that are high risk go first then 75 and above 70 and above and then folks of with high risk conditions 65 and above oh you're going down to 65 and above and then high risk conditions okay what what makes what are the factors make the BIPOC community more susceptible to the disease I'm just curious that's a great question yeah there is a great question there are some long-term factors and there are some short-term factors the long-term factors are the broader kind of systemic racism and institutional racism that puts people of color at more risk generally and so just a longer term institutional for example people of color statistically simply have less access to care they tend to live in places where care is less likely they tend to live in places where the environment is less healthy they tend to have incomes that are lower than others so so there's those bigger systems but then there's more proximal reasons things like for COVID for example if you're an essential worker that works in a job facing the public you have higher risk for infection if you're a person of color you're much more likely to have a job like that for people with limited English proficiency so coming from other countries here it's likely more difficult for you to have understood and heard all the messaging so you're at higher risk there culturally you may have some cultural practices and because you come over and you surround yourself maybe with families from your culture there might be cultural practices that are not as safe as other practices so you may be doing more large gatherings or have other cultural practices that might be more risky that's putting you at higher risk and then health wise people of color have higher rates of diabetes higher rates of heart disease higher rates of emphysema our first nations people are indigenous to Abenaki have much higher rates of asthma as an example so emphysema so there are short-term health reasons and then those are underlaid by the longer term systemic issues in our country that are a little less visible but when you look into it you realize oh that policy uniquely affects this group it doesn't look like it on the surface but when you dig in you realize this group continually gets these hits in all kinds of policies that we have that collectively put them at a higher risk so in Vermont our community of color I said three times it's probably actually four or five times the infection rate even though they're a very small part of our population okay thank you uh rips that Gina thanks I'm sorry if we interrupted your slide because I heard you refer to some later slides and I was waiting I had questions earlier but I was waiting and now that there's only a few minutes left I'm asking now so I'm sorry if we derailed the things um yeah but I and I noticed earlier that we have made a lot of investments in a wide variety of programs uh that address health and wellness in ways that go beyond mainstream health care and I also appreciated that we're trying to support cultural competency in the health care system and I'm curious looking forward what further investments do you anticipate being needed in the next year not only to address the pandemic but to support the work after the pandemic because now that we're talking about it obviously more needs to be done so I'm curious if you have any you know preliminary ideas around what where we should be heading okay can I step in here and say I really appreciate your question representative Gina and given our time I'll give Tracy a chance to do any high high level but this is an area that we will come back to we will want to have Tracy or others from the Department of Health come and talk to us at much greater length so just to identify that yeah I'll give you just a couple of sentences we're recognizing the same thing um we already knew this this wasn't news to us COVID-19 just put a spotlight on these disparities um and part of the investment is a greater investment internally at the department to have a stronger health equity presence so that we're tracking it and putting more investment in it and then part of it is to more systemically get money out to the communities so that these partnerships don't just need to be revitalized every time there's an epidemic but that it's ongoing so I would say those are two strategies one internal capacity building and two getting money out to the community to vulnerable communities and having an ongoing partnership because it's these chronic diseases underneath that's the second part right so it's COVID and then the chronic diseases underneath we could get a handle on that and then the deeper stuff of course receipts at all um which isn't just a department of health job but but everyone's that's the way long term we address this so we have to figure out how to continue and invest in this way and I'm hoping the federal government is seeing that um Biden's recent executive orders on health equity hopefully signal more funding for this type of work okay um I see representative Goldman has a question I'm going to ask if you can state the question and maybe it's something we can come back to but uh again we're operating under a more constrained time frame this morning but we will have more time to look at this together yeah I'm happy to say yeah I'm happy to state my question um we're looking at an audio only reimbursement bill and I'm wondering if you the department of health have an opinion about this population and looking at um that kind of modality in supporting them and you may not know that answer but I'm curious of that intersectionality yeah and I'm sorry is audio only is that um limited uh hearing no it's talking about use access to health care by telephone only without video and oh sorry reimbursement that you know I thought it was a new description for a group and I'm like way out of it sorry okay um so telehealth and reimbursement I can't speak to that right now I know that we're finding telehealth incredibly valuable but I can't speak to um that particular uh piece of legislation or is it a bill so I'm we're not we're working on that in committee again this afternoon so can I represent goal we cannot your questions I think is an appropriate is obviously is a good question uh can you articulate that in a in an email to deputy secretary and deputy commissioner dole and and copy it to the committee and maybe we can work that into our deliberations around telehealth which we're in the midst of as well yeah I'm just going to ask about whether the department of health has a position okay yeah and maybe yes representative lipert may I add just just two small points on what we're doing around vaccine besides so on the day we opened we highlighted particularly in the limited English community um and got them in early in terms of setting up accounts because we knew it would take longer for them to sign up so we got good uptake there in the limited English community um and now as we move through 75 plus etc recognizing there are some areas that still might be hesitant there's a lot of vaccine hesitancy and mistrust particularly among our community of color we may go in and do some specialized clinics um maybe even at some multi-generational households to try to pick up those higher risk individuals so we are doing some tailored outreach and work as well as funding communities to do a lot more education they're developing multilingual videos around vaccine safety they're filming themselves getting vaccinated and spreading that all around so we're funding all of that to really decrease the vaccine hesitancy so that we can get this group more comfortable with getting vaccinated right well again we're we've covered a lot in a short period of time but there's a lot more we appreciate your follow-up on the crf dollars and the special grant dollars so we understand that better particularly if we if and as we're in the position to appropriate additional dollars so that we can be sure that we're on the same page in terms of targeting some of those dollars and we will be coming back to the issue of health disparities COVID related and non-COVID related particularly for the BIPOC community but others as well and we'll be scheduling that at another point in time I want to all just name one other thing that before we finish because we really do need to stop unfortunately and that is some conversation about vaccine hesitancy generally and you know that's a nice phrase to put it I mean I think it's a kind of a become a more benign way of describing some some Vermonters who actually want no part of the vaccination process and others who are hesitant but but I think there are also I want us to make sure that we have an understanding of how to access and questions or how to resolve questions or give information to constituents about the vaccination process vaccination safety etc the irony is there are more Vermonters demanding access more quickly rather than it seems and then that for those who are wanting to reach herd immunity it's a good sign but just a quick update on that we are reaching higher levels than expected nationally so nationally only about 40 or 50 percent of people working in long-term care facilities have been vaccinated here at 60 percent long-term care facility residents we're at 90 percent that's higher nationally even our healthcare workers in hospitals we're at 80 to 90 percent it's 70 percent nationally so luckily even though we have a vaccine hesitant state around children's vaccines and others for some reason and I think it might be around just the the tons of transparency and communication we've had we're actually getting higher uptake rates it appears than many other parts of the country which is good news so maybe I'll just end with again accolades to the Department of Health for working based on science with our with Governor Scott and his administration I think there's many of us who feel a deep level of appreciation for what has been able to have happened in terms of keeping Vermonters safe during the COVID pandemic even though it's we're we can we recognize we're in we continue to be in a very very difficult situation this is not resolved but so thank you for being with us this morning and we will continue to invite you back you are other colleagues in the Department of so with that I'm going to take us off of