A United Front: South Dakota Health Systems Join Forces to Get the State Vaccinated

By Alex Strauss

The FDA approved the first COVID-19 vaccine on December 18 and by December 21, the first South Dakota patients were being vaccinated. And as the rollout continued, South Dakota quickly pulled far ahead of other states in the percentage of the population getting vaccinated. 

As of this writing, South Dakota has fully vaccinated nearly 16 percent of its population, compared to a national average of just 11 percent. Only Alaska and New Mexico are doing better and only by a couple of percentage points. South Dakota's health systems have distributed nearly 400,000 vaccine doses. 

How did a state with such a vast geographical area, a large number of rural residents, and a highly competitive healthcare environment manage to pull this off? To find out, we spoke to some of the people involved in that effort at the state's three largest health systems. 

Taking on the Public Health Role

"One of the biggest challenges early on in the pandemic was that we were thrust suddenly into a public health role instead of the typical day-to-day episodic care that we are used to," says internist Shankar Kurra, MD, Vice President of Medical Affairs at Monument Health Rapid City Hospital. "Unlike other diseases such as hypertension or diabetes, a pandemic, by definition, does not spare anyone."

Like healthcare providers around the state, Monument had to quickly adjust to its role as the public health leader in the region. And that required a whole new structure for streamlined communication within its own system, with the state health department, and with other healthcare entities. Those wide open communication channels, including frequent conference calls with the state and the other systems, served them well as the release of the COVID-19 vaccine loomed closer. 

"We were very fortunate that the health department has been an excellent partner in making sure that we were all kept informed," says Kurra. "Already in November, they were letting us know that the vaccines were getting close to their trial dates and we were beginning to coordinate across the state on how we would do this. That allowed us to get prepared."

Communication is Key

"I think the key to our success as a state has been clear messaging and consistent communication," says David Erickson, MD, Chief Medical & Innovation Officer for Avera Health. 

"We are a small state and we already knew each other well. There are a lot of things, such as the Sturgis Motorcycle Rally, on which we have to work together that most people never realize. We get on calls together. When it came to the vaccine, everyone's goal was just to get shots in arms. We all know that vaccination is the only way forward out of this pandemic," he says.

Erickson says the fact that public messaging regarding the COVID-19 vaccines comes from the state health department, and that all of the health systems are invited to provide input, helped to lay the groundwork for a strong and streamlined vaccination effort. "If we were all pushing out different communication pieces, it would be disastrous," he says. 

Dividing to Conquer

The first step to vaccinating South Dakota was to divide the workload. The state's health systems conferred to decide who would take which counties. 

"Some of those decisions were easy because one health system had a major presence there," says Sanford Health Chief Physician Jeremy Cauwels, MD. "Other communities were mixed. And others didn't really have a presence from any of the three."

The 66 counties were divided among the state's three major health systems, Mobridge Hospital, and the Northern Plains Health Network, including Huron Regional Medical Center, Prairie Lakes Healthcare in Watertown, Madison Regional Health System, and Brookings Health System. Avera and Sanford agree to share responsibilities in the state's most populous East River counties, Minnehaha and Brown. 

Each system receives a weekly supply of vaccines from the state's allocation, depending on their needs. (The VA, the IHS, and federal retail pharmacies receive their own supplies from federal allocations.) 

"Each side has a vaccine coordinator they make their requests," says Dr. Erickson. "Avera has 24 sites around Eastern South Dakota where we administer these vaccines. We have an internal currier and distribution system from Sioux Falls. Our goal is to have shots in arms within a week of receipt of the vaccines." 

"There are trades back and forth depending on where we're going that week," says Dr. Cauwels. "Every day is sort of a work in progress to make sure that Sanford, Avera, and Monument are doing the things they need to do to make sure that people get taken care of. This vaccine doesn't do any good in our freezers."

Doing What They Do Best

Vaccinating people against a pandemic is new territory, but South Dakota's health systems are no strangers to providing vaccinations - even in remote, rural areas. 

"It's important to remember that we gave a quarter million flu shots before the COVID-19 vaccine was even available," says Dr. Cauwels. "This is something we know how to do and we do it very well. In South Dakota, we are willing to cover miles, put things in vans, transport things. We just have to make sure there are people ready to use those vaccines when we get them there."

In some cases, this has meant joining forces not only with other healthcare providers but also with community resources like the Salem Armory in Salem, where National Guard members are helping with the vaccination effort. All three doctors we talked to praised the state health department for giving South Dakota's health systems the authority to take the vaccination ball and run with it.  

"We are giving vaccinations to everyone anyway," says Cauwels. "It made sense to work with the infrastructure that already exists. The state decided not to get bogged down in the details and to let those who already know how to do this do what they are good at."

Sharing the Burden

The COVID-19 effort has not only required a high level of communication between the state's major health systems, but also significant cooperation to keep the state on track. When, having overcome some logistical challenges, Monument Health finished vaccinating one of the priority groups before the East River health systems had reached that point, Monument agreed to share some of their allocation so the other systems could catch up.

"This allowed us to all be in the same place, so that we could all move on to the next phase together," says Dr. Kurra. "At no point during our discussions did any of the health systems look at this in any other way than 'how can we collaborate to meet this challenge?' It was remarkable and heartening to see. The best part is that we prevented long-term consequences for South Dakotans so we have a healthier state."

"The Ebola scare a few years ago required the same type of tabletop discussions, but it never required this level of implementation because it never came to fruition," says Dr. Cauwels. "I don't think there has ever been anything that has encompassed as many people as have been involved in this effort."

"This experience has allowed us to build additional relationships at multiple levels at all of the organizations," says Dr. Erickson. "Ultimately that is going to benefit every organization in the state as well as the people of South Dakota. From that standpoint, I think it is a very positive thing."