We all read the headlines and heard the horror stories, such as “Pursuit of Vaccine Devolves Into ‘Hunger Games’ for Pa. Seniors” from PennLive. “How do I get an appointment?” might have been the first thought that came to mind, but many librarians also wondered, “Shouldn’t libraries be involved in this effort?” In the U.S., the vaccine rollout and appointment systems were part of a complex bureaucratic maze—which, in many cases, served only the most patient, persistent, and tech-savvy individuals. Much to our chagrin, the next headlines we started to see were variations on “12-Year-Old Helps Hundreds of Seniors Sign Up to Get COVID-19 Vaccine” from ABC7 News. It made me wonder why a tween had to step in and become familiar with website content, advanced searching skills, and tech tools—which are part and parcel of the librarian skill set—in order to fill a role that would come so naturally to libraries and librarians.
We are now seeing headlines such as “Lessons Learned From the Pandemic” from a variety of sources. What lessons have libraries learned? Specifically, what lessons have libraries learned so that they can leverage not only their expertise, but also their roles in their communities in order to provide integral services to their patrons—and assure that they survive and ultimately thrive, in even the worst of times? Libraries of all types need to prepare a playbook plan now so that they can take the lead in public health emergencies going forward and be seen as an obvious resource—and not just an afterthought.
STEP ONE: IN-THE-CAN INFORMATIONAL DOCUMENTS
In the case of the coronavirus vaccine rollout, a two-front perfect storm ensued: Deeply penetrating and widespread misinformation and disinformation surrounding the vaccine became ubiquitous, while a slow and complicated rollout of the shot made it very difficult for willing citizens to get jabs. Borrowing lessons learned from this fiasco, libraries can prepare a four-step game plan that will translate to public health crises faced in the future (hopefully, they are a long way off!).
The fight against misinformation and disinformation is especially critical during public health emergencies, when people may be consuming much more media than they typically do in an effort to stay informed and protect their health. Libraries need to prepare in-the-can informational documents so that they are ready to go with rock-solid scientific information, even when emergencies are in their nascent stages. In preparing basic one-pagers regarding whatever phenomena are being faced, it is important that they look to gold-standard scientific sources such as the WHO, CDC, and National Institutes of Health (NIH).
For vaccine data, Bloomberg’s Covid-19 Vaccine Tracker resource contains a plethora of information regarding vaccine distribution and administration worldwide. There is a global total chart that lists the total doses administered, doses per 100 people, the percentage of the population who have had one dose and those who are fully vaccinated, and the daily rate of doses administered, by country and by U.S. state. There is also a timeline that tracks the nine most promising vaccines, with data on progression to availability, along with other details such as efficacy and storage requirements. The Global Epidemics site from the Brown University School of Public Health uses data from the WHO and Microsoft in order to assess risk level by U.S. county. Following a standard number of cases per 100,000 residents, counties are categorized by color—with green allowing for only one case per 100,000 (which is described as “on track for containment”), yellow for one to nine cases (which is considered “community spread”), orange for 10 to 24 cases (which is considered “accelerating spread”), and red for 25 or more cases (which is described as the “tipping point”).
STEP TWO: DEFINITIONS OF COMMON VERBIAGE
We can play a role in helping our patrons understand the common verbiage that is being used in the crisis. For example, the pandemic introduced us to once uncommon terms that have now become part of our lexicon: social distancing, lockdown, and remote learning, to name a few. To that end, it is imperative that we understand what is meant by the vocabulary used in the news that we consume. For example, there is a huge difference between doses delivered and doses administered; a location may have doses available, but that number is not very meaningful until it represents shots in arms.
Although President Joe Biden promised that there would be enough vaccines for every American by May 1 (and he beat that number far in advance of the deadline), having contracts in place with vaccine manufacturers doesn’t mean that people are able to get appointments. Furthermore, when mass vaccination site capabilities are touted, the possible daily number of jabs that can be given does not directly translate to the capability to actually administer those jabs. U.S. chief medical advisor to the president, Anthony Fauci, has stated that in order to reach the goal of herd immunity, 70%–85% of the population would have to have immunity either through prior infection or vaccination. Ultimately, actual shots in arms are the only reliable determinant of how and when we reach that number.
It is also important to understand the difference between efficacy and effectiveness. Per Bloomberg, efficacy numbers represent reductions in risk. For example, if a vaccine had a 95% efficacy, and you were able to clone yourself, the vaccinated version of you would be 95% less likely to get the disease than the unvaccinated version. Effectiveness is how well a vaccine actually performs in the real world, where age, health history, medications taken, and conditions under which the vaccines are administered may be completely different from those present in trial conditions.
Big Data algorithms also played a role in determining jab prioritization and, upon review, reporting uncovered biases. CNET is an outlet that shared the following examples. A Stanford Health algorithm meant to determine vaccine distribution prioritized healthcare workers, but ranked them by age, with the oldest workers getting jabbed first. However, it failed to recognize that many of these workers were semiretired doctors who no longer saw patients. Optum Health’s algorithm also raised red flags; it was built on the premise that the sickest patients spend the most money on healthcare, failing to recognize that many people are simply unable to spend money on healthcare, regardless of their health situation. As a result, wealthy, white patients were prioritized.
STEP THREE: APPLICATION OF EXISTING SKILLS
Rooting out bias and flagging flawed data are a natural fit with the librarian skill set; indeed, Pew Research Center has found that libraries and librarians are seen as the most trustworthy sources of information, but we are rarely consulted to do such tasks. We need to market ourselves and our skills so that we can work with municipalities to help to set priorities, not only for public health services, but also for other community services (such as infrastructure and capital improvements). This role could be seized by public librarians, who could then actively partner with community officials.
In addition, we can apply our online searching and website navigation skills to serve patrons. Librarians are experts at finding reliable sources and searching them with aplomb, and yet, we saw example after example of untrained volunteers navigating byzantine appointment systems in order to assist their fellow community members. Public health-related or not, in the event that our patrons are required to understand search syntax and website organization in order to function in a life-or-death situation, libraries of all types have an obligation to help.
There are myriad libraries that did step in to fill this role; we can look to them for best practices and lessons learned in developing our toolkits. For example, according to WGRZ, many public libraries in western New York state teamed up to provide in-person assistance to patrons who needed help in securing appointments, as did the Anne Arundel County Public Library in Maryland. Katherine Hollerbach, the library’s chief of public services and branch management, tells WBAL-TV 11, “The digital divide is real and the pandemic has made it even worse, and one of our big jobs is bridging that digital divide. … So, people have to have access to a computer, and they have to have an email address. Right away we saw, OK this is the type of thing that we help with all the time.” It is imperative that libraries of all kinds embrace that role.
STEP FOUR: COMMUNITY PARTNERSHIPS
In a wonderful example of a community partnership, per WTOL 11, the Toledo Lucas County Public Library director announced its appointment-finding initiative in a joint statement with Toledo’s mayor, the Lucas County commissioner, and the city’s health commissioner. These types of relationships are huge opportunities for libraries, but they need to be built long before we are operating in crisis mode. Since the library is seen as an egalitarian, welcoming space, it makes sense for us to become problem-solving epicenters. For example, we should have tried to position ourselves as possible vaccination sites. The New York Times quotes Emanuela Taioli, director of translational epidemiology at Mount Sinai Medical Center in New York City, who believes that vaccines should be given directly to places, such as libraries, that are full of common social interactions. “It’s intimidating to go to the Javits [Convention] Center, frankly,” she says. “It’s all with good intention, but the National Guard is there.”
Oftentimes, the perception that everything at the library is free is a sentiment that works against us, but in the case of the COVID-19 vaccination, this belief could be more of a help than a hindrance. According to Fortune, a U.S. Census survey from March 2021 found that almost 7 million Americans are planning to forgo the jab because they are concerned about the cost, not realizing that the U.S. government has purchased the vaccines and is providing them free of charge. If the shots were offered at libraries, the assumption might be that no money will change hands.
Additionally, in some rural communities, residents live far from mass distribution clinics. Another possibility is for bookmobiles to serve as mobile jab clinics, with healthcare personnel riding along with librarians and giving vaccines on the routes. Again, cooperative agreements should be discussed and game plans formulated well in advance of need. Once a pandemic hits, it becomes very difficult to quickly mobilize within a complex environment that has a lot of moving parts. If our plans are secured in advance, we will be able to nimbly pivot and begin assisting immediately. We can’t wait for the authorities to wonder, “What about libraries?” We need to step in at the outset and announce that we are ready to go.
ALL LIBRARIES CAN STEP UP
This role is not limited solely to public libraries. University libraries could prepare and distribute the latest scientific information by partnering with on-the-ground experts and scientists at their institutions. During this pandemic, for example, librarians could have immediately contacted the schools of medicine and public health at their universities to gain access to cutting-edge information that they could then publish, while functioning as a clearinghouse for vaccine appointments if they were being given at that institution. Corporate and law firm libraries could curate scientific documents, as well as information on the effect of the crisis on their lines of business, and distribute them firmwide. They could also volunteer to help employees find appointments.
These are just a few examples of how we can apply our skills to make a dramatic difference in the lives of our patrons by helping them through situations that repeatedly are deemed unprecedented. If we have a plan in place to provide these services, we will always have precedent to follow in situations labeled as once-in-a-lifetime.