COVID-19 Grant/General Findings

At the beginning of this project, the feasibility of each site providing vaccinations was unknown. Notably, all programs were able to establish the partnerships and processes necessary to provide vaccines to their participants. In doing this, many SSPs strengthened relationships with local and state health departments. Furthermore, SSPs built the infrastructure necessary to respond to similar events in the future.

Success was found not only in establishing the necessary infrastructure to respond to a global pandemic but also in tailoring this infrastructure to community needs. Throughout the project, grantees spent much time deconstructing the components of vaccine hesitancy locally and focusing on understanding what was driving it on a regional level. Additionally, SSPs prioritized widespread participant feedback. Many grantees took the time to create Community Advisory Boards and updated surveys. As a result, grantees were able to get to know their participants on a deeper level. 

In addition to this more intimate understanding of community, many programs expanded catchment areas, enhancing legitimacy within both their participant base as well as overall public health structures in their larger community. This success allowed SSPs to embed themselves more broadly in their regions. The community-focused approach grantees took also emphasized hiring, employing, and retaining folks within the participant base. By the end of the project, most programs came up with improved processes compared to where they started.

Despite the fruitful successes of this project, grantees faced and continue to face sizable obstacles and challenges. Although programs aimed to strengthen partnerships with local and state health departments, many place-based concerns arose. Barriers existed in the bureaucratic aspects of this work, with problems arising through other contracts, leasing, and insurance. Weather also proved to be an obstacle as cold winters proved to make outreach difficult for many programs. All organizations in this project are being negatively affected by gentrification in their communities. Gentrification, in addition to community pushback of grantees' work, has resulted in over-policing, unwarranted surveillance of programs, and unnecessary disruption of services.

 Challenges arose not only within larger community pushback but also within participant pushback. Generally, the perceived risk of COVID-19 did not start out high in PWUD. This only decreased throughout the project period as the global pandemic became the new normal, causing participants to be even less incentivized to get vaccinated. Moreover, trust in the government was understandably very low in these populations, making the back-and-forth guidance from entities such as the Center for Disease Control and Prevention (CDC) and the World Health Organization (WHO )even more difficult to navigate.

 On top of vaccine hesitancy, some areas struggled with vaccine access, particularly in more rural and low-income communities. Certain programs also found standardizing the vaccine process challenging. Furthermore, many programs faced barriers in ensuring that their insurance met the requirements to provide vaccines in the first place. All of these challenges fed into COVID fatigue and burnout among both staff and participants, all of whom were already stretched thin due to the opioid crisis and staying up-to-date with the Unstable drug supply.

The COVID-19 SSP Demonstration Project brought some very important patterns and themes to the forefront. The successes and challenges programs faced, innovative and solution-based strategies programs developed, as well as programs' lived experience, hard work, and expertise should be duly noted.

Lessons were learned regarding recruitment and retention. Grantees prioritized recruiting folks with lived experience, and in some cases participants, resulting in unique working circumstances. They adapted to this by setting different boundaries and working with new staff to meet them where they are, ensuring that schedules meet particular needs of participants. The taxing nature of the work added additional stress on overall retention, exacerbated by common COVID stressors. Grantees focused on providing staff with the tools they need to benefit their mental and physical wellbeing, such as flexible scheduling.

The important role that SSPs play in their communities was also highlighted through this project. Being a trusted source, PWUD were more likely to get vaccinated after conversations with SSP staff. Using harm reduction values by meeting people where they are proved to be a fruitful way to start these conversations. Additionally, peer advocates spreading the word among PWUD was the most effective tactic to get folks vaccinated. These successes not only helped legitimize SSPs within their participant base but also within their larger communities.

Importantly, this project also emphasized that SSPs need sustainable funding sources in order to operate at full capacity. With this funding available, SSPs were able to address emerging issues. As these issues manifest themselves in different ways regionally, the approaches SSPs took had a significant diversity, solidifying the expertise programs have regarding their own, unique communities. This is why SUSTAINABLE funding is vital to address future issues.

NASTAD wants to recognize the role trauma played within the funding structures of this project. Traditional funding streams have created a very stressful environment for SSPs, consistently worrying if their funding will be pulled. NASTAD aimed to frame structural aspects of this project's funding to be non-punitive. Despite the measures we have taken, there is a lot of work to be done in order to deconstruct the system where this trauma stems from.

Lastly, the comprehensive results of this pilot project cannot be understated in supporting the underlying hypotheses for the work:

1. SSPs will maximize modest amounts of funding to address the needs of marginalized populations unlikely to engage and respond to emerging health crises.

2. Translating harm reduction principles into grantmaking practice can enhance effectiveness in program administration and delivery.

This investment yielded impressive outcomes not only in terms of vaccination numbers for populations that tend to be mistrustful of traditional medical services and systems, but also catalyzed significant growth in program capacity around clinical protocols, community partnerships, and data collection processes. The grantmaking process itself was lean and efficient, reducing indirect costs and bureaucratic process by passing through NASTAD and AU instead of health departments, and making funding accessible for smaller, less resourced programs that do not have the bandwidth to engage directly in complex federal funding processes and mechanisms. Through the utilization of low-barrier application and program monitoring approaches, grantees were able to balance high-quality service delivery with the production of rich and actionable data on and for their programs. Harm reduction program staff expressed gratitude for the opportunities afforded by these grants, noting that it is an important start in terms of investment in their programming, but also that ongoing and meaningful federal investment would create opportunities for larger scale impacts—suggesting new possibilities for closing the gaps in disparities in health outcomes for people who use drugs and/or are experiencing homelessness. On the whole, while the individual funding amounts for each SSP funded through this program were relatively moderate, the impacts can be scaled disproportionately.