How the pandemic led to innovation in one state’s public health response

The Biden administration’s plan in early January 2022 to send 500 million at-home COVID-19 tests to Americans free through the U.S. Postal Service was a historic undertaking that, perhaps unsurprisingly, hit a few snags.

Logistical obstacles kept tests out of many people’s hands at the peak of the omicron variant. After hearing lots of negative feedback from residents who said they never received their tests or that they were delayed weeks, officials in the Washington State Department of Health decided to act. They bought the tests themselves and worked with Amazon to provide next-day delivery.

Elizabeth Perez, chief of public affairs and equity at the Washington State Department of Health, said the effort showed what is possible when government leaders innovate to find solutions.

“Now, they want everything to come the next day in an Amazon box,” Perez said during a panel discussion last week at the Amazon Web Services Summit in Washington, D.C. That initiative, known as “Say Yes to the Test,” succeeded in sending more than 13 million COVID-19 test kits to state residents.

It can be challenging for governments to innovate, however, if they are unable to shake the fear of failure. Les Becker, the department of health’s chief of innovation, said changing the culture inside an agency is critical, as it can help new ideas be free flowing and supported, even if they end up not working out.

“That removal of fear [of failure] is probably one of the hardest things that we have to do from an innovation lens to get people to open up the ideation,” Becker said. “It's really important for us to create an environment where people feel like they can be open and supported in that piece.”

Health department officials have already formed several ideas as part of a broader transformation process that marks what Becker called a “fresh approach” to public health at the end of the pandemic. The department is experimenting with expanding their use of pollen sensors to give better information on air quality, for example.

And community engagement has gotten a revamp as health officials look to overcome the misinformation and mistrust that took hold during the pandemic. Before, when the agency wanted to share information with its hundreds of community groups, Perez said she and her colleagues would convene a Zoom meeting, which presented challenges for keeping the meetings orderly, keeping conversations flowing and taking notes.

Using AWS, the department built an online community group to allow people to connect with each other, share resources and information, and get questions answered by the state without needing to sit through long meetings. Washington, Perez said, doesn’t “have to be the convener.” Instead, state officials can let residents or community groups lead the discussion.

In time, public health could lean into generative artificial intelligence to provide more predictive capabilities, like notifying people about benefits they may be entitled to when they reach a certain age, or having their health data sent to the hospital if they are admitted after a traffic crash for more seamless treatment.

Having the data available for those predictive tasks is crucial, but not always easy given the obstacles that still exist in government.

“It gets back down to the foundational challenge that government and education has,” Kim Majerus, AWS’ leader of U.S. education, state and local government business, said in an interview at the summit. “And that is, where is the data? How do they leverage the data? The good news is, they know they have it. The bad news is, it's sitting in each and every one of the different departments.”

A less tech-forward but still innovative effort that stemmed from the pandemic was the department’s partnership with Amazon Fresh to offer free grocery delivery to Supplemental Nutrition Assistance Program recipients in the state. Users can access a first-of-its-kind portal to order their groceries for delivery, and Perez said the effort is “thriving” and set to expand further. 

Becker, Washington’s chief of innovation, said the portal showed that innovation can take many forms in state government and does not need to rely purely on technological advancement.

“There can be innovation without technology, there can be innovation supported by technology, and there could be technology innovation,” Becker said.

Public health agencies are still reckoning with the long-term effects of the pandemic and trying to learn lessons for future emergencies. Becker said if the once-in-a-lifetime COVID-19 must force leaders to rethink how their departments operate.

“There's that tendency for everybody to just want to forget about COVID, forget about public health, forget about all these things,” he said. “But if we do that, then whatever happens in the next 10 years, five years, two years, it doesn't matter, we're going to experience the same problems that we experienced as a system again. Then as our boss often says, shame on us.”