Effective Pandemic Response: Lessons from Kauai.

Local health jurisdictions have struggled to protect their communities during the pandemic, and successes are few. The Kauai District Health Office (KDHO) of the Hawaii Department of Health serves a rural island community of 73,000 residents. As a state agency, KDHO works closely with the county mayor and administration. Kauai has experienced comparatively low COVID-19 case and case-fatality rates while maintaining strong community and leadership cohesion. Kauai's response was highly rated by residents in a recent Community Assessment for Public Health Emergency Response survey. In this article, we describe examples of local response efforts in the areas of (1) policy and regulations, (2) health-directed isolation and quarantine, (3) case investigation and contact tracing, (4) testing availability, (5) vaccine rollout and availability, and (6) public information, as well as the factors that have contributed to Kauai's successes. KDHO regularly prioritizes agencywide initiatives that cross program silos; staff have experience using the incident command system in real-world situations; the community health worker team is multicultural, multilingual, and well established; and staff are integral members of the community they serve. Preexisting partnerships were strong, including those with county agencies, healthcare partners, and nongovernmental organizations, which facilitated early and effective collaboration. Response successes include implementation of unified command, coordinated public messaging, early protective measures, effective disease control and outbreak response, attention to secondary impacts of the pandemic, free community testing, mass vaccination, and mobile vaccinations and testing. The value of local health departments engaging regularly and authentically with partners and communities cannot be overstated. It has saved lives on Kauai. Local health jurisdictions should focus on all-hazards and all-staff endeavors to enhance their disaster response effectiveness.