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The weakness that I indicated for the Rand Schrader clinic had to do with proper preparation for the increase in care for the communities’ newest public health crisis; Monkeypox. I came into the academic internship just two days after monkeypox was announced as a public health emergency. I knew the clinic that primarily serviced HIV patients would become a center for diagnosis, care, and treatment so I imagine the staff at the clinic had similar thoughts. My preceptor did an excellent job speaking to her staff and doing a purposeful reintroduction to intradermal vaccine administration. She brought in an educator from the department of public health to brief the staff on vaccine route, scheduling, and allowed her nurses to express their concerns. The clinic instituted protocol to isolate suspected monkeypox patients in specific rooms to be assessed by physicians. I think that the COVID-19 pandemic prepared the clinic and the staff for quick response and adjustable staff to accommodate patients.

Now, presenting evidence-based practice to your team is tricky when we’re talking about a new disease outbreak like this. Vaccine efficacy is not defined as the route has now changed from 0.5mL subcutaneously (subq) to 0.1mL intradermal (ID). On June 3rd, the WHO stated, that there is a “need for clinical studies of vaccines and therapeutics to better document their efficacy and understand how to use them in this and future outbreaks” (WHO, 2022). New interim guidance released 6 days ago by the California Department of Public Health regarding the new route for vaccine administration and their rationale behind the change. Intradermal administration of JYNNEOS smallpox and monkeypox vaccine recommended to extend scarce supplies guidance is being based off a 2015 study of 524 subjects. This is evidence based, of course, but now the hundreds of thousands of vaccines being given this way will need close monitoring. Careful data collection by those institutions will give an idea of efficacy. The guidance by the CDPH states “will continue to monitor emerging data in its ongoing evaluation of its interim guidance” (2022). Keeping up to date on changes will be communicated and disseminated through the clinic care teams thus minimizing the weaknesses I identified in the initial SWOT analysis for the Rand Schrader clinic.