Case Study:

Managing COVID-19 Mask and Vaccine Mandates in Albon County, Michigan
What to do when Public Health Becomes Politicized

Case Note: This case is set in the late summer of 2021. Albon County, Michigan has much in common demographically and statistically with Albany County, New York. Similarly, the federal agency Disease Control Department (DCD) shares many features with our Center for Disease Control (CDC). However, the characters in this case are fictional as are many important details designed to highlight important public administration and policy aspects of the case.

Case Note: The date of this case is an important detail because you are working on this case AFTER August of 2021 and hence you have the advantage of hindsight—you know, at least in part, the story of what has happened with the pandemic since then. The case works best if you maintain the narrative fiction that you do not have certain knowledge of the future.

Figure 1: The Daily Positive COVID-19 cases in Albon County, MI is identical to the same time series for Albany County, NY.

The date is August of 2021 and Ellen Worthley is excited. She is now several weeks into her first job after graduating from the Rockefeller College with her Public Policy major. She has been at this job since early July and is working as Assistant Manager for Sean McAllister, the elected County Executive in Albon County, MI. Ellen feels that her work could not be more important or interesting. McAllister was elected three years ago as the first Democratic County Executive in several decades, running on a moderate platform that stressed principles of “good government” and “evidence-based policy” to promote job creation and economic growth.

Although McAllister has been quite popular and successful with his policy goals for the first several years of his term, he is now facing an uphill re-election campaign for two related reasons. First, the arrival of the COVID-19 pandemic with its associated lockdowns and restrictions on commerce has hurt his goals of job creation and economic growth. Second and relatedly, a virulent political backlash against the “overreach of big government” has arisen around the dual issues of mask mandates in public places and efforts to fully vaccinate the entire population. Much of Ellen’s current work assignment relates to these two issues.

Case Setting

Albon County is located on the Upper Peninsula of Michigan with a rural suburban area around a small city. It is demographically and statistically very similar to Albany Co, NY. Indeed, the epidemiological statistics for Albon, MI and Albany, NY are identical (as well as their statistics on population, economic growth, employment, etc.). It is July 24, 2021, about 400 days into the pandemic. The pandemic in Albon County started with an initial surge and a small “echo” surge in the Fall 2020, followed by the big winter disaster. Things started to slow down in the Summer when the indoor mask mandate was lifted (see Figure 1). Fortunately, during the spring of 2021, new vaccines had been approved by DCD and were coming into use. Unfortunately, a varying degree of public willingness to get vaccinated has hampered public health efforts to fight the spread of the virus.

Figure 1 shows the number of Daily Positive COVID cases in Albon County from the beginning of the pandemic until about the time when Worthley was hired. During the spring, vaccines were rolling out well and the effect was to tamp down the pandemic. The County Health Commissioner had felt confident enough to relax mandates requiring mask wearing in all public places. However, as the summer began to draw to close, vaccination rate had slowed down significantly and public health officials were beginning to sound an alarm about returning to mandating wearing masks in all public indoor spaces. Parents are concerned about masks in the schools (both for and against). Many parents seem not yet willing to have their children return to schools while the pandemic is still a force, while other are vociferously opposed to any regulation that will require students to wear masks in schools.

Worthley’ s Job is to Manage the County’s COVID Citizen Task Force

As the pandemic was starting to heat up, McAllister appointed a widely representative citizen task force to give his office input into how best to proceed. He may be regretting this action as the controversy starts to heat up and members of his own task force have begun to circulate what may be counter-productive information and policy suggestions, fueling rather than mediating further conflict within the community. One of Worthley’s first assignments is to work with a team to draft a confidential policy memo sketching options for managing mask and vaccine mandates, including recommending which of the options are “best.” This background piece should be designed to move the task force forward toward consensus.

Below is a listing of the members of the county’s COVID-19 task force along with a brief sketch of how each member of the task force tends to view the pandemic. It seems as if differing members of the task force may have widely varying points of view about what is causing the pandemic, how critical it is, and overall, what are the problems that need to be solved. Members of the newly created COVID-19 Task Force seem to have different definitions of the problem. Indeed, sometimes they appear to be living in different worlds!

  • Kathleen Simpson, MD and DPH, is the Commissioner of Health who sees the problem as saving lives, preventing serious illness, and preserving the effectiveness of the public health system.
  • Camille Johnson is the Press Secretary for Albon County and sees the problem as communicating effectively to the public, preventing misinformation.
  • Abigail Irons is a dedicated anti-vaccer who sees many problems including loss of personal freedom, overreach of government, and infringement on liberty, especially religious liberty.
  • Carlos Castaneda is the President of the Albon Regional Chamber of Commerce and sees the problem as keeping businesses open and preserving a viable local economy.
  • Aaron Wang is the Chair of the Albon School Board and sees the problem as keeping the schools open, avoiding as possible remote schooling, and protecting the health of all children.
  • Lucile Drummond is the leader of a group of parents in the community who seek to have children free of masks in the schools.
  • Karl Freelander is President of the local school’s parent association, and he sees the problem as keeping children safe in schools so that children can attend school face-to-face.
  • Rev. Amy Dietrich is the elected chair of the Albon Council of churches and sees the problem as preserving the right of local churches to decide for themselves how to handle their worship services (freedom to worship as one chooses).

It appears as if McAllister’s opponent in the upcoming November elections –David DeTuya— is seeking to create a coalition out of all those in the County who oppose mask-wearing and vaccine mandates, thereby transforming what might otherwise be seen as a public health issue into a potent political issue. Mr. DeTuya and their coalition are pushing for a return to normal and urging to take a more endemic approach handling the pandemic. From their perspective, the pandemic will not end with the virus disappearing; instead, we are close enough to have immune protection from vaccination and from natural infection such that there will be less transmission and much less COVID-19-related hospitalization and death, even as the virus continues to circulate.

Ellen is looking forward to work with their team in drafting a policy memo with options for managing mask, testing and vaccine mandates, including recommending which of the options are “best,” working with the task force to reach consensus.

Date Class Topics Deliverables
Week 1
Introduction to the case
Team formation
Stakeholder Analysis
None
Week 2
Discussion on Stakeholders
Preparation for the panel
Sources of evidence
Individual: Assignment 1
Week 3
Panel
Group: Assignment 2
Week 4
Panel Debrief
Developing hypotheses, criteria, and outcomes
Individual: Assignment 3
Week 5
DCD Simulator
Group: Assignment 4
Week 6
Meet the Developers
Watch videos
Prepare questions on evidence and value of the simulation
Week 7
Work in teams
Poster presentations
Work on memo and poster
Week 8
Final presentations
Group: Assignment 6a
Week 9
Class conclusion
Individual: Assignment 6b
Peer Evaluations